Progress has been made in the treatment of long bone shaft fra ctures in recent years with its therapeutic focus on the mechanical priorities o f the disorder shifting to the biological ones. ‘Biological internal fixation’ is a new concept. ‘Flexible fixation’ has been recommended to promote forma tion of callus, and precise indirect reduction to reduce operative lesion. Inspi ring results have been achieved in the internal fixation systems and external fi xator which resulted from the clinical application of the new concept. The inter nal fixation systems include interlocking intramedllary nail, point contact fixa tor(PC-Fix), limited contact-dynamic compression plate(LC-DCP), bridging plat e(BP), Less Invasive Stabilization System(LISS), locking compression plate(LCP), and so on.

Spine surgery,one of the most important ramifications in orthopedics,has stemmed from modern medicine,in vivo implantation and biomechanics.Its continuous perfe ction and development have been goin g side by side with advancement of medical s cience,close affiliation of new materials and engineering,and unceasing invention of new techniques.The Chinese Spine Surgery Group of the Chinese Medical Association Orthopedic Society was es-tablished in 1985.Since then great progress has been made in both basic th eory and clinical practice.Chinese surg eons have done a marvelous job in almo st every field of spine surgery,such as treatment and basic research of spin al fracture and dislocation and /or com bined with the spinal cord injury,sp inal infection and neoplasm,and degenerative spine diseases.They have also de-veloped many new techniques and meth ods independently.With increasing communication with both domestic an d international scholars,spine sur gery in China has reached a new level and caught up with the most advanced in the world in some fields.This paper reviews the brief history of Chinese spin e surgery with special reference to th e Chinese Spine Surgery Group,surge ry ap-proaches,internal fixation techni ques,minimally invasive surgery an d basic research. [

It is generally known that postoperative pain can cause many adverse clinical effects on the patients of orthopaedic surgery such as lack of exercises of the involved limb,atrophy of the related muscles,anchylosis,osteoparosis,et al,which will ultimately affect the patient's final recovery and living quality.This paper introduces some recent advanced theories about the orthopaedic postoperative pain diagnosis,evaluation and various kinds of treatments hoping to achieve more effective perioperative analgesia in orthopaedic surgery.

Objective To investigate the characteristics of histopathological changes of osteoarthritic cartilage. Methods The specimens of patellar articular cartilages from 31 knees of 29 patients with osteoarthritis and 2 knees of 2 young adults were studied under transmission electron microscope (TEM) and immunohistochemistry. The ultramicroscopic changes of patellar cartilage and the expression of type Ⅱ collagen in the extracellular matrix were analyzed. Results In Stage Ⅰ, the immunohistochemical staining of type Ⅱcollagen enhanced in all layers of articular cartilage, especially in the superficial layer, the staining was positive, particularly at the peripheral area of chondrocytes. TEM showed broken collagen fibrous networks, more lipid droplets, glycogen and vacuoles in cytoplasm, organelles swelling and increasing. In Stage Ⅱ, the immunohistochemical staining of type Ⅱcollagen increased in the superficial and middle layer of articular cartilage, especially in the chondrocytes around fissures; it was also positive in extracellular matrix, besides, there was irregular nucleus, chromatin concentration and organelles decreasing. In StageⅡ, severe disordered arrangement of collagen fibers, macrolipid droplets and a great number of vacuoles appearing in cytoplasm. In Stage Ⅲ the nuclear pycnosis, cells breaking into numerous fatty debris and forming a micro-scar or an empty lacuna. Index of staining of the immunohistochemical characteristics of type Ⅳ collagen from StageⅠ-Ⅳ were 48.43?11.96, 53.36?10.12, 8.01?3.89, 4.34?2.39 respectively, while in comparison with the normal cartilages, there were significant difference in all stages (P

Objective To analyze the fracture characteristics, operative indicators, complications and treatment results of intertrochanteric fractures of femur in over 80 years old cases. Methods A total of 87 cases (90 hips) of intertrochanteric fractures with mean age over 80 years treated with operative methods from October 1996 to October 2004 were reviewed upon fracture types, preoperative primary diseases, operative methods and postoperative complications. Results The average age was 83.5 years. Of all, 74 cases had different physical diseases included cardiovascular, cerebrovascular, respiratory, digestive system and others (average 2.4 diseases per person). Treatment methods included DHS and intramedullary interlocking nail such as Gamma nail, PFN and reconstructive nails. A follow up for six months in 63 cases showed that excellence rate of functional evaluation was 84%(53/63). Conclusions The full evaluation and treatment of preoperative diseases are the prerequisite for the intertrochanteric fractures in the elderly, for the intertrochanteric fractures in the elderly have high incidence and many preoperative diseases and severe complications.

