Objective To investigate the clinical Results of microwave heliotherapy on the malignant bone tumors of scapula. Methods Form June 1998 to February 2008, 17 patients with malignant bone tu-mors of scapula were treated with microwave heliotherapy. There were 12 males and 5 females, 48 years old on the average (ranging from 13 to 59 years). The tumors included: the primary malignant tumor of the scapula (12 cases), the metastases of the scapula (5 cases). Locations of tumors included: the SI region (14 shape or curved nick on the surface of scapula. The lesions were heated at 50 ℃ fur 20 min at 2450 MHz microwave, with surrounding soft tissue protected by copper mesh. The necrotic tumor tissues were excised after the treatment of microwave heliotherapy. Results The axillary nerve of the patient with the metastases of the scapula was cut off, and the broken ends were sewed up after the tumor was excised. The duration of surgery was from 60 minutes to 180 minutes (120 minutes on average). The blood loss was from 300 ml to 1000 ml (460 ml on average). All patients were followed up for 3 months to 10 years (4.2 years on average). Three cases with Ewing sarcoma died due to brain metastases, pulmonary metastases or all body metastases 8 to 24 months postoperatively. Three cases with malignant fibrous histiocytoma died due to pulmonary metastases or all body metastases 10 to 22 months postoperatively. Five cases with the metastases died due to metastases 6 to 14 months postoperatively. Three patient's superduet function of shoulder joint was re-stricted. Conclusion The clinical Results demonstrated that the advantages of microwave heliotherapy in-cluded quick increase of temperature, sensitive responses, easy control of temperature, and effective inacti-vation of tumor cells in the malignant bone tumors of scapula.

ObjectiveTo explore the application and outcome of locking compression plate in the treatment of unstable distal radius fracture.Methods From January 2006 to December 2008,eighty-two patients with consecutive unstable distal radius fractures were preformed with open reduction and locking compression plate fixation by volar, dorsal or bilateral approaches. There were 31 males (bilateral fractures in two patients) and 49 females with an average age of 51 years (range, 17-74 years).According to AO/OTA criterion, there were seven patientswith type A3 fractures, four with type B 1, 12with type B2, 10 with type B3, 16 with type C1, 21 with type C2 and 12 with type C3. The locking plate fixations through simple volar approach was performed in 61 patients, fixations through dorsal approach in 12, volar 1/3 radius cylindrical steel plate fixation through volar and dorsal approach in five, bilateral fixations through volar and dorsal approaches in four. Furthermore, the external fixator was used in 19 patients, fixation of the ulna fractures in seven, and bone graft in 39. ResultsThe patients were followed up for average 20.7 months ( range, 1-4 years), which showed postoperative complications including bubble appearing around the incision in three patients, infection in one, median nerve injury in three, screws penetrating into extensor compartment in four, threads penetrating into radiocarpal joint because of reduction loss in two, rejection in one and traumatic arthritis in seven. According to the Cooney criterion, the result was excellent in 56 pateints, good in 19, fair in six and poor in one, with excellence rate of 91％. Conclusions The locking compression plate can provide firm fixation and allow early functional exercise and hence is suitable for unstable distal radius fracture especially the osteoporosis patients with comminuted compression fracture.

Objective To investigate the feasibility of determining the surface density of RGD-containing peptide on allogenic bone by isotopic tracing technique using RGD peptide labelled with 125Ⅰ,and the impact of the input concentration of RGD-containing peptide on the surface density,and to obtain the history between the surface density and the input concentration of RGD-containing peptide.Methods The synthetic RGD-containing peptide was labelled with 125Ⅰ,and the specific radioactivity was calculated.The reactive solutions of RGD-containing peptide with the radioactive 125Ⅰ-RGD as a probe were prepared at the input concentrations of 0.01 mg/ml,0.10 mg/ml,0.50 mg/ml,1.00 mg/ml,2.00 mg/ml,4.00 mg/ml.Using EDC as the cross-linking agent,the reaction was carried out by placing the allogenic bone pieces into the reactive solutions of RGD-containing peptide with different input concentrations.After the reaction,the surface density of RGD-containing peptide grafted onto the allogenic bone pieces was calculated by evaluating the radioactivity and the surface area of the bone pieces.The impact of the input concentration of RGD-containing peptide on the surface density was measured and the curve was ascertained.Results After measuring in the radiodensity γ-counter,the result showed the RGD peptides have been marked with 125Ⅰ successfully.The allogenic bone pieces were radioactive after the reaction,which demonstrated that the RGD-containing peptide had been grafted onto the surface of bone pieces successfully.It was also found that with the increasing of input concentration,the surface density raised.Conclusion The surface density of RGD-containing peptide is related to its input concentration.With the increasing of input concentration,the surface density raises to the saturation value gradually.

