Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.

Objective To evaluate the character of the collagen-chitosan-chondroitin sulfate scaffold seeded with rat adipose tissue-derived stromal cells. Methods A dipose tissue were harvested from 6 weeks old Wistar rats and the stromal cells were harvested by type Ⅰ collagenase and then cultured in vitro. Type Ⅰ collagen was fully mixed with chitosan, freeze-dried and cross-linked with chondroitin sulfate, then freeze-dried again and sterilized by ethylene oxide. The pore diameter, water content, porosity of the scaffold were tested. The adipose tissue-derived stromal cells were digested, seeded into the plates, scaffold, and cen-trifuged into pellet, and then induced into cartilage. MTT detection for cell proliferation was done. After 3 weeks, the cell morphology, and cell proliferation and adhesion were observed, and chondrngenic differenti-ation was also analyzed. Results The pore diameter, water content, porosity tested for the scaffold showed an appropriate form. Cell proliferation showed faster in the scaffold and pellet culture system after 5 day, there was still cell proliferation in the scaffold system after 14 days but no obvious changes in the pellet cul-ture system; ceils on the scaffold proliferated densely showed by histological staining, but there was a scaf-fold structure residues in the inner layer. The finding of type Ⅱ immunohistochemistry stain showed that cells express strong positive for type Ⅱ collagen in the scaffold and pellet culture system whereas it was weakly positive in the plate culture system; the specific mRNA for cartilage, type Ⅱ collagen, aggrecan and SOX-9 were expressed in all three systems showed by RT-PCR, but type X collagen was expressed continu-ously in the plate culture system and expressed after 21 days in the pellet culture system, whereas it was not detected in the collagen-chitosan-chondroitin sulfate scaffold system. Conclusion The parameters of the collagen-chitosan-chondroitin sulfate scaffold were suitable in our study. The results suggested that it can promote the adipose tissue-derived stromal cells proliferation and chondrogenic differentiation better than the plate and pellet culture systems and maintain the phenotype of chondrocytes well; it is the optimal choice for cartilage tissue engineering in the future.

Objective To study the effects and advantages of the treatment for simple bone cysts of the long bones in children with AO titanium elastic nail and autologous bone marrow injection. Methods Eighteen patients with a simple bone cyst at humerus or femur were managed with AO titanium elastic in-tramedullary nail combined with autologous bone marrow injection. There were eleven boys and seven girls in total, with the mean age of 8.1 years, ranged from 6 to 12 years. Twelve cysts was located in the proximal end of humerus, five in the proximal end of femur and one in the middle part of the shaft of femur. Twelve cysts were active and six inactive according to Neer standard. Radiographic evaluation was performed three, six, twelve and eighteen months after operation during the 11 to 23 months follow-up by taking anteroposteri-or and lateral X-ray pictures. Then we measured residual radiolucent areas on X-ray pictures and did statistic research with group comparison. Results Six cysts (33.3%) healed completely, and twelve (66.7%) healed with residual radiolucent areas which were visible on X-ray pictures 3 to 6 months after operation. Residual radiolucent areas on X-ray pictures gradually reduced during the different phases and it has statistical signif-icance by group comparison. There was no recurrence or major complication except for one patient with mild irritation of skin caused by the end of the nail up to now. Conclusion The treatment for simple bone cysts of the long bones in children combined with AO titanium elastic nail and autologous bone marrow injection not only has satisfactory healing rate but also can provide early stability to the long bones, and accelerate the healing of cysts which allows early mobilization and thus obviates the long-term need for a plaster cast and decreases the prevalence of the most common complication: a pathological fracture.

Objective To investigate retrospectively the long-term results of discectomy for patients with lumbar intervertebral disc herniation. Methods From July 1988 to May 2003, 273 cases of 1040 patients with lumbar intervertebral disc herniation undergone surgical treatment in our hospital were followed up. All patients were divided three groups according the time of follow-up. The follow-up time was three years as middle follow-up group (Ⅰ), five years as longer follow-up group(Ⅱ) and ten years and more as sup-longer follow-up group (Ⅲ). Sixty-eight cases(24.91%) were in group Ⅰ, including 42 males and 26 females, with the average age of 43.7 years (14-63 years). The group Ⅱ included 141 cases (51.65%), 92 males and 49 females, with the average age of 46.1 years (18-76 years). As group ⅡⅢ, 64 cases (23.44%) were included 46 males and 18 females, with the average age of 43.5 years (20-63 years). The standards Scoring System of Chinese Spinal Association (CSA) and Japan Orthopaedic Association (JOA) were used for investigation. Results According to CSA system, the total good and excellent rate of surgical treatment for lumbar intervertebral disc herniation was 89.0%. The percentage of the satisfactory of the group Ⅰ, Ⅱ, Ⅲ were 92.6%, 91.5% and 79.7% respectively. There was significant difference between group Ⅰ and group Ⅱ, Ⅲ. The score of JOA were 24.75±5.08, 22.43±6.55, 21.64±7.18 postoperatively, with significant difference between group Ⅰ and group Ⅱ, Ⅲ. Conclusion The mid-term results of surgery for patients with lumbar iutervertebral disc herniation is good, and the good and excellent rate decreases gradually with the follow-up time. The results were similar to each other for evaluation between the standard of CSA and JOA.

