Objective To summarize the clinical features of chronic ruptured patellar tendon, and introduce the augmentation technique of repair of chronic ruptured patellar tendon with high strength polyester sutures and postoperative rehabilitation.Methods Six cases of chronic patellar tendon rupture were treated and reinforced with high strength polyester sutures from 2002 to 2007.Patellar tendon ruptures was primary end Ho -end repaired, and reinforced with 4 polyester sutures that were passed through in-traosseous tunnels within the patella and tibial tubercle.The surgery reestablished knee extensor continuity and restored the length of patellar tendon.Augmentation techniques were reliable, and allowed patients to walk and bend the knee, regain adequate quadriceps strength early.Postoperative rehabilitation: on the 1st day after surgery, walking upright and passive flexion of 90° was allowed, and brace protection was unnecessary; 3 weeks later, straight leg raise; 6 weeks later, brisk walking; 12 weeks later, squatting and climbing stairs; 6 months later, sports was allowed, including the jump and kick.Results All patients were followed up from 1 to 5 years.No patient sustained a re-rupture.All patients satisfied with their result.The Lysholm score were 100.Kach knee had restored full range of motion 6 months later, and regained adequate quadriceps strength.Conclusion Augmentation techniques with high strength polyester sutures is reliable and demonstrate good intermediate to long-term results.It can avoid re-operation for removal of the cerclage wire, allow patients to walk and bend the knee, regain adequate quadriceps strength early.

Objective To study the difference of transverse incision and longitudinal incision for B-T-B graft harvesting in reconstruction of anterior cruciate ligament.Methods Sixty four cases of reconstruction of anterior cruciate ligament from January 2004 to December 2004 were observed.Transverse incisions were used in 32 cases,and longitudinal incision were chosen in the other 32.The operation time,the length of incision,the thickness of scar,the injury of saphenous nerve and the joint function of knee were compared.Results All patients were followed up more than 1 year.The average duration of surgical procedure with longitudinal incision was 11 minutes shorter than that with transverse incision.The scar of transverse incision is smaller and thinner than that of longitudinal incision.The injury of saphenous nerve and knee joint function of knee revealed no notable difference in the 2 groups.Conclusions Transverse incision for B-T-B graft harvesting in reconstruction of anterior cruciate ligament is a better choice.

Objective To introduce Torg's modified Bristow procedure for recurrent anterior dislocation of the shoulder joint,and to evaluate it's clinical result.Methods 25 shoulders with recurrent anterior dislocation were treated with Torg's modified Bristow procedure from January 2002 to December 2006.Based on history,physical examination and X-ray examination,all the diagnosis were confirmed.The follow-up period ranged from 1 to 5 years,with an average of 3.1 years.Results All the cases had Hillsachs lesions and Bankart lesions.After 2 years,only one shoulder had redislocated and 96% of patients were satisfied with the operative repair.The Rowe standard rating scale:excellent 72%;good 24%;fair 4%;poor 0%.Conclusion Torg's modified Bristow procedure provided a good functional result in patients with recurrent shoulder dislocations.

110?),5 good(90?-109?)and 1 acceptable(60?～89?)and no poor results(

Objective: To compare the effect of double-mirror combined with gallbladder removal and laparoscopic cholecystectomy for gallstones. Methods: From January 2016 to December 2017, 120 patients with gallstones in the Department of Hepatobiliary Surgery of Dongyang People's Hospital were enrolled.The patients were divided into laparoscopic group (n=60) and double-mirror group (n=60) according to the random number table method.Laparoscopic cholecystectomy was performed in the laparoscopic group, and double-mirror (laparoscopic and choledochoscopy) combined with gallstone removal was performed in the double-mirror group.The surgical results of the two procedures were analyzed.Surgical index, postoperative recovery status, postoperative complications and recurrence rate of one year after surgery were observed. Results: The success rate of surgery in both two groups was 100.0%.The operation time of the double-mirror group [(48.2±5.3)min] was significantly longer than that of the laparoscopic group [(41.2±5.8)min](t=6.901, P<0.001). The first exhaust time [(14.3±2.5)h], the first time of getting out of bed [(21.1±3.7)h], and the recovery time of diet [(2.8±0.6)d] in the double-mirror group were significantly shorter than those in the laparoscopic group [(19.2±3.8)h, (25.1±4.8)h, (3.5±0.7)d] (t=8.344, 5.112, 5.881, all P<0.001). There were no statistically significant differences in the amount of bleeding and postoperative hospital stay between the two groups (all P>0.05). The total incidence rate of postoperative complications in the double-mirror group was 3.3%, which was significantly lower than 15.0% in the laparoscopic group (χ²=4.904, P=0.027). In the double-mirror group, the recurrence rate of calculi was 1.7% in 1 year after surgery, which in the laparoscopic group was 0, there was no statistically significant difference between the two groups (χ²=1.008, P=0.315). Conclusion Double-mirror combined with gallbladder stone removal and laparoscopic cholecystectomy can achieve good stone removal effect, the short-term efficacy is similar to long-term efficacy, laparoscopic cholecystectomy has shorter operation time.Double-mirror combined with gallstone removal has advantages in postoperative recovery and lower complications.

