This paper reviews the advances concerning the diagnosis and treatment of carpal collapse. Systematic study on carpal collapse was launched only two decades ago. The improved roentgenologic diagnosis has deepened our understanding of the disorder. Its classification has helped doctors conduct objective follow ups of the progress and prognosis of the disease. And the related biomechanical research has made clear mechanism of the collapse which can serve as an important basis for choice of operative methods. The various partial carpal arthrodesis, of which the commonest is four corner arthrodesis, and proximal row carpectomy are proved to be effective in relieving most symptoms and ending the continuation of collapse, so they have become major treatment methods for the disease. But operative methods have to be chosen in the light of detailed conditions of radiocarpal and midcarpal joints. The silicon arthroplasty has been abandoned due to its serious complications.

The study of normal carpal kinematics has a history of only about 100 years. The initial in vitro research has shifted to the recent in vitro research. Information about the 3 dimensional movements of the carpal bones in vitro was obtained in studies using implanted radiopaque markers or transcutaneous pins with biplanar radiography, low frequency magnetic field technology and reconstructing the geometry of the bones from computed tomography (CT). On the other hand, information about the 3 dimensional movements of the carpal bones in vitro was obtained in studies reconstructing the geometry of the bones from computed tomography (CT) and using the advanced matching techniques. Most of the results obtained through the two methods are in concordance. The distal row of bones is relatively tightly bound to one another and the proximal row of bones is less so but still moving together. The foundation of the carpal kinematics was laid by in vitro studies. In vitro data largely concur with in vitro data, and only larger out of plane motions within the proximal carpal row are described in most in vitro studies. In vitro studies have also showed larger interindividual variations. Due to the limitations of both in vitro and in vitro studies, so far there has been no unanimity about the interpretation of carpal functional anatomy. In this paper, the authors summarize the research advances in normal carpal kinematics.

Objective To analyses the efficacy of treatment of blood vessels wounded with firearm in limbs by microsurgical technique Methods From March 1979 to October 2000,560 cases whose blood vessels were wounded with firearm in limbs were repaired by microsurgical technique Results Five hundred and twenty cases were good,17 cases were disable,15 cases were amputated limds,and 8 cases died Conclusions The majority of blood vessels wounded with firearm in limbs can be obtained good results being repaired by microsurgical technique

Objective:To study the X-ray manifestations of distraction osteogenesis in tibial bone transfer, put for-ward the classification and formulate the standard treatment protocols.Methods:Data of 42 cases among 321 cases with dysplasia of distraction osteogenesis who had tibial bone transfer from January 2012 to December 2018 were retrospectively analyzed. There were 27 males and 15 females aged from 4-65 years old, with an average of 33.1 years. The dysplasia sites were 26 cases of proximal tibia, 3 cases of tibial shaft and 13 cases of distal tibia. The length of tibial defect ranged from 3.5 cm to 21.7 cm, with an average of 6.7 cm. The main management protocol included systemic assessment, local assessment, fixator adjusting stimulation and surgical intervention. The fixator adjusting stimulation included transport slowing, transport stopping, transport backing, and accordion techniques. The main surgical intervention was second site osteotomy and bone grafting. According to the X-films, the dysplasia of the tibia transport can be divided into four types: longitudinal defect; transverse defect; insect erosion defect; full-length defect. External fixation index (EFI) was used to evaluate the healing and mineralization of distraction osteogenesis. The limb function was evaluated by Paley method.Results:All 42 cases were followed up for 33.71 ± 11.7 months (range, 24-72 months). The types of dysplasia were as follows: 25 cases (59.5%) of longitudinal defects, 8 cases (19.0%) of transverse defect, 2 cases (4.8%) of insect erosion defect, and 7 cases (16.7%) of full-length defects. After the treatment, except for 2 cases of amputation, all the dysplasia healed and the patients recovered limb walking. External fixation index of 40 cases was 1.55-2.83 months/cm, with an average of 1.76 months/cm. According to Paley evaluation method, 27 cases were excellent, 10 cases good, 1 case fair, and 2 cases poor, thus the excellent and good rate was 92.5% (37/40). The complications after treatment included: nail tract infection (3 cases), axial displacement of transferred segment (4 cases), clubfoot (2 cases), and amputation (2 cases). The total incidence of complications was 26.2% (11/42), which was symptomatically treated.Conclusion:The X-film manifestations of dysplasia at the osteotomy site in tibial bone transport can be divided into four types: longitudinal defect, transverse defect, insect erosion defect, and full-length defect. The different types were treated by general and local evaluation, frame adjustment stimulation and surgical intervention. The remedial results of the dysplasia were excellent.