Objective To determine the best method of revision for failed pedicle screw by investigating the change in maximum insertional torque and axial pullout strength after placing a larger diameter and/or longer screw or augmenting the failed hole with bone shims or PMMA. Methods Six fresh male adult cadaveric spines from T10-L5 were harvested. These specimens, aging from 23 to 51 years with an average of 36.7 years, were divided into six groups: 1)Using a larger diameter screw; 2)Using a longer screw; 3)Using a larger and longer screw; 4)Augmenting with bone shims; 5)Augmenting with PMMA; and 6)Reinsertion after being backed out. The first three groups were subdivided into two groups. Maximum insertional torque and axial pullout strength of each original screw were recorded as control data. Change of maximum insertional torque and axial pullout strength between original and corresponding revision screws were noted. Measurements were analyzed using one-way ANOVA statistically by SPSS10.0. Insertional torque change after simply removing and replacing a 5.0 mm?40 mm screw was also measured. Results Among the changes in pedicle dimensions, the greatest improvement in peak insertional torque and axial pullout strength occurred when using a 2 mm larger and 10 mm longer screw, with an increase of 37.06% and 18.22%; a 2 mm larger screw increased peak insertional torque and axial pullout strength by 20.15% and 19.99% respectively, while a 1 mm larger and 5 mm longer screw increased by 19.23% and 10.07% respectively; use of a 5 mm or 10 mm longer screw decreased peak insertional torque by 32.80% and 14.02% respectively, with axial pullout strength down by 27.36% and up by 43.25% respectively. Use of bone shims caused a decrease of the insertional torque and axial pullout strength by 14.99% and 29.34% respectively. Hole augmentation with PMMA lead to a significant increase in insertional torque but a decrease in axial pullout strength by 37.40%. Simply removing and replacing an original screw resulted in a decrease in insertional torque by 34.22%. Conclusion Revision for pedicle screw is most effective when using a 2 mm larger diameter screw, next by using a 1 mm larger diameter and 5 mm longer screw. Use of a bone shim should be avoided. The efficacy of hole augmentation with PMMA need to be further investigated.

Objective To evaluate the clinical manifestation and operative treatment for the scolio-sis of Marfan syndrome, and analyze its clinical outcomes as well. Methods The retrospective study cov-ered 10 patients including 8 females and 2 males with an average age of 12.9 years (9 to 16 years), who had undergone operations from January 1990 to December 2002. The Cobb's angle in the coronal and sagittal plane, the trunk shift, the apex rotation and shift were evaluated both before and after operation respectively. In the group, there were four cases with family history. Of the 10 cases, the classification of scoliosis was single curve in two cases, double curves in six cases and three curves in two cases. Results All the pa-tients were followed up for a mean time of 15 months, ranged from 4 months to 3 years. The trunk shift changed from the mean distance of 2.17 cm to 1.41 cm. The apex rotation decreased about 1?. The apex shift changed from the mean distance of 4.57 cm to 2.14 cm. The mean Cobb's angle in the coronal plane changed from 88? to 42?. The correction rate was about 46.38% (18.18% to 81.54%). The Cobb's angle on the final follow-up was 46?( 11? to 96?), and the mean lost angle was 4?. The mean Cobb's angle of the thoracic kyphosis was 20?(-10? to 52?) preoperatively and 23?(0? to 35?)postoperatively, and 24?( 0? to 35?) on the final follow-up. The Cobb's angles of the thoracolumbar kyphosis of 5 cases improved from 85? to 10? after operations, and there was no angle loss on the follow-up. Conclusion The three dimensional corrective instrumentation can be used effectively for the correction of the scoliosis of Marfan syndrome. The critical points for the successful operation are the simultaneous correction of the coronal and sagittal plane deformities, prevention of the dural expansion in the lumbar or lumbosacral canal, rigid and multi-segmental internal fixation, extensive and ample bone fusion, and correct external fixation after operation.