Objective To establish a clinical score system of giant cell tumors (GCT) according to its morphological features presented on three-dimensional (3D) computed tomographic imaging. Methods Sixteen patients with GCT around knee were included from January 2006 to March 2009. Of the tumors, 9 were located in the distal part of femur, and 7 were in proximal part of tibia. Each patient was exposed to spiral CT preoperatively. Then these primitive CT dates were inputted into digital Orthopedics clinical research platform. With 3D surfaces reconstruction and volume rendering, we reconstructed 3D morphology of GCT. The measurement index included pathological fracture, the degree of involvement of cortical bone, the volume of tumor, the distance between tumor and joint surface and the percentage of involvement areas of articular surface. On account of previous literature and above data, clinical score system of GCT was established. Its feasibility was testified by clinical data. Results A new clinical score system of GCT was established. It was named Hu-Chen Giant Cell Tumor Scale. Full score of the system was 12. In the 16 patients, 5patients whose points was more than 9 elevated by Hu-Chen Giant Cell Tumor Scale preoperatively were treated by wide excision and prosthetic replacement. The postoperative average MSTS score of 5 patients was 27, and there were no recurrence. The 5 patients whose points was 6-8 elevated by Hu-Chen Scale were treated by intralesional excision and structured allograft. The postoperative average MSTS score of the patients was 29, and 1 case underwent recurrence whose points was 8. The 6 patients whose points were less than 6 elevated by Hu-Chen Scale were treated by intralesional excision and morsellized allograft. The postoperative average MSTS score of the patients was 27, and there were no recurrence. Conclusion Hu-Chen Giant Cell Tumor Scale established based on digital techniques includes lots of factors which determined surgical strategy. The grating system is an effectively, reliable method in treatment of GCT.

Objective\ Treatment of spondylolisthesis using freeze dried femoral ring allografts plus morselled cancellous autografts (called as composite cortical ring) by anterior lumbar interbody fusion (ALIF). Methods\ Fourteen patients were treated by this procedure, there were six males and eight females. The age of the patients range from 40 to 56(average 46). Ten segments were of grade Ⅱspondylolisthesis, five segments were of gradeⅠ. Ten patients were treated with RF as internal fixation, four patients with short Harrington rod as internal fixation. Results\ The fusion rate and clinical results of ALIF were analyzed by comparing the findings on the X-ray films taken preoperatively and 6 months postoperatively as well as by JOA score. The fusion rate of 15 segments of 14 patients(two segments of 1 patient was fused) is 85.7%, the average improvement rate of JOA score is 73.3%at an average follow up of 26.6 months. Conclusion\ ALIF with composite cortical ring could successfully restore the spinal structure, maintain the interspace height distracted intraoperatively, obtain high fusion rate and excellent clinical results.\;