There has been great interest in NiTi alloy in medical domain si nc e Buehler found its memory effect in 1963. In the recent 30 years, a lot of basi c and clinical researches of the alloy have been reported in the world. From the biomechanical viewpoint, the ossification and resorption of bone are related to the stress. Different stresses are required in the different kinds of fracture healing. Many measurements have been used to test the biomechanical properties o f the Nitinol orthopedic instruments. The clinical applications of the instrumen ts in hand surgery started in China in 1980's and resulted in satisfactory outco mes. This article summarizes the progress made in the basic researches of the ni tinol orthopedic instruments and their clinical applications in hand surgery.

Objective To investigate the anatomic and histological properties of carpal ligaments. Methods 34 cadaver specimens of adult wrists were prepared, of which 32 were fixed in formalin and 2 were fresh. We dissected the specimens and observed the origination, insertion, course, spatial relationship of carpal ligaments with the radiocarpal joint capsule and neighboring relationship with each other. The width and thickness of middle segment of each carpal ligament as well as the length were measured. 8 cadaver specimens of adult wrists were dissected and encircled by paraffin wax. Partial carpal ligaments were sectioned and stained with hematoxylin and eosin. Then they were put under a light microscope for observation. Results The radioscaphoid, radioscaphocapitate and radiolunate ligaments were found to have similar tissue structures. They were composed of wavy and tendinous collagen fiber fascicles, among which a small amount of loose tissue was found to be intermingled with vessels. The radioscapholunate ligament was mainly composed of loose connective tissue with no bulky tendinous collagen fiber fascicles, few fiber fascicles but rich vessel bundles. The palmar, dorsal and proximal regions of the scapholunate interosseous ligament and the lunotriquetrum interosseous ligament had different histological properties. The difference was especially obvious in the proximal regions compared with the dorsal and palmar regions. The dorsal regions of the 2 ligaments were mainly composed of bulky and bunchy transverse collagen fiber fascicles while the palmar region was composed of oblique ones. The proximal regions of the 2 ligaments were mainly composed of fibrocartilage with no vessels or nerves. At the joining part between the radioscapholunate ligament and the scapholunate interosseous ligament, the vessel bundles of the radioscapholunate ligament were noticed to penetrate the scapholunate interosseous ligament in the palmar region. Conclusions The major ligaments of the wrist are palmar. The palmar ligaments are stronger than dorsal ligaments. Many adjacent ligaments oriented in a V- shaped configuration, which can strengthen the wrist stability. Most of the carpal ligaments are mainly composed of dense and bulky collagen fiber fascicles, but the radioscapholunate ligament is mainly composed of loose connective tissue blending with rich vessels, which fulfill the function of supplying blood. The proximal regions of the scapholunate and lunotriquetrum interosseous ligaments are mainly composed of fibrocartilage structure with no vessels among them.

