Objective To observe the reparative response and expression of basic fibroblast growth factor (bFGF) protein in the rotator cuff subjected to subacromial impingement. Methods Subacromial impingement of the infraspinatus tendon was experimentally created in 50 male SD rats by thickening the undersurface of the acromion with one platelike bony transplantation of the ipsilateral scapular spine. The contralateral shoulders that had undergone a sham operation were used as controls. The rats were sacrificed at 3, 7, 14, 28, and 56 th day, the whole shoulder joint was removed for detecting bFGF protein and the reparative response in the impinged infraspinatus tendon. Computer image analysis system were used to monitor the expression intensity and numbers of positive cells of bFGF protein. The OD scores and the size of area represent the expression intensity and numbers of positive cells respectively. Results All rats with experimental subacromial impingement showed an infraspinatus tear on the bursal side of the tendon. The shoulders in the control group were found intact without any alteration. There was proliferating cells in the fragmented tendons and vascularised connective tissue covering the area of ruptured area, whose source was the subacromial bursa. Few tenocytes and bursal cells expressed bFGF protein in unwounded tendons. In contrast, tendons subjected to impingement exhibited an increased signal for bFGF protein in both resident tenocytes concentrated along the epitenon and infiltrating fibroblasts and inflammatory cells from the subacromial bursa. Conclusion The bFGF protein is upregulated during tendon healing and the subacromial bursa is the main source of both bFGF secreting and rotator cuff repair; one should preserve as much as possible the subacromial bursa.

Objective To evaluate the efficacy of arthroscopic capsular release of frozen shoulder.Methods Twenty-five patients with frozen shoulder were treated arthroscopically from October 2001 to October 2003 in this hospital.The operation was performed under general anesthesia.The arthoscope was inserted through a posterior approach and the radiofrequency electrotome was inserted via an anterior approach.The synovitis of the biceps tendon and the rotator interval was thermo-coagulated.The superior glenohumeral ligament,the middle glenohumeral ligament,and the intra-capsular part of subscapularis tendon were cut to release the capsule.The combination manipulation was performed to release the residual contracture.The range of motion of the shoulder and the American Shoulder & Elbow Surgeons(ASES) scores were recorded at 3 and 6 postoperative months,respectively.Results The operative time was 75~95 min(mean,85 min).No intraoperative complications were found.As compared with preoperative conditions,the motion of inward rotation revealed no significant improvement at 1 week after operation(?~2=8.558,P=0.073) and other shoulder motions were significantly improved at different postoperative stages(P0.05).Conclusions Arthroscopic release for the treatment of frozen shoulder may obviously shorten the period of the disease and obtain good curative effects.

Objective To analyze the safety and tolerability of endoscopic retrograde cholangiopancreatography ( ERCP) for elderly pa-tients in diagnose and therapy. Methods From Jan. 2010 to Dec. 2013, 1 560 patients were collected in our hospital for diagnosis and treatment, 1 116 cases were 60~69 years old, and the other 444 cases were over 70 years old. Retrospective data including clinical and bio-chemical characteristics, ERCP diagnosis and complications were analyzed. Results Using Logistic regression, the potential factors of com-plex multivariable were analyzed, and there was no statistical difference between the two groups (P=0. 039). The successful intubation, in-tubation difficulties and failed intubation in the examination and the treatment were of significantly difference between the two groups (P<0. 05). There were no significant difference between the two groups in common bile duct stones of bile duct obstruction and clinical di-agnosis (P>0. 05), but the ERCP diagnosis, postoperative complications and complications of acute pancreatitis were of certain difference (P<0. 05). Patients over 70 years old were of better tolerance, but their bile duct stones was about two times than that in patients of 60~69 years old (P=0. 004). Conclusion The results show that ERCP for elderly patients in diagnose and therapy is safe and well tolerated, and there were relatively less complications in patients over 70 years old.

