Objective To describe the surgical technique of arthroscopic reconstruction of anterior cruciate ligament with quadrupled stranded semitendinosus tendon and suture plate, and to review the short term outcome of its clinical application. Methods Fifty one cases of chronic anterior cruciate ligament ruptures were reconstructed arthroscopically with quadrupled stranded semitendinosus tendon. During the operation the harvested semitendinosus tendon was cut into two segments of equal length, and then folded to four strands. The proximal end of the graft was fixed to a small plate that lied over the orifice of the femoral tunnel, and the distal end was fixed to a button that covered the orifice of the tibial tunnel. The patients were followed up for 12-24 months and were rehabilitated according to a special plan. The range of motion and stability of the knee, the muscle function of the thigh, the knee function in daily activities, and the ability for running were evaluated periodically. The influence of the combined meniscal and cartilage lesion on the restoration of knee function was also studied. Results The ranges of motion of the injured knee were regained in all cases three months after operation. The quadriceps/hamstrings peak torque ratio reached more than 90% of the uninjured leg two years after operation. The results of KT-1000 examination showed that the anterior stability of the knee after anterior cruciate ligament reconstruction decreased slightly with time, but in 73.8 percent of all cases the anterior stability of the injured knee were equal or better than the uninjured knee. According to Lysholm knee scale score, the average knee score were 56.7?7.4 and 98.5?0.3 respectively before and two years after operation, and the difference was of statistical significance. The average knee score of the group with cartilage lesion was 96.44?2.36, and that without cartilage lesion was 99.47?0.24 two years after operation. The data showed a significant statistical difference between the two groups. The accelerating and decelerating running ability were regained in all cases without limping one year after operation. Conclusion Arthroscopic reconstruction of anterior cruciate ligament with quadrupled stranded semitendinosus tendon and suture plate is a reliable way to restore the knee function. The combined cartilage lesion has an obvious influence on the knee function.

Objective To introduce the rehabilitation methods after arthroscopic reconstruction of the anterior cruciate ligament with quadrupled stranded semitendinosus tendon and suture plate, and to evaluate the clinical outcome. Methods Fifty one cases of the anterior cruciate ligament ruptures were reconstructed arthroscopically with quadrupled stranded semitendinosus tendon and suture plate. The patients were instructed postoperatively for rehabilitation for more than one year. According to Lysholm knee score scale, the knee function score were 56.7?7.4 before surgery. The rehabilitation program included brace immobilization and weight bearing, exercises for muscle strength, range of motion, proprioception, and muscle extension. Through analysis of stability, muscle strength, range of motion and gaits, and through knee scale score evaluation, the applicability and effectiveness of this rehabilitation program were studied. Results The ranges of motion of the operated knee were regained in all cases three months after surgery. The quadriceps/hamstrings peak torque ratio reached approximately 80 percent of the uninjured leg one year after operation. KT 1000 examination showed that the anterior laxity of the operated knee was greater than the normal knee in 11.76 percent and in 10.41 percent of the patients respectively, six and twelve months postoperatively, but the side to side differences were less than 4 mm. In the other patients, the anterior laxity of the operated knee was equal to or less than that of the normal knee. One year after operation, 95.83 percent of the patients regain normal gaits, and the total knee score were 97.8?1.2 according to Lysholm knee score scale. Statistically the difference between the Lysholm score before and one year after operation has prominent significance. Conclusion For the patients after ACL reconstruction, this rehabilitation procedure was practical and effective for the functional restoration of the injured knee as well as the injured leg.

Objective To introduce a method of arthroscopie treatment of purulent knee arthritis, and to evaluate its clinical value. Methods Twenty-seven cases of knee pyarthrosis were treated by de-bridement and subtotal synovectomy under arthroscope and combined with intravenous antibiotics and systematic postoperative rehabilitation. The clinical results were evaluated through examination of the temperature, joint effusion and range of motion of the knee joint. Results The temperature resumed to normal at an average of three postoperative days. All the knees regained the normal extension and more than 120 degree of flexion at six weeks after operation. 85. 2% of the knee flexion function resumed to normal in 3 months. Lysholm knee function score was 89. 4 ? 4. 1 in average and there is a significant statistical difference ( P

Objective To study the clinical outcome of arthroscopic reconstruction of posterior cruciate ligament (PCL) with hamstring tendons and mini-plate and button. Methods From January 1998 to December 2000, 21 cases of PCL ruptures were reconstructed arthroscopically with five to seven strands of hamstring tendons and mini-plate and button. There were 14 males and 7 females aging from 27 to 49 years with the mean age of 36.4 years. All of the patients were free from posterolateral corner ligament injury. The interval from injury to diagnosis was 2.5 months ranging from 2 weeks to 15 months. There were 3 fresh and 18 old injuries. The patients were followed up for more than 12 months and were evaluated for knee function. Results No extension limitation occurred and the flexion degree were more than 120? in all cases 3 months postoperatively. One year after operation, the quadriceps-hamstrings peak torque ratio reached more than 90% of the uninjured leg; posterior drawer test at 70? flexion were negative in all but two cases who had one-degree instability; posterior drawer test at 30? flexion were one degree positive in six cases, and negative in other cases; the Lysholm knee score were 90.7?2.3. Conclusion Arthroscopic reconstruction of PCL with hamstring tendons and mini-plate and button is relatively simple and reliable for the restoration of knee function.

