[Objective]To study the feasibility and significance of a safe arthroscopic entrance technique to posterior compartment of the knee joint.[Method]Exploratory surgery of posterior compartment of 239 knee joints was performed by arthroscope or its working instruments through the combined entrances of anteromedial,anterolateral,intercondylar notch,posteromedial,posterolateral and trans-septal.Their results were evaluated.[Result]With this technique,complete arthroscopic visualization of the posterior compartment of knee joint and arthroscopic procedures for this compartment could be easily performed in 216 cases(239 knees),except 5 cases with arthro-stiffness.There occurred 1 case of saphenous nerve injury but no complications such as injuries of popliteal neurovascular structures.[Conclusion]Combined entrances of posterior compartment of knee joint is a satisfactory approach for arthroscopic surgery of posterior compartment of knee joint and can give a high efficiency and quality of arthroscopic surgery for posterior compartment of knee joint.

BACKGROUND:Transformation growth factor beta 1 is mostly used to induce the chondrogenic differentiation of bone marrow mesenchymal stem cel s, but there is a poor induction efficacy.
OBJECTIVE:To explore the chondrogenic differentiation of bone marrow mesenchymal stem cel s co-cultured with articular chondrocytes or induced by transforming growth factor beta 1.
METHODS:Articular chondrocytes and bone marrow mesenchymal stem cel s from SD rats were harvested and divided into 1:2, 2:1, 1:1 concentration groups. Cel s induced by transforming growth factor beta 1 acted as control group. After 20 days of induced culture, MTT was used to detect cel viability, alcian blue colorimetric assay was applied to measure glycosaminoglycan content, and western blot assay was employed to determine the expression of col agen type II.
RESULTS AND CONCLUSION:The absorbance value in the control group was significantly lower than that in the 1:1 and 2:1 groups (P<0.05). Glycosaminoglycan content and protein expression of col agen type II were also lower in the control group than the 1:2, 1:1, 2:1 groups. But there was no difference between 1:1 and 2:1 groups (P>0.05). The results show that bone marrow mesenchymal stem cel s co-cultured with articular chondrocytes can be induced to differentiate into chondrocytes, and meanwhile, there is a saturation phenomenon during the chondrogenic differentiation of bone marrow mesenchymal stem cel s.

Objective To investigate the effects of preemptive analgesia with parecoxib sodium on postoperative analgesia and delirium after nerve injury-free surgery for fracture of thoracic and lumbar vertebrae and to promote the postoperative rehabilitation of the patients. Method 80 patients meeting the criteria were selected. and randomly divided into observation group and control group.40 patients each group. The observation group used parecoxib sodium for preemptive analgesia. while the control group used sufentanil. and the analgesia effects and the incidences of delirium were observed. Results The differences in operative time and intra-operative blood loss between the patients of the two groups were statistically insignificant. In 2 h. 6 h. 12 h.24 h and 48 h after the surgery.the VAS score and the accumulative time of intravenous self-controlled analgesia pump being pressed of the observation group were significantly lower than those of the control group. and the differences were statistically significant (P<0.05). The first time for the patients of the observation group to press the intravenous self-controlled analgesia pump is (3.84±0.62) h after the surgery, is significantly later than that of the control group (1.05±0.47)h.and the difference is statistically significant (P<0.05). The incidence of delirium in 7 days after the surgery in the patients of the observation group was 10.00%. and is significantly lower than that of the control group (25.00%) (P<0.05). Conclusion Using parecoxib sodium for preemptive analgesia before nerve injury-free surgery for fracture of thoracic and lumbar vertebrae can elevate the postoperative analgesia effects of the patients.decrease the incidence of postoperative delirium, and is highly safe and consequently worthy of clinical application.