Objective To investigate the clinical effect of Zero-profile anterior cervical interbody fusion on single-segment cervical spondylosis in the elderly, and to compare with the effect of traditional anterior cervical decompression and fusion (ACDF) with titanium plate.Methods Clinical data of elderly patients who underwent anterior cervical discectomy and fusion operation (one-or two-level) in our department from June 2009 to March 2014 were retrospectively analyzed.The 49 patients who took anterior cervical interbody fusion with the Zero-profile cage were considered as the Zero-P group, and the other 60 patients who received ACDF with titanium plate as control (ACDFP group).The operation time, blood loss, Neck Disability Index (NDI) score before and after operation, Cobb angle of the cervical spine and Cobb angle of the operated segment before and after operation, the fusion rate 1 year after operation, the dysphagia rate after operation according to Bazaz index were recorded and assessed.Results The operation time and blood loss had no statistical difference between the two group (P＞0.05 for both).The NDI scores were declined in the two group after operation as compared with before treatment (P＜0.05 for both), while there were no statistical difference in NDI score between the two groups (P＞0.05).The Cobb angle of cervical spine had little improvement 1 day after operation as compared with before operation, and improved significantly 3 month after operation in the two group.The Cobb angle of operated segment (Cobb S) was reduced 3 months in the two group after operation as compared with before treatment, and the Cobb S was declined much more in Zero-P group than in control group (P＜0.01).There was no statistical difference in the number of patients with successful fusion between the two group (46 cases vs.56 cases, x2 =0.08, P＞ 0.05).Conclusions The clinical effect of Zero-profile anterior cervical interbody fusion is equivalent as the traditional ACDFP.Zero-profile anterior cervical interbody fusion has less exposure and blood loss, which is more suitable for the elderly patients with cervical degenerative disease.

ObjectiveTo investigate the feasibility of preventing tendon adhesion by using bFGF/ vitamin C composite biodegradable membrane.MethodsSixty Newzerland rabbits were divided into experimental and control groups randomly.After the animal model was established, the tendon autografts were encapsulated with the bFGF/vitamin C composite biodegradable membrane in experimental group, while no tendon autografts encapsulation in control.Three weeks after surgery, regular HE staining and AgNO3 staining were performed to observe the fibroblast nuclei and vitamin C.The quantity of collagen fibrils was measured by Luzex-F Image Analyzer.Eight weeks after surgery, the peritendinous adhesion and the maximum tensile load were analyzed.Results At 3 weeks after surgery, the numbers of vitamin C granules, fibroblast nuclei and collagen fibrils in the experimental group were significantly more than those in the control group(t = 11.78 ,P ＜0.001) .At 8 weeks after surgery, the peritendinous adhesion in the experimental group was significantly slighter than that in the control group(Z =3.922,P ＜0.005) ,and the maximum tensile load in the experimental group was significantly higher than that in the control group (t = 8.39, P ＜ 0.001) .ConclusionbFGF/vitamin C composite biodegradable membrane can stimulate the proliferation of fibroblasts and synthesis of collagen fibrils,improve the biomechanical property of tendon autografts and prevent the tendon adhesion.

Objective To investigate the influence of C arm X- ray perspective computer auxiliary surgery navigation system on lumbar vertebral pedicle screw fixation in the elderly.Methods 286 patients(aged≥65 years) treated by lumbar spine post decompress and pedicle screw fixation for lumbar vertebral degeneration were divided into navigation (n=153) or non-navigation (n=133) groups.The amount of blood loss,surgery duration and time of beginning to walk after surgery were measured and compared, the improvement grading was determined by Oswestry disability index (ODI) before surgery and at the last follow-up. Results The surgery duration [(27.6+6.3)ain vs.(33.8±9.9)min],the volume of blood loss[(135.7±21.1)ml vs.(165.4±32.1)ml] and the time of beginning to walk after surgery[(134.6± 12.3)h vs.(169.0±23.9)h] were obviously reduced in navigation group as compared with non-navigation group (P ＜ 0.05). The grading improvement rate by ODI[(76.6±±3.7)％vs.(69.8+6.6)％] was higher in navigation group than in non navigation group (P＜0.05). Conclusions Using C arm X-ray perspective computer auxiliary surgery navigation system to lumbar pedicle screws fixation is helpful in the elderly for improving clinical efficacy.