Objective Of all the knee ligament,the anterior cruciate was totally disrupted the most frequently.Although a high degree of success and satisfactory results of replacement of anterior cruciate liga-ment with autograft tendon by arthroscopy were demonstrated,the objective of the investigation was to retro-spectively analyze miscellaneous pitfalls in anterior cruciate ligament reconstruction procedure and present its treatment.Methods Between January1995and June2002,consecutive194male and female patients between thirteen and fifty-eight years of age who sought treatment for a chronic tear of the anterior cruciate ligament were treated by arthroscopic assisted anterior cruciate ligament reconstruction.The time-interval between the index injury and the surgery was from1.5to37months.The diagnosis of anterior cruciate liga-ment injury was established by Lachman test,pivot-shift examination and MRI.The procedures included au-tograft bone-patellar tendon-bone replacement fixed with Kurosaka interference screws in75cases,allograft bone-patellar tendon-bone with Kurosaka interference screws in13cases,autograft bone-patellar tendon-bone fixed with Aesculap Endobutton suture plates in11cases,allograft bone-patellar tendon-bone with Aesculap Endobutton suture plates in6cases,hamstring autografts fixed by Aesculap Endobutton suture plate in89cases.Results There were39intraoperative pitfalls happened in36cases,in which2intraop-erative complications were unsalvageable.The causes of pitfalls could be classified into tunnel,graft materi-als,fixation and other problems.The most common pitfalls were the mistakes of position and direction of guide wires for bone tunnel occurred in8cases.The interference screw was loosened in2cases.Bending of the guide wire happened in3cases.Short and bifurcated of harvested grafts were the most common problem in reconstruction with hamstring autografts and Aesculap Endobutton suture plate technique.In the present,there were no complications of patellar fracture and breakage of reconstructive materials.Conclusion A deep knowledge and technique are necessary to determine and perform in anterior cruciate ligament recon-struction procedure,only if mastering the essentials of different anterior cruciate ligament reconstruction methods and handling flexibly,could an orthopedist cope with miscellaneous pitfalls rightly.

Objective To study the 2-4 years intermediate-term clinical effects of bone-patellar tendon-bone (B-PT-B) autograft plus interface screw method and quadruple semitendinosus tendon autograft plus endobutton plate fixation method in anterior cruciate ligament (ACL) reconstruction after ACL injury and to estimate the correlation of various implants and fixation techniques with clinical effect. Methods A retrospective analysis was done on 104 cases with ACL injury as well as detailed clinical data from October 1998 to October 2000. ACL reconstruction with bone-patellar tendon-bone autograft (PT group) and kurosaka interface screw fixation were performed in 55 cases and quadruple semitendinosus tendon autograft and endobutton plate fixation (ST group) in 49 cases. The average follow up was 38.5 months in the PT group and 35.7 months in the ST group. We compared the intermediate myodynamic recovery, ROM, lachman test, pivot shift test, IKDC score, lysholm score, Werner score and X-ray view of tunnul enlargement between two groups. Results In the PT group, the circumference of thigh was (1.097?0.079) cm, shorter than that of normal side, and (0.896?0.126) cm in the ST group. The cases accounting for 82% (45/55) in the PT group and 88% (43/49) in the ST group had extension limitation less than 3?. Knee flexion limitation of 0?-5? accounted for 87% (48/55) in the PT group and 86% (42/49) in the ST group. Bilateral comparison of Lachman test less than 5 mm accounted for 93% (51/55) in the PT group and 96% (47/49) in the ST group. Negative rate of pivot shift test was 89% (47/55) in the PT group and 92% (45/49) in ST group. Bilateral comparison of AP knee laxity with 20Ib KT-1000 in laxity with less than 3 mm accounted for 53% (29/55) in the PT group and 57% (28/49) in the ST group. Lyoholm score in the PT group was increased from preoperative 69.2?6.4 to postoperative 86.7?4.3 and that in the ST group from 68.3?7.5 to 88.4?8.6. Knee motion standard of IKDC score in the PT group was 78%(43/55), which was found normal or nearly normal, and 82%(40/49) in the ST group. Patellar femoral pain Werner score was 43.0 ?6.1 in the PT group while 45.0?6.3 in the ST group. The X-ray showed that tunnel enlargement phenomena was 53% (29/55) in the PT group while 43% (21/49) in the ST group. Conclusions From 2-4 years intermediate-term follow up, there is no significant difference in ACL reconstruction using patellar tendon autograft plus interface screw method and quadruple semitendinosus tendon plus endobutton plate fixation method. Bone grafting in the donor site can reduce the incidence of anterior knee pain. Twisting technique is beneficial to overcome of the postoperative laxity caused by viscular elasticity of quadruple semitendinosus.