Objective Short-segment pedicle instrumentation for thoracolumbar burst fracture was known to have a relatively high incidence of failure and correction loss, intracorporeal gap secondary to reduction being probable causes. The purpose of this study was to evaluate the intracorporeal gap after reduction and the biomechanical effect of vertebroplasty on thoracolumbar burst fractures. Methods Six fresh adult thoracolumbar specimens were collected, and 10 segmental specimens (T11-L1, L2-L4, T12-L2) were processed. Burst fracture was created using free-drop test. Then the fractures were reduced and augmented with injectable self-setting calcium phosphate cement. The intracorporeal gap and bone mineral density(BMD) were measured using spiral CT and dual energy X-ray absorptiometry(DEXA) before fracture, after reduction and after vertebroplasty respectively. The stiffness in middle vertebrae and above discs were measured under flexion, extension, lateral flexion and torsion stress before fracture and after augmentation. The ultimate strength against compression was tested in the augmented vertebrae and the integral vertebrae below it. Results Burst fractures were created in eight of ten specimens. 1) There was no evident intracorporeal gap before fracture, which appeared after reduction with average volume of 5.25 cm3 (13.9% of total corporal volume), and it decreased to normal level after vertebroplasty. 2) The BMD was normal in all specimens before fracture, which decreased significantly after fracture reduction, and it was significantly higher after vertebroplasty than that before fracture or after reduction. 3) There was no significant difference of stiffness in vertebrae before fractures and after augmentation. The mean value of ultimate strength against compression in the augmented vertebrae decreased slightly but not significantly in contrast to the vertebrae below it. In contrast to the value before fracture, the stiffness of above discs decreased significantly under flexion and extension stress but not significantly under lateral flexion stress after augmentation, while the stiffness of the specimen decreased significantly under torsion stress. Conclusion 1) Posterior reduction in thoracolumbar burst fracture can not reestablish intact corporeal structure, which may be an important cause of postoperative implant failure and correction loss. 2) Vertebroplasty with injectable self-setting calcium phosphate cement is helpful to reestablish intact corporeal structure, and restore stiffness and strength of the injured corpora nearly to its initial value.

Objective To investigate the clinical results of percutaneous vertebroplasty(PVP) for symptomatic vertebral hemangioma. Methods Eleven patients(2 males and 9 females) suffered from symptomatic vertebral hemangioma(11 thoracic segment levels and 3 lumbar segment levels) were treated with PVP under DSA or CT guidance. The main goal of this procedure was to relieve hemangioma related pain. All patients were examined with CT scan after intervention and were followed up from 3 to 34 months (average, 15.2 months). Results The procedure was technically successful in all patients, with an average injection amount of 6.3 ml cement per vertebral body. No clinically significant complications were found. There was no epidural leakage, and the 2 paravertebral leakages detected with CT had no clinical importance. Partial or complete pain relief was achieved in all patients associated with improved mobility, and 1 patient experienced transitory worsening of pain followed by significant pain relief. Patients were discharged in 1-4 days (average, 1.5 days) after the procedure. Pain relief was sustained in all patients at the last following-up. Conclusion PVP is a valuable minimal invasive alternative procedure in treatment of symptomatic vertebral hemangioma and provides satisfactory pain relief with less complications.

Objective Lateral dislocation of the patella pulled laterally from the trochlea and across the lateral femoral condyle,was often a transient phenomenon with spontaneous reduction,diagnosis based on the results of physical examination and clinical history was difficult.The present was in an effort to explore the mechanism and definition of acute patellofemoral dislocation as well as assessment with MRI of the injury.Methods From May2001to July2002,34patients aging from11to25years with18males and16females,had a history of knee joint,28of which were experienced a twisting injury with the knee in flexion and internal rotation of femur on a fixed foot.Sagital,coronal and transverse MRI were performed with T 1 WI,T 2 WI,STIR and TSHIRT sequences.The manifestations of MRI were analyzed retrospectively,and clinical data,X-ray films,CT scan and the findings of arthroscopy were studied as well.Results All of34cases injured were found the signal intensity abnormalities of subchondral bone in the inferior medial part of patella and the anteri-or lateral part of lateral femoral condyle,which suggested that bone was injured.MRI findings of cartilage fis-sure at medial patella were found in20cases and injury of the patella retinaculum was seen at MRI in27cas-es.MRI findings revealed joint effusion in all patients,and lateral subluxation of the patella was seen at MRI in23cases.Conclusion The resultant jury on MRI findings of acute patellofemoral joint dislocation caused by a-cute impingent of patellar medial facet to lateral femoral chondyle at the various degree of flexion and rotation of the knee include the osteochondral fracture in the inferior medial part of patella,the anterior lateral part of lateral femoral condyle,the subluxation or dislocation of patella,the injury of medial patella retinaculum and the joint effusion.MRI could be helpful for the diagnosis of the disease,and demonstrate the location and ex-tent of injury on the different compartments of the involved knee.