Objective To investigate the efficacy of the enhancement treatment on osteoporotic vertebral compression fracture and its complications in the elderly.Methods From September 2007 to February 2012,183 patients with osteoporotic vertebral compression fracture underwent percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) in our department.157 of them were completely followed up (PKP group,n=96; PVP group,n=61) and totally 182 vertebral bodies were fractured (PKP group,n=107; PVP group,n=75).Visual analogue scale (VAS) score and Oswestry disability index (ODI) score were evaluated before and 3 days and 3 months after the surgery.Plain film radiography was taken to evaluate the vertebral body height.ODI score was evaluated at the end of the follow-up.The leakage of polymethylmethacrylate (PMMA) during the operation and the refracture were recorded.Results The mean height of the vertebral body before operation had no difference between PVP and PKP group [(1.31±0.18) cm vs.(1.32±0.16) cm,t =0.72,P＞0.05].After the operation,the mean height of the vertebral body was lower in PVP group than in PKP group [(1.50±0.20) cm vs.(1.66±0.17) cm,t=2.28,P＜0.05].The mean amount of the PMMA injected into the vertebral bodies was less in PVP group than in PKP group [(2.93±0.34) ml vs.(3.34±0.49) ml,t=2.39,P＜0.05].In the PVP group,the VAS scores were (7.5±0.79),(3.0±0.6) and (1.9±0.9) before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation (t =15.59,P＜0.05).In thePKPgroup,the VAS scores were (7.3±1.0),(3.0±0.8) and (2.2± 0.9)before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation (t=10.69,P＜0.05).In the PVP group,the ODI scores were (78.9±7.3),(30.0±3.7) and (25.5±3.5) before and 3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation (t=20.83,P＜0.01) and 3 months after operation versus at the end of follow-up (t=4.03,P＜0.05).In the PKP group,the ODI scores were (78.8±6.8),(29.8±4.43) and (23.8 ± 2.7) before operation,3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation (t=21.52,P＜0.01) and 3 months after operation versus at the end of follow-up (t=3.14,P＜0.05).There were no significant differences in VAS and ODI scores between the two groups before versus after operation (t=0.34,P＞0.05).The incidence of refracture was 8.2％ in PVP group and 9.4％ in PKP group,which had no statistical difference between the two groups(x2 =0.06,P＞0.05).All the leakage was asymptomatic.The incidence of PMMA leakage was 20.0％ (15 cases) in PVP group and 9.3％ (10 cases) in PKP group,which had a statistical difference between the two groups (x2 =4.22,P ＜ 0.05).Conclusions Enhancement treatment for osteoporotic vertebral compression fracture can quickly relieve the pain and improve the quality of life.PKP and PVP show no differences in the effect of analgesia and the improvement of life quality,but PKP has the advantages in recovering vertebral height and reducing PMMA leakage.

Objective Objective To analysis the clinical curative effect on elderly patients with choledocholithiasis by endoscopic retro-grade cholangiopancreatography ( ERCP) and endoscopic sphincterotomy ( EST) and discuss its clinical significance. Methods 256 patients with choledocholithiasis were collected for diagnosis and treatment by ERCP. The stone characteristics was mastered by ERCP and the pa-tients were treated with EST. Results Patients with choledocholithiasis were successful in 249 cases (97. 27%) for ERCP intubation and 239 cases (93. 36%) for stone remove. After EST,the stones were removed successfully at one time in 199 cases (83. 26%),2 times in 40 cases (16. 74%). 7 patients (2. 73%) with multiple diverticulum and papillary position poor by intubation failure were changed over to op-eration treatment. After ERCP,patients were performed endoscopic nasobiliary drainage (ENBD) 64. 44% (154/239). Pull out the drain-age tube of 90. 91% (140/154) of the patients after stones disappeared which was proved by angiography for 3~5 days. 14 cases (9. 09%) were performed second times to remove the stones due to the presence of residual stones. Postoperative complications occured in 15 cases (6. 02%) including 9 cases of acute pancreatitis and 6 cases of infection of biliary tract, and they were cured after 1 week of corresponding treatment. Transient increase of serum amylase occurred in 39 cases, and all of them recoveried after 3 days without special treatment. Con-clusion The results showed that ERCP ( or EST) were well tolerated by elderly patients with choledocholithiasis,and they were of obvious curative effect and quick recovery,which is worthy of promotion and application.