Objective To evaluate the clinical effect of thoracic discectomy via trans-facet-joint approach in the treatment of thoracic disc herniation.Methods Thirty-three cases were included in this group from October 1994 to August 2009.There were 27 males and 6 females.The age ranged from 18 to 72 years old,with an average of 41.8 years.The course of disease ranged from 12 days to 36 months and was lesser than one month in 13 cases.The weakness and numbness of lower limbs occurred after trauma in 9 cases.Fifteen cases were diagnosed as simple thoracic disc herniation.Six cases were associated with ossification of posterior longitudinal ligament and 12 cases were associated with ossification or hypertrophy of yellow ligament.A total of 45 discs were involved,including 32 in lower thoracic segments(71.11%),8 in upper thoracic segments(17.78%)and 5 in middle thoracic segments(11.11%).All the herniated discs and the ossified OPLL were excised via the trans-facet-joint approach.For the cases with ossification or hypertrophy of yellow ligament,the laminectomy and replantation were performed.The screw-rod system was used on both sides in 14 cases,on one side in 19 cases.Results Follow-up was acquired in 27 patients,ranged from 12 to 63 months(mean,37 months).According to Epstein and Schwall grade,there were excellent in 15 cases,good in 10 cases,improved in 2 cases and poor in 2 cases.The excellent and good rate was 86.21% and total effective rate was 93.10%.Postoperative complications occurred in 3 cases,including exacerbation of preexisting deficits in 2 cases and implant failure in 1 case.The former 2 cases were treated with methylprednisolone,dehydrant,neural nutrition and hyperbaric oxygen.One patient had recovered to preoperative level,the other had not recovered to the preoperative level.The implant was removed 18 months after operation for the implant failure.The post-operative CT or MRI showed that all the replanted lamina obtained fusion,and the canal decompression was complete.Conclusion Thoracic discectomy via trans-facet-joint approach can improve the clinical result obviously.

Objective To investigate the difference between the different surgical methods for thoracic ossification of ligamentum flavum(OLF)combined with cervical spondylotic myelopathy(CSM).Methods From January 1991 to January 2003,56 cases with thoracic OLF combined with CSM were reviewed retrospectively.Forty of 56 cases had been followed up for more than two years.There were 22 males and 18 females with an average of 58 years(range,27-70 years).The course of the diseases were 1 to 120 months,with an average of 16.5 months.The pathological factors for thoracic myelopathy included:OLF for 25 cases,OLF combined with ossification of posterior longitudinal ligament(OPLL)for 12 cases,OLF combined with thoracic disc herniation for 3 cases.There were 23 cases combined with cervical OPLL and 17 cases combined with cervical stenosis.Eighteen cases underwent cervical laminoplasty and thoracic laminectomy,9 cases underwent only thoracic laminectomy,and 13 cases underwent both cervical and thoracic posterior decompression in multiple stages.Results Forty cases were followed up for 24 to 227 months,with an average of 67.5 months.According to Epstein standard,the excellent and good rate was 88.9% for 18 cases who underwent cervical laminaplasty and thoracic laminectomy(16/18),66.7% for 9 cases who underwent only thoracic laminectomy(6/9),and 53.8% for 13 cases who underwent both cervical and thoracic posterior decompression(7/13).Statistics analysis showed that the outcome of one-stage surgery was better than multiple stages surgeries,and outcome of those whose operation intervals less than 1 year was better than those of more than 1 year.Conclusion Thoracic and cervical decompression should be performed at one stage for those with upper thoracic OLF combined with CSM.Thoracic decompression should be performed firstly for those with severe lower extremities syndrome and few upper extremities syndrome.Thoracic and cervical decompression in one or multiple stages should be performed for those with severe upper and lower extremities syndrome,and operation interval should be less than one year.

Objective To investigate the surgical technique and efficiency of the "Cave-in" 360°circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OPLL).Methods From October 2005 to October 2009,26 TSS cases with OPLL were surgically treated,including 17 males and 9 females.Nineteen cases had upper thoracic spinal stenosis(T1-4)with OPLL,while 14 of them also had ossification of ligamentum flavum(OLF).All the other 7 cases had middle and/or lower(T5-12)TSS with both OPLL and OFL.All patients had severe spinal cord compression,and preoperative Frankel Grade was B in 6 cases,C in 13 cases and D in 7 cases.All these cases were surgically treated by 360° circumferential decompression("Cave-in" technique).Firstly,posterior wall was removed to decompress thoracic spinal cord.Secondly,the residual facets and pedicles were removed and posterior 1/3 of vertebral cancellous bones were cut along pedicles at 60° angle inclination to make a "culvert".Finally,the culvert walls were pressed to collapse and the OPLL blocks were removed to achieve ventral decompression.Pedical screw fixations were performed in all patients.Results All cases had immediate postoperative neurological improvement except 2 who experienced transient postoperative neurological deterioration for 13-27 days.At the end of 6-30 months follow-up,all these patients had neurological improvement.At the last follow-up,Frankei Grade was C in 2 cases,D in 15 cases and E in 9 cases.Conclusion This "Cave-in"360° circumferential decompression removes ventral and dorsal spinal compression from the posterior approach in TSS cases.It is a direct decompression procedure,which reduces the rate of postoperative paralysis.

