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.

BACKGROUND: How to evaluate the cervical curvature correctly has been a greatly concern of spine surgeons. In recent studies, cervical curvature index(CCI) and cervical spine angle(C2-7) were often used by foreign researchers.OBJECTIVE: Ishihara method and spine angle(C2-7) method were applied to measure the cervical curvature, and the correlation between the two methods was compared as well.DESIGN: An observational controlled trial based on the patients.SETTING: Department of Orthopaedics of Peking Union Medical College Hospital.PARTICIPANIS: Totally 63 cases including 34 male and 29 female patients with cervical spondylopathy were involved in the Department of Orthopaedics of Peking Union Medical Clooefe Hospital from July 2002 to July 2003.METHODS: The 63 cervical spondylopathy patients' cervical spine lateral X-ray films were evaluated.MAIN OUTCOME MEASURES: Main outcomes: ① The patients' CCI and the cervical spine angle; ② Relationship between their CCI and the cervical spine angle. Secondary outcomes: ① Regressive equation derived from their CCI and the cervical spine angle; ② Comparison of CCI and the cervical spine angle between male and female. RESULTS: The CCI(Ishihara method) was averaged 10. 1 (SD, 11.6), and the cervical spine angle(C2 -7) 17. 5 °(SD, 13.5). A highly significant correlation was found between the two indexes( P＜0.01). Sex and age factors were found to be irrelevant to them.CONCLUSION: The CCI (Ishihara method) and the cervical spine angle (C2-7) are significantly correlated with each other.

BACKGROUND: Measurement is frequently performed in diagnosis of orthopedics, and involved in various correction andtreatment of congenital and acquired deformity. The perioperative measurement of affected knees of patients undergoing totalknee replacement (TKR) is significant.OBJECTIVE: To clinically evaluate and validate 4 domains of a self-designed simple medical orthopedics tool measurementapparatus (OTMA) according to the results of Cybex Norm measurement system, an international standard measurementapparatus, for osteoarthritis patients during TKR.DESIGN, TIME AND SETTING: Stratified, randomized, Controlled experiment. The study was performed at the Department ofOrthopedics, Peking Union Medical College Hospital between October 2004 and March 2006.PARTICIPANTS: A total of 47 patients (66 knees) with osteoarthritis of knee, undergoing TKR, were selected and randomlydivided into 2 groups: OTMA group (n=24, 33 knees) and Cybex group (n=23, 33 knees).METHODS: Range of motion (ROM) of two groups was measured respectively using OTMA and Cybex Norm, before and 3months after treatment as well as the final time of 1-year follow up. The ROM results were evaluated by Hospital for SpecialSurgery Knee Score (HSS) scale for knee joint. The visual analog scale and MOS 36-item Short Form Health Survey (SF-36)scale were filled to verify the applicability and reproducibility of OTMA. The correlation of measurement results and subjectivescale evaluation was analyzed to verify the evaluation efficiency of OTMA.MAIN OUTCOME MEASURES: Coincidence of ROM of two groups at different time points; correlation of scale scores and ROM.RESULTS: All patients were followed up. The coincidence rate of measurements between OTMA and Cybex Norm was 98.3%,HSS scale scores were increased with increasing ROM in both groups (P < 0.01). Correlation analysis showed that ROM washighly correlated with scale results, consistent with the clinical manifestation of patients.CONCLUSION: The measurement process was accepted by all patients, and could be performed repetitively. OTMA displaysprecise measurement, which could reflect clinical symptoms of patients and assist clinical diagnosis.