Objective To investigate the surgical curative effect of long-segment fixation and fusion on the degenerative scoliosis (DS) in the elderly.Methods The clinical data of 27 patients with DS undergoing surgical treatment from January 2011 to December 2013 in our department in Beijing Hospital were retrospectively analyzed.All patients suffered from degenerative scoliosis accompanied with lumbar canal stenosis, lumbar spondylolisthesis, lumbar vertebrae lateral slip in coronal surface, spinal vertebral rotation deformity and kyphosis.The decompression osteotomy and fixed segment, blood loss volume and operation time were recorded.The differences in scoliosis angle (Cobb angle), lumbar lordotic angle, top vertebral rotation degree (Nash-Moe vertebral rotation grade), apical vertebral offset distance, visual analogue scale (VAS) score and Oswestry disability index (ODI) score were compared between pretreatment versus the last follow-up.Results The selective 1-5 segment decompression and 5-10 segment fusion were selected in a total of 27 patients.Some patients were treated with Smith-Petersen osteotomy (SPO).All of 27 cases were treated with a lamina and inter-transverse fusion, among which 25 cases took inter-vertebral fusion additionally.The time of postoperative follow-up was more than 1 year.The Cobb angle, lumbar lordotic angle, apical vertebral offset distance, VAS and ODI scores were improved after treatment as compared with pretreatment [(11 6) vs.35 6 , (32±10) vs.(17±9) , (16.3±8.2) mm vs.(32.2±9.8) mm, (3.3±1.6) vs.(7.3±2.1), (18±14) vs.(33±14), t=2.469, 2.313, 2.331, 2.362, 2.395, P=0.021, 0.030, 0.029, 0.026, 0.023 respectively].The satisfaction survey result was excellent in 19cases, good in 5 cases, fair in 3 cases.Complications were found in 9 patients, among whom 2 cases had screw loosening in the internal fixation, 2 cases had adjacent segment degeneration, 1 case had pulmonary infection, 1 case had urinary tract infection, 2 eases had spinal fluid leakage, 1 case had epidural hematoma.No serious complications and deaths were observed.Conclusions Under strictly controlling the therapeutic indications, the limited decompression and long-segmental fixation and fusion have good therapeutic efficacy on degenerative scoliosis in elderly patients.

Objective To investigate the effect of pedicle screw augmentation with bone cement perfusion on the long segment fixation and fusion in the elderly patients with spinal deformity treated by osteotomy.Methods The cohort data of the older patients aged ≥70 years with spinal kyphosis were retrospectively analyzed in Beijing Hospital,Department of Orthopedic Surgery,Division of Spine Surgery from January 2012 to June 2014.32 cases with complete clinical date were included in this study.The kyphosis of all patients was secondary to thoracolumbar osteoporotic compression fracture.All patients were treated by posterior thoracolumbar spinal osteotomy with long segment fixation and fusion.The patients with fusions including sacral vertebral body fusion or the T score of BMD were less than-5 were excluded.Some patients with neurological compression symptoms also underwent selective decompression in spinal canal and nerve root foramen.All patients were divided into two groups:with (n=14)versus without(n=18)screw augmentation with bone cement perfusion(augmentation vs.non-augmentation/control group).The follow-up time was no less than 12 months.The data of age,gender,operative time,blood loss volume and preoperative bone mineral density were compared between two groups.Cobb angle of postoperative spinal surgery region,lordosis angle of postoperative lumbar,VAS and ODI improvement were analyzed.Data of surgical fixation and fusion segments were recorded.Pedicle screw loosening was compared between two groups.Results In the augmentation group,the pedicle screw loosening didn't occur.But control group showed screw loosening in 7 cases,a euphoric zone around screw in 4 cases,pedicle screw pullout in 2 cases,and vertebral cutting phenomenon with euphotic zone around screw in 1 case.There were no significant differences in ODI improvement rate and surgical satisfaction between the two groups.Conclusions When operative procedures of surgeon are in precision and skillful,bone cement augmentation technique for pedicle screw can reduce the occurrence of pedicle screw loosening in older patients during osteotomy and long segment fixation and fusion operation for spinal kyphosis.