Objective To analyze the clinical results of percutaneous vertebr oplasty (PVP) for osteolytic spinal tumor. Methods Forty patients with osteolyt ic vertebral metastases or myeloma were selected from Feb. 2000 to Jun. 2003 to undergo percutaneous vertebroplasty. All patients complained of back pain. Among them, 6 cases had radiculopathy, and 1 had paraplegia. Based on CT or MR scanni ng, the posterior vertebral wall was involved in 21 cases. 42 PVP was performed on 59 segment levels under fluoroscopic or CT guidance, including 1 at cervical spine, 29 at thoracic spine, 27 at lumbar spine and 2 at sacrum, and biopsy was performed in 28 cases simultaneously. CT scanning was conducted after interventi on to assess the lesion filling and cement leakage, and all patients were asked to remain lying on bed for 4 hours prior to axial loading. In combination with P VP, radiotherapy, chemotherapy, medicament were administered before or after the intervention. Results The procedure was technically successful in all patients with an average injection amount of 6.5 ml cement per vertebral body. Partial or complete pain relief was achieved in 39 cases, associated with improved mobilit y in 38 cases, the symptoms of patients with radiculopathy and paraplegia were u nchanged. Two cases with severe multiple vertebral destruction underwent PVP at one segment, neither of them experienced improved mobility. In one case, the sev erity of pain was unchanged, while the other experienced partial pain relief for 48 hours. Leakages were detected with CT at 21 levels of 17 cases. 2 of 7 epidu ral leakage produced transitory radicular pain, which were relieved in 6 h and 8 h respectively. 2 with intervertebral foraminal venous leakage, 8 with paravert ebral leakage, and 6 with intra-disc leakage had no clinical symptoms. 37 cases were followed up from 2 to 32 months (average, 8.5 months). Exclusive of poor re sults in 2 patients, pain relief was sustained in 29 cases, and 6 patients exper ienced relapse of pain following partial pain relief, which was related to the d eterioration of tumors. Conclusion PVP of osteolytic spinal tumors is a minimal invasive procedure that provides immediate and stable pain relief with improved mobility. It can be combined with radiotherapy or chemotherapy.

Objective To study the retrieved human allografts pathologically in order to probe into the histological changes of implanted allograft. Methods The specimens were retrieved from seven cases between February 2003 and March 2004, and the allografts had been in situ from two to 16 months. Of seven cases, four were diagnosed primarily as malignant fibrohistocytoma of proximal humerus, osteosarcoma of femoral shaft, bone giant cell tumor of distal femur and bone giant cell tumor of proximal tibia each, which were treated with wide resection of tumor and massive allograft transplantation and internal fixation of plate or inter-locking nail; two were open comminuted fracture of distal femur, treated with massive allograft transplantation and internal fixation, underwent autograft bone transplantation because of united massive allograft, had a punch biopsy of allografts for observation; one was tibial open fracture being fixated with inter-locking nail and small segment allograft transplantation, sustained infection at two weeks after primary operation and underwent debriment, removal of internal fixation and external fixation. Results Of seven cases, five were found with bone absorption radiographically, and were classified into three types:1)sever bone absorption; 2)bone absorption associated with sinus and effusion of the wound; 3)bone absorption accompanied by pyogenic infection. The later condition was caused by bacterial infection without a relationship of allograft. And the former two conditions could be classified into two subtypes: 1)osteoclastic absorption, which was followed by new bone formation; 2)inflammatory absorption, which was found with infiltration by round inflammatory cell, preponderantly lymphocytes, and mononuclear phagocytes with few osteoclasts, osteoblasts or new bone formations. Moreover, in sever bone absorption, vascular lesions such as vasculitis, swelling of endothelial cells or proliferation changes in the vessels, and obliteration of the arteries. Conclusion An intensive infiltration accompanied by vascular lesions may be the evidences of histological changes suggestive of an immune reaction directed against the grafts, and the failure of the clinical outcomes.