Objective To investigate the changes and clinical implications of VE-eadherin during the courseof progressive cerebral infarction.Method One hundred sixty-seven patients with acute cerebral infarction of Rong Jun General Hospital of Shandong Province and the Central People' s Hospital of Tengzhou were diagnosed in our hospital from May 2006 to July 2007,were diagnosed according to the ill%gnome criteria set by the 4th national cerebrovascular disease conference in 1995.Of them there were 102 ases with progressive cerebral infarction patients and 65 cases with non-progressive cerebral infaction.The progressive cerebral infarction patients were divided into 3 groups according to Pullicino's expressions:the big infarction focus(32 patients) ,the medium-sized infarction focus(34 patients) and the small infarction focus(36 patients) .The neurological deficits were divided into 3 groups according to the crrteria set by the 4th national cerebrovascular disease conference in 1995:light-defictits(38 patients),the moderate dificits (32 patients) and sever ditlcits (32 patients).The 65 non-progressive irffarction patients were stable without headache,vertigo and tinnitus.Arother 60 healthy subjects were entered as control group.Blood samples of all the patients' were collected at 0 h,24 h,3 d,7 d,14 d,24 d and the serum VE-eadherin by ELISA method was asaayed.All the data were analyzed by SPSS 10.0 software and One-way ANOVA was applied to intergroup comparisons for mote than two groups.Results The VF-cadherin level of patieras with progressive infarction increased in acute stage,reached the peak 3 days after onset,declined remarkably 7 days later and got nearly normalized within 21 days.The results were significantly different from those of non-progressive and controlgroup(P＜0.01).The VE-cadherin concentration was higher in patients with bigger size infarction and more sever symptoms.Conclusions The VE-cadherin level is related to the infarction size,course and the severity,and higher in the progressive group.VE-cadherin could be used for predicting prognostic of cerebral infarction and clinically valuable for treating ischemie cerebrovascular disease.

Objective　To review the recent progress in the treatment of wrist disorder by limited intercarpal arthrodesis and the related experimental study. Methods　Recent original articles related to limited intercarpal arthrodesis, including clinical practice and experimental study, were extensively retrieved and carefully analyzed. Results　Limited intercarpal arthrodesis could relieve pain and stabilize the wrist joint with partial motion. Conclusion　 With suitable indication and well selected operation approach, the limited intercarpal arthrodesis should be the optimal surgical intervention than total carpal athrodesis in the treatment of wrist disorder.

Objective To clarify the relationship between the first metatarsal web space and associated vessels and its application in dissection of the toes for thumb and finger reconstruction. Methods The relationships of the first dorsal metatarsal artery to the first deep transverse metatarsal ligament and the extensor expansion were observed on 42 adult cadaver lower limbs. Clinically 36 cases of thumb defects were reconstructed using the method of tracing the first dorsal metatarsal artery around the space of extensor expansion to dissect toes. Results The distal segment of the first dorsal metatarsal artery of Gilbert type I and type Ⅱwas located superficially to the layer of the extensor expansion.The time of harvesting the toe was shortened from 90 minutes to 50 minutes with 100%survival of reconstruction. Conclusions The distal segment of the first dorsal meatarsal artery lies constantly to the superficial layer of the extensor expansion.Consequently the location of the first metatarsal artery of Gilbert type I and type Ⅱbecomes much easier, by adopting the method of combination of sequential dissection and reverse dissection around the space of the extensor expansion.

Objective To explore the clinical significance of plasma LP (a) ,Hcy ,hs-CRP and cTnI concentrations in patients with AMI .Methods Plasma LP(a) ,Hcy ,hs-CRP and cTnI concentrations of 162 patients with AMI and 165 healthy people recrui-ted as control group were determined .Immunofluorescent dry quantitative method and electro-chemiluminescence immunoassay were used in the determination ,and statistical analysis were used in data comparison .Results Before treatment ,the plasma LP(a) , Hcy ,hs-CRP and cTnI concentrations in 162 AMI patients were significantly higher than those in control group (P<0 .01) .After treatment ,the plasma hs-CRP concentrations in 97 improved patients returned to normal (t=1 .586 ,P>0 .05) ,but the plasma cTnI concentrations significantly decreased (t=3 .322 ,P<0 .01) .The plasma Hcy ,hs-CRP and cTnI concentrations in 36 died patients were significantly higher(P<0 .01) .Conclusion Plasma LP(a) ,Hcy ,hs-CRP and cTnI determination were valuable for the diagno-sis of AMI patients ,the most valuable indicators for patient prognosis and follow-up were plasma hs-CRP and cTnI .