OBJECTIVE: To investigate the correlation between serum vitamin D level and clinical outcomes after repair of rotator cuff tears. METHODS: A total 122 patients who met the inclusion criteria and were followed up for 12 months from March 2018 to March 2020 were analyzed retrospectively, including 50 males and 72 females with an average age of(62.10±8.39) years old (ranged, 34 to 82 years old). All patients were divided into deficiency group(vitamin D<20 μg/L) and control group(vitamin D≥20 μg/L), including 62 cases in the deficiency group, with vitamin D (14.80±3.18) μg/L;60 cases in the control group, with vitamin D(25.17±5.64) μg/L. The two groups were compared in terms of age, gender, body mass index(BMI), tear size, degree of retraction, degree of fatty infiltration, injury factors, postoperative pain VAS score, postoperative shoulder joint function score, and re-tear rate. The age of all patients was divided into two categories:<60 years old and ≥60 years old;BMI was divided into <24 kg/m² and ≥ 24 kg/m²;tear size was divided into ≤3 cm and >3 cm;retraction degree was divided into ≤2 cm and >2 cm;fat infiltration was divided into ≤2 grade and >2 grade;and the course of the disease was ≤3 months and >3 months. The correlation between Sugaya re-tear type and the variables listed above were analyzed and calculated. RESULTS: There were no major complications such as joint infection, anchor withdrawal and revision surgery in any of the 122 patients who were followed up on. There were no statistical differences in age, gender, injury factor, BMI, tear size, degree of retraction, degree of fatty infiltration, and duration of disease between the two groups (P>0.05). The Constant-Murley scores, UCLA scores, and ASES scores of the two groups all improved considerably after surgery(P<0.05);however, there was no statistical differences in the postoperative shoulder function scores between the two groups (P>0.05). There was significant difference in VAS between the two groups 1 month and 3 months after operation, with vitamin D deficiency group scoring higher, and there was no significant differences 6 and 12 months after operation. Tear size(>3 cm), degree of retraction(>2 cm), degree of fatty infiltration(>2 degree) were all shown to be the independent risk factors for retear after surgery by Logistic regression analysis(P<0.05). The comparison between the two groups of patients using a 2×5 row list showed that the Sugaya classification of rotator cuff re-tear(grade Ⅰto Ⅴ) between the vitamin D deficiency group and the control group was statistically different(t=14.228, P=0.007). It was discovered that the Sugaya classification after surgery was statistically different between the two groups. CONCLUSION Vitamin D deficiency is not correlated with clinical function scores and re-tear rate, however it is associated with the early postoperative pain (1 and 3 months) and the quality of rotator cuff healing (Sugaya classification) after surgery.
Adult ; Aged ; Aged, 80 and over ; Arthroscopy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rotator Cuff Injuries/surgery* ; Treatment Outcome ; Vitamin D