Objective To investigate the correlation between plasma cathepsin L (CatL) levels and establishment of cerebral collateral circulation in acute ischemic stroke patients with cerebral artery stenosis.Methods The patients with acute ischemic stroke with at least one cerebral large artery (including internal carotid artery,middle cerebral artery,vertebral artery,and basilar artery) stenosis ＞ 70％ diagnosed by whole cerebral angiography were enrolled.ASITN/SIR blood flow classification system was used to systematically evaluate the establishment of cerebral collateral circulation.Grade 0-2 was defined as poor collateral branch and 3-4 was defined as good collateral branch,Enzyme linked immunosorbent assay was used to detect the plasma CatL level.Results A total of 79 acute ischemic stroke patients with cerebral artery stenosis were enrolled,including 63 male and 16 female.Their mean age was 58.76 ± 12.24 years old.There were 51 patients (64.56％) in the poor collateral branch group and 28 (35.44％) in the good collateral branch group.There was no significant difference in plasma CatL levels between the good collateral circulation group and the poor collateral circulation group (7.09± 2.27 mg/L vs.8.79±3.53 mg/L;t =2.751,P =0.069).Multivariable logistic regression analysis showed that only the high National Institutes of Health Stroke Scale score was the independent risk factor for poor collateral circulation (odds ratio 0.935,95％ confidence interval 0.823-0.963;P=0.046),and there was no significant independent correlation between plasma CatL levels and collateral circulation (odds ratio 0.910,95％ confidence interval 0.766-1.081;P =0.285).Conclusion There was no significant correlation between plasma CatL levels and cerebral collateral development in acute ischemic stroke patients with cerebral artery stenosis.

OBJECTIVE To study the drug resistance genes in imipenem-resistant Pseudomonas aeruginosa.METHODS Five main drug resistance genes:IMP,VIM,SPM and GIM which are pertinent with metal ?-lactamase and outer membrane protein oprD2 gene were analyzed using PCR method.RESULTS The oprD2 genes in 48 strains of imipenem-resistant P.aeruginosa were negative,and in 14 strains were positive from all 62 strains tested.There were 16 strains with positive IMP type and 5 strains with positive VIM type metal enzyme genes positive,7 metal enzymes producing strains were with negative oprD2 gene.The SPM and GIM metal enzyme genes detected were all negative.CONCLUSIONS The loss of outer membrane protein oprD2 gene is the main mechanism of imipenem resistance in P.aeruginosa in Tai′an area.

Objective To explore effects of sequel recanalization PCI therapy(primary coronary intervention,PCI) on cardiac function for the patients with acute ST segment elevation myocardial infarction(STEMI),and related factors.Methods 116 patients with STEMI enrolled were divided randomly into two groups:sequel recanalization PCI group(58 cases) and conventional PCI group(58 cases),and the patients of sequel recanalization PCI group were fully absorbed for thrombus before conventional PCI,then compared estoration of their cardiac function of the patients of two groups at once and 2 weeks after PCI procedure,respectively.Meantime to study the effect related-factors for cardiac function by Logistic regression analysis.Results There were significant differences between two groups in RESVmax(P =0.03) 、RESVmin(P = 0.00) 、REFmax(P = 0.00)、 REDVmax(P = 0.01) and the ratio of E/A(P =0.02)(all P＜0.05);it showed that the restoration of cardiac function of sequel recanalization PCI group was faster than that of conventional PCI group.If sequel recanalization PCI served as a variable for predicting REFmax being 50%,the results of logistic regression showed that OR(odds ratio) value was 3.47,95% CI(confidence interval) 1.39-9.75,P =0.04.Among other variables,as was time-to-recanalization(OR =4.59,P =0.01);infarct size(OR =4.59,P=0.01);Kiliip grades(OR = 3.99,P =0.02)and age(OR=2.75,P=0.04).Conclusion The sequel recanalization PCI could be better than conventional PCI for the patients with STEMI in restoration of heart function,but there should be some other effective factors.