Objective To evaluate the clinical results and safety of pedicle screw fixation for the treatment of spinal disorders. Methods From January 1988 to December 1999, 475 patients (216 males amd 259 females) with an average age of 49.1 years old in the male and an average age of 48.7 years old in the female, underwent pedicle screw fixation for spinal disorders. Diagnoses included 217 cases of spondylolisthesis, 76 lumbar stenosis, 32 degenerative lumbar spine instability, 72 thoracic or lumbar spine fractures, 60 scoliosis, and 18 others. The instrumentations were as follows: Dick 55 cases, Steffee 79 cases, CD 54 cases, RF 82 cases, DRFS 59 cases, TSRH 29 cases, USS 19 cases, SOCON 44 cases, Dynalock 24 cases, Diapson 22 cases, Tenor 5 cases, and CDH 3 cases. The fusion ranges involved one segment in 310 cases, two segments in 96 cases, and three segments in 9 cases. Hooks were applied in 60 cases. Results Four hundreds and twenty eight patients(90.l%) were followed up for (6.0?3.7)years. In the patients of degenerative spondylolisthesis, spondylolysis, lumbar stenosis, degenerative lumbar instability and thoracolumbar fracture, the amelioration of nerve function was 79.9%, 87.9%, 77.0%, 89.3%and 62.7%; the improvement of spinal motion was 90.5%, 90.9%, 83.6%, 92.9%and 52.5%; the amelioration of low back pain was 89.9%, 87.9%, 85.2%, 89.3%and 84.8%; and the amelioration of leg pain was 93.9%, 90.9%, 93.4%, 92.9%and 79.7%respectively. The mean reduction rate of degenerative spondylolisthesis, spondylolysis and spinal fracture was 90.5%, 87.9%and 91.5%respectively. The SOCON technique showed the highest reduction rate of an average of 92.3%, followed by RF of 90.8%, and Dick, Steffee and DRFS of 81.2%, while other instrumentations showed no satisfactory result in reduction. Complications occurred in 90 cases, in which 26 cases occurred during operation with the incidence of 6.1%, while 64 occurred after operation with the incidence of 15.0%. Conclusion Pedicle screws provide fixation of short segments with satisfactory clinical results and relatively high fusion rate. Perfect surgical technique is the key to reduce the incidence of complications.

Obiective To evaluate the value of allograft bone for acetab ular and femoral reconstruction in THA revision surgery. Methods A total of 19 p atients underwent reconstruction of acetabular and proximal femoral bone defects from June 1996 to December 2000 were reviewed. Eleven of the patients were men and 8 women with a mean age of 66.5 years and 63.2 years respectively at the t ime of resision surgery. According to AAOS system, the acetabular bone defects w ere classified into type I in 2 hips, type II 10 hips and type III 4 hips, and o n the femoral side, there were type I in 3 hips, type II 11 hips and type III 2 hips respectively. The reconstruction of bone defect of acetabulum included stru ctural allograft in 3 hips, impacted morselized allograft in 3 hips, and metal w ire mesh with morselized allograft in 3 hips. In all 3 of femoral segemental def ects, the reconstructions of the proximal femoral bone defects were done with st ructural allografts. Metalwire mesh with morselized allograft for femoral bone d efects were performed in 2 cases and morselized allogratts alone for femoral bon e defects in 4 cases; both acetabular and femoral bone defects were reconstruct ed with impacted morselized allografts in 6 cases (7 hips), and 4 patients with no bone grafts; Harris score system and radiograph were used for the final eva luation. Results Ninteen patients were followed up for an average period of 46 m onths (ranges, 6 to 68 months), Harris score improved from 42.7 points pre rev ision to 82.7 points at final follow up, the incorporation of allografts bone in 15 patients (16 hips) were noticed radiographically in all but one hip was fo und reabsorption of the structural allograft and radiolucents were found in the other 3 patients. No infection was encountered in this series. Conclusion If th e different types of bone defects were properly identified and suitable allogrft s adopted, reconstruction of bone defects with allografts during the THA revisi on surgery is a useful and reliable method. [

Objective To evaluate the standing bending, traction and fulcrum bending radiographies in the prediction of scoliosis correction. Methods 27 patients with thoracic scoliosis with an average of 16.4 years old were selected for the evaluation. All the patients were treated with the posterior correction and bone grafting fusion, and fixed with the third generation system of the segmental vertebral fixation, such as TSRH, CD, or CD+Horizon. Measurement of the Cobbs angle was carried out in the preoperative posterior anterior radiographies with the natural position, standing bending, traction and fulcrum bending and in the postoperative posterior anterior radiographies. Results Mean of Cobbs angle at the thoracic curve after operation was 31 degrees, which decreased significantly in comparison with the preoperative data. Average correction rate was 51.6%. The postoperative Cobbs angle at the thoracic curve was positively correlated with the preoperative Cobbs angle in the standing bending, traction and fulcrum bending radiographies. It was significantly different from the preoperative Cobbs angle in the standing bending and traction radiographies, while no difference was seen with the fulcrum bending radiography. Conclusion The fulcrum radiography can be used to evaluate the flexibility of the thoracic scoliosis, and is better than the standing bending and traction radiographies. The three methods should be used together for the analysis of the scoliosis to predict the result of the scoliosis correction.