Objective To investigate the efficacy of allograft bone in posterior spinal fusion in scoliosis. Methods From March 1995 to March 2000, 60 patients with scoliosis, who underwent posterior spinal instrumentation and fusion using allograft or autograft bone, were evaluated prospectively. All of the patients were randomized into group A (30 cases using only allograft bone) and group B(30 cases using autograft iliac bone).Among the patients in group A, there were 16 with congenital scoliosis, 12 with idiopathic scoliosis, 1 with neurofibromatsis scoliosis and Marfan syndrome respectively. The average age at surgery was 14 years 6 months. the average preoperative major curve was 86.6? with an average number of 8 fused segments (range, 4 to 10 segments). Whereas in group B, there were 15 with congenital scoliosis, 9 with idiopathic scoliosis, 5 with neurofibromtasis scoliosis and 1 with Marfan syndrome. The average age at surgery was 13 years and 8 months. The average preoperative major curve was 77.8? with an average number of 7 fused segments (range, 5 to 10 segments). The mean operative duration, average blood loss, complications and loss of correction between the two groups were analyzed comparatively. Results Each patient had a minimum 2-year follow-up with an average duration of 4 years 5 months. Group A was better than group B by a shorter operative duration, less blood loss. At last follow-up, the major curve measured an average of 44? (range, 31? to 72?) in group A and 41? (range, 24? to 68?) in group B respectively. There were 3 (10%) and 2 (6.7%) pseudoarthrosis occurred in group A and group B respectively. One superficial infection developed in group A. There was no significant difference of the average loss of correction and complication rate between the 2 groups. But there were 6 patients who had donor site pain in group B. Conclusion A satisfactory outcome can be achieved in posterior spinal fusion in scoliosis using allograft bone especially when a large amount of bone graft is needed.

Objective To investigate the changes of the intervertebral angle and retrolisthesis of the last instrumented vertebrae (LIV) after anterior correction and instrumentation in adolescent idiopathic scoliosis patients. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent anterior correction and instrumentation in recent 4 years, their Cobb angle of the curve, correction rate, trunk shift, LIV rotation, obliquity between LIV and the pelvis, intervertebral angle and retrolisthesis of the LIV were measured and analyzed. Results There were total 50 patients included. The apex of the main curve was located at thoracolumbar junction or lumbar spine. The coronal Cobb angle of the main curve were 47.78??9.39? and 10.32??8.50? before and after surgery respectively, with an average correction rate of 79.05%. The average rotation of LIV before surgery was 1.54??0.58?, and improved to 1.06??0.47? after surgery. The obliquity between LIV and the pelvis before and after surgery were 23.80??7.91? and 9.16??9.46? respectively. The intervertebral angle was 3.72??3.05? before surgery, and -2.22??5.85? on Bending films, 1.56??5.97? after surgery respectively. The changes were of significance in the intervertebral angle after surgery compared with that before surgery(P=0.029). The angle was 4.87??7.95? at final follow up, the change was also significant compared with that after surgery(P=0.038). 19 patients had LIV retrolisthesis postoperatively, and the average retrolisthesis distance was (4.79?1.75) mm. There were significant differences between the patients with retrolisthesis and the patients without retrolisthesis in apical vertebral rotation and intervertebral angle on Bending films(P=0.047 and P=0.033) respectively. Conclusion The intervertebral angle is much improved after anterior correction and instrumentation surgery, but it increases gradually at follow up. The retrolisthesis of LIV may be correlated with the apical vertebral rotation before surgery and the intervertebral angle on Bending films.

Objective To analyze the value of three-dimensional computed tomography (CT) reconstruction imaging for the diagnosis and treatment of congenital scoliosis. Methods 76 patients with congenital scoliosis were examined with X-ray of total spine and three-dimensional CT reconstruction, and the results were analyzed. Compared with X-ray film, the findings with the CT imaging were classified into three groups: Group Ⅰ, no supplementary useful information was obtained; Group Ⅱ, further confirmation of findings which were unclear or ambiguous on X-ray film, with improved visualization and comprehension of the type of the deformity; Group Ⅲ, substantial new information was obtained. Results Group Ⅰ: 11 (14.5%) patients, without supplementary useful information obtained with three-dimensional CT reconstruction imaging. The patients aged from 2 to 16 years(11.00?10.09 years), and the Cobb angle ranged from 28? to 102?(55.60??21.06?). Group Ⅱ: 49 (64.5%) patients, with confirmatory finding or improved visualization and comprehension of the previously identified deformities obtained with CT imaging. The 49 patients aged from 4 to 28 years (13.53?4.47 years), and the Cobb angle ranged from 20? to 115? (55.41??23.44?). Group Ⅲ: 16 (21%) patients, with substantial new information obtained with CT reconstruction images which was unrecognized with X-ray film. The patients aged from 6 to 16 years (12.88?2.68 years),and the Cobb angle ranged from 37? to 145?(73.19??28.18?). The difference of age of patients between 3 groups was of no significance (P=0.052), but the difference of Cobb angle between 3 groups was significant statistically (P=0.039). Conclusion Three-dimensional and multiplanar reformatted CT imaging allows better visualization and understanding of the deformities of scoliosis, and supplementary useful information may be obtained which was obscure or unrecognized with X-ray film, especially for patients with severe deformities. Its application in clinical practice may contribute to the diagnosis of the type of deformity and the segments involved, as well as the individualized operative planning.