ObjectiveTo observe the clinical efficacy of hyperbaric oxygen (HBO) in treatment of diabetes complicated with acute cerebral infarction (ACI) and its effect on insulin resistance (IR).Methods One hundred and twenty-eight patients with diabetes complicated with ACI were divided into control group and treatment group with 64 cases each by table of random digit.The control group was treated with routine medication,while the treatment group was treated with HBO besides routine medication.The two groups were treated for 14 days.The neural function defect degree score,fasting blood glucose(FPG),fasting insulin (FINS) and insulin action index(IAI) were assessed before and after treatment in each group.Correlation between the difference value of IAI and neural function defect degree score was analyzed with Pearson correlation analysis.ResultsThe total effective rates in treatment group and control group were 87.50％ (56/64) and 70.31％(45/64) respectively,with a significant difference between two groups (P＜ 0.05).IAI after treatment in control group and treatment group showed significant difference compared with that before treatment(P＜ 0.05 or ＜ 0.01 ),but IAI after treatment in treatment group and control group had significant difference (-4.03 ± 0.51 vs.-4.22 ± 0.55,P ＜ 0.05).There was negative correlation between the difference value ofIAI and neural function defect degree score(r =-0.696,P ＜ 0.01 ).ConclusionHBO may increase the clinical efficacy in treatment of diabetes complicated with ACI,and also it improves IR significantly.

Objective To investigate the efficacy of dual plating internal fixation with olecranon osteotomy approach for the emergency surgery of complex distal humeral fractures (intereondylar and supracondylar fracture).Methods Forty-seven cases of complex distal humeral fractures were treated with emergency surgery from May 2002 to May 2007.The dual plating internal fLxation was implemented with olecranon osteotomy approach in a posteubital slight arc shaped median incision.Early postoperative rehabilitation was necessary.Results The follow-up period differed from 5 to 50 months,averaged 18 months.All fractures healed in 3-6 months after surgery.The Cassebaum scoring system was used for the assessment of cubital joint function,36 cases were excellent,4 cases were good,5 cases were common,and 2 cases were bad.The excellent and good rate was 85.1%.Conclusions For complex distal humeral fractures,dual plating internal fixation emergency surgery with olecranon osteotomy approach ensures the early postoperative rehabilitation of the cubital joint and the maximum possible functional recovery.It shows the efficacy is satisfactory.

BACKGROUND: Studies have shown that osteoporosis often leads to a failure in pedicle screw fixation. Considering that the use of ordinary pedicle screw fixation cannot achieve a strong and stable fixation of the osteoporotic vertebra,special measures to strengthen the internal fixation is indispensable.OBJECTIVE: To evaluate the effect of bone cement augmentation combined with expandable pedicle screw fixation on the fixation strength of osteoporotic thoracolumbar vertebrae.METHODS: Twenty osteoporotic thoracolumbar vertebral specimens were randomly divided into four groups: conventional pedicle screw group implanted with normal pedicle screw, and the other three groups implanted with expandable pedicle screw. Bone cement augmentation with polymethylmethacrylate (PMMA) and calcium sulfate was done in the PMMA group and calcium sulfate group, respectively, followed by expandable pedicle screw implantation. No bone cement was used in the expandable pedicle screw group. The maximum axial pull-out strength and yield energy absorption value of the unilateral pedicle were detected, and the maximum removal torque of the contralateral pedicle was determined. Bone cement leakage after augmentation was observed.RESULTS AND CONCLUSION: Compared with the conventional pedicle screw group, the other three groups showed a significant increase in the maximum pull-out strength, maximum removal torque and yield energy absorption values (P < 0.05). Moreover, these parameters were significantly higher in the PMMA and calcium sulfate groups than the expandable pedicle screw group and conventional pedicle screw group (P < 0.05), but there was no significant difference between the PMMA and calcium sulfate groups (P > 0.05). No leakage of bone cement was found in all the groups. To conclude, the combined use of expandable pedicle screw and can significantly enhance the stability of the osteoporotic thoracolumbar vertebrae, and the PMMA and calcium sulfate cements have similar effects.