Objective:To construct the rehabilitation strategy of anterior cruciate ligament reconstruction based on the evidenced method and evaluate the effectiveness in clinic.Methods:The rehabilitation strategy was firstly built based on evidenced method. And then 80 patients from Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital from January to August, 2019 were randomly and equably sent to experiment group and control group. Patients in experiment group or control group were accepted the evidenced method or regular method as treatment strategy, respectively. The visual analogue scale (VAS), thigh circumference, motion range of knee joint and Lysholm score were recorded before and after surgery.Results:Six papers met the inclusion criterion and were been screen out from 1 535 papers, and then the evidenced rehabilitation strategy of anterior cruciate ligament reconstruction was made. The VAS scores in 12 and 24 h were 1(0-2), 1(1-3) in experiment group and 2(1-3), 3(1-3)in control group, the differences were significant between two groups( Z values were 4.955, 6.489, P<0.001). The motion ranges of knee joint in 2, 4, 6, 12 weeks after operation were (61.6±5.1)°, (85.3±6.6)°, (114.6±5.2)°, (127.6±3.4)° in experiment group and(54.9±4.6)°, (71.0±8.8)°, (105.1±5.9)°, (115.8±4.0) °in control group, the differences were significant between two groups( t values were 6.209-14.138, P<0.001). The Lysholm scores at 6,8,12 weeks after operation were 58.8±3.7, 71.1±3.1, 84.3±3.7 in experiment group and 56.0±3.4, 65.4±4.3, 75.6±3.0 in control group, the differences were significant between two groups( t values were 3.511, 6.867, 11.439, P<0.001). Conclusions:This evidenced rehabilitation strategy of anterior cruciate ligament reconstruction in this study was helpful to alleviating the pain, improving motion range of knee joint after anterior cruciate ligament reconstruction.

AIM To develop a sensitive, specific and reliable reversed phase high performance liquid chromatographic method(RP\|HPLC) to determine the total and unbound(free) concentrations in human plasma of amitriptyline and its major metabolite, nortriptyline. METHODS\ The assay involved a simple extraction procedure. The mobile phase consisted of acetonitrile and distilled water(30∶70, V/V ), containing triethylamine(0 5%) and orthophosphoric acid(0 3%), pH 3 1. Separation was achieved on the C18 ODS column and the effluent was measured for UV absorption at 240 nm. RESULTS The calibration curves were linear in the range of 4～400 ?g?L -1 for total concentration, and in the range of 4～64 ?g?L -1 for free concentration for both amitriptyline and nortriptyline. The lowest limits of detection were 4 ?g?L -1 for both compounds. The absolute recovery rates were 102 0%?3 77% for amitriptyline and 99 3%?7 13% for nortriptyline. The precision values(RSD) of intra day and inter day for both amitriptyline and for nortriptyline were determined to be

AIM　To develop a sensitive, specific and reliable reversed-phase high performance liquid chromatographic method(RP-HPLC) to determine the total and unbound(free) concentrations in human plasma of amitriptyline and its major metabolite, nortriptyline. METHODS The assay involved a simple extraction procedure. The mobile phase consisted of acetonitrile and distilled water(30∶70, V/V), containing triethylamine(0.5%) and orthophosphoric acid(0.3%), pH 3.1. Separation was achieved on the C18 ODS column and the effluent was measured for UV absorption at 240 nm. RESULTS　The calibration curves were linear in the range of 4～400 μg*L-1 for total concentration, and in the range of 4～64 μg*L-1 for free concentration for both amitriptyline and nortriptyline. The lowest limits of detection were 4 μg*L-1 for both compounds. The absolute recovery rates were 102.0%±3.77% for amitriptyline and 99.3%±7.13% for nortriptyline. The precision values(RSD) of intra-day and inter-day for both amitriptyline and for nortriptyline were determined to be <5%, and <8%, respectively. The method was applied to determine the total and free concentrations in plasma of the healthy volunteers after a single oral dose of 50 mg amitriptyline. CONCLUSION　The assay was simple, repid, highly selective and sensitive. It is suitable for the routine analysis of total and free drug concentrations in plasma using readily available instruments with lower cost.

Objective To compare the clinical outcomes of anterior cruciate ligament(ACL)reconstruction by using allograft and autograft of patella tendon.Methods From August 2003 to December 2005,82 ACL reconstruction patients were studied retrospectively,including 59 cases using autograft of patellar bone-tendon-bone(BPTB)and 23 cases using BPTB allograft.Physical examination,scores of IKDC,Lysholm-Tegner and VAS as well as KT-2000 measurements were used for evaluation pre-and post-operation.Results 41 autograft and 17 allograft patients were finally followed up.One allograft patient suffered re-rupture of the reconstructed ligament.Positive ADT test were found in 5 autograft and 1 allograft patients and positive Lachman test were found in 3 autograft and 1 allograft patients.No statistically significant differences were revealed in ROM.IKDC,Lysholm-Tegner Score and KT-2000 measurements showed no significant differences between two groups,but VAS for autograft group were significantly higher than allograft group(P