Objective To investigate the influence of sodium fluoride(NaF)on alkaline phosphatase (ALP)activity and bone gla protein(BGP)synthesis in yellow ligament cells from different surgical simples in vitro.Methods The human ligament cells were divided into three groups according to its sources,including normal yellow ligament cells(NLF)group(from acute traumatic thoracolumbar fractures with paraplegia in 7 patients),degenerative yellow ligament cells(DLF)group(from degenerative lumbar stenosis in 9 cases)and ossified ligament cells(OLF)group(thoracic yellow ligament from 8 patients).Twenty-four groups of cells were obtained under vitro cell culture by the method of tissue adherence.Different concentrations of NaF were added into the medium when the cells spread to the fifth generation.Then,the morphological changes were observed and ALP activity and BGP synthesis were tested.Results Human yellow ligament cells from different samples can proliferate and be passaged in vitro.The cell in ossific groups and degenerative groups were pleomorphic and could form calcium nodules.High concentration of NaF(1.0 mmol/L)can lead to cytotoxic reaction in all 24 groups.Low concentrations of(0.01-0.125 mmol/L)NaF can enhance the ALP activity and BGP synthesis in DLF groups while no effect was found in OLF and NLF groups cells under the same concentration of NaF.Conclusion The fact that fluoride can promote ALP activity and BGP synthesis in degenerative yellow ligament cells in vitro indicates fluoride may play an important role in inducing further ossification of human ligament cells.

Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail ant-rotation(PFNA-long)in treating long-segment fracture in middle-up part of femoral bone.Methods From June 2006 to December 2009,32 cases of long-segment fracture in middleup part of femoral shaft were treated by closed reduction or limited open reduction and fixation with PFNA-long,including 30 males and 2 females with an average age of 3.8.8 years(range,20-69).All patients had closed fractures in shaft of femur.The average time from injury to operation was 4.2 days(range,3 hours to 12 days).All fractures were fixed with the PFNA-long.The patients were followed at 1,2,3,6,9,12 month after surgery,respectively,and next time at least once per year.The clinical outcomes were evaluated according to Harris criteria and radiological examinations.Results The mean operating time of all cases was 55 minutes(range,35-90),and the mean blood loss during surgery was 75.6 ml(ranged,30-150 ml).All patients walked with walking aid 4-7 days after surgery.They were followed up for 9-37 months.All fractures healed after 3.1-5.4 months(mean 3.7 months).No complications such as infection,lower limb vein infarction,cut-out or breakage of the implants occurred.But 2 cases had hip internal reverse-lamb shortening malformation,According to Harris criteria,the clinical results were excellent in 23 cases,good in 7,and moderate in 2,and the excellent and good rate was 93.75%(30/32).Conclusion PFNA-long is an effective and minimally invasive method for long-segment fracture in middle-up part of femoral shaft,with minimally invasive,high fixation-strength and accord with biomechanics characteristics;and with a high rate of bone union,early functional recovery and less complications.

Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of open pelvic fractures associated with anorectal injuries were admitted to Shandong Provincial Hospital and Laigang Hospital,and early emergency treatments of this injury were retrospectively studied.Of these 25 patients,23 were male and the remaining 2 were female,and the mean age was 30.1±10.9 years (range,16-56 years).Fisher's exact test and multivariate logistic regression analyses were used to determine the risk factors related to mortality caused by this injury.Results Of the 25 patients,19 survived,other 6 patients were dead.The overall mortality was 24%.Fisher's exact test identified that the following risk factors including Tile classification,ISS,GCS and RTS were associated with the injury mortality.Patients with Tile C pelvic fracture ,ISS ≥ 25 points,GCS≤8 points or RTS≤8 points had a high probability of resulting in death.Multivariate logistic regression analysis was performed with the four variables noted above,and the results demonstrated that RTS ≤ 8 points was the only independent risk factor for mortality of patients with this injury.Conclusion Stabilization of hemodynamic condition,aggressive debridement and irrigation of the wound,early diversion of the fecal stream and early stabilization of pelvic fracture are critical strategies for the emergency management of open pelvic fractures associated with anorectal injuries.Furthermore,based on our findings,it can be concluded that RTS≤8 was reliable for predicting the probability of death in patients with this injury.