BACKGROUND: Routine magnetic resonance imaging(MRI)scans can comparatively show intra-articular soft tissue structures,but there are still some limitations in the diagnosis of intra-articular lesions and injury due to deficiency in contrast of imaging.Enhanced MRI scan has been applied to the liver,brain and other parts,which effectively improves the diagnostic accuracy,but there are few reports on the enhanced scans of knee.OBJECTIVE: To evaluate clinical application value of MRI enhancement pattern in diagnosis of knee injury.METHODS: Totally 21 patients with knee injury(22 knees)were routinely scanned by 0.5T Signa Contour MRI scanner(GE company,USA).Then enhancer was injected into knee joint by the same physician and MRI enhancement pattern was performed in these patients.Film-reading and comparison were completed by two associate chief physicians.RESULTS AND CONCLUSION: Different levels of joint structural damage,such as bone,meniscus,ligaments,and articular cartilage and so on,were found in all patients by routine MRI scan.The extent and scope of its damage had been more clearly displayed by enhanced MRI scan.Meanwhile,misdiagnosis of meniscal injury by routine MRI scan was confirmed by enhanced MRI scan in 2 patients.Some damaged parts that were not found by routine MRI scan were Confirmed by enhanced MRI scan.All these demonstrated that positive rate of knee injury in MRI enhancement pattern was higher than conventional MRI scan.There was significant difference in meniscus injury between two patterns(P = 0.035).MRI enhancement pattern in comparison with conventional MRI can further improve the diagnostic accuracy rate of knee injury.

Objective To evaluate the clinical therapeutic effectiveness of Ilizarov technique for the treatment of congenital brachymetatarsia.Methods We retrospectively analyzed the 5 patients who had been treated in our department for congenital brachymetatarsia (12 metatarsal bones in 10 feet) from January 2008 to January 2011.All of them were female,aged from 22 to 26 years (mean,24.2 years).All cases were bilaterally involved.Three of them suffered from bilateral brachymetatarsia of the first metatarsal bone,one from bilateral brachymetatarsia of the fourth metatarsal bone,and the other one from bilateral brachymetatarsia of the first and fourth metatarsal bones.Bone transport was conducted with a monolateral mini-fixator in 3 patients and with a modified semi-ring Ilizarov fixator in the other 2.Dorsal incision was used for all osteotomy before the external fixator was mounted.Bone transport began 7 days after surgery at a rate of 0.3 mm/d and was completed in 3 times.Results The 5 patients were followed up from 12 to 48 months (mean,22.0 months).The metatarsal bones were lengthened by 13.5 mm(12 to 17 mm) on average.The functions of the toe and ankle joint were normal without skin necrosis,vascular or nerve injury,tylosis of the footplate,or walking pain.The lengthened segments were mineralized well,with an average lengthening index of 48 d/cm(45 to 53 d/cm) and average time of external fixation of 64.8 days.At the last follow-up,the average AOFAS score was 92.2 points (90 to 95 points).Conclusions Although the Ilizarov technique necessitates a patient's prolonged fixation with an external fixator in the treatment of congenital brachymetatarsia,it has advantages of simplicity,minimal invasion,and satisfactory correction of brachymetatarsia.Consequently it is a good treatment for this disease.

Objective To investigate outcomes of different surgical approaches for treating cases of fracture and dislocation of the lower cervical spine.Methods The study involved 26 cases of fracture and dislocation of the lower cervical spine treated surgically from December 2002 to January 2012,including 19 males and 7 females with age ranging from 27 to 62 years (average 39 years).According to the AO classification,there were 12 cases of type B3.1,three of type B3.2,two of type C2.1,three of type C3.1,and six of type C3.2.Preoperative spinal cord function graded by Frankel criteria was six cases of grade A,five of grade B,seven of grade C,six of grade D,and two of grade E.Conventional skull traction was done for all patients before operation.Vertebral cannal decompression and interbody fusion through anterior,posterior or anterior-posterior approaches were determined according to type of fracture dislocation and severity of spinal cord injury.Radiography was performed regularly after operation to review the correction of dislocation,restoration of vertebral height,and interbody fusion.Spinal cord function was also evaluated postoperatively.Results No large blood vessel injury or aggravation of spinal cord injury occurred intraoperatively.There were no complications of incision infection,leakage of cerebrospinal fluid,herniation of bone graft or implant breakage postoperatively.All cases obtained successful correction of fracture and dislocation of the lower cervical spine as well as the recovery of cervical sequence,physiological curvature,and vertebral height in the 12 to 24 months of follow-up (average 16 months).Bony fusion was obtained for all cases at postoperative 3-6 months (average 3.5 months).Spinal function evaluated by Frankel criteria at the latest follow-up showed was grade A in six cases,grade B in three,grade C in five,grade D in five and grade E in seven,with different degree of improvement for all cases.Conclusions Operative approaches should be selected according to the specific status of fracture and dislocation of the lower cervical spine.Anterior approach can be performed for vertebral or intervertebral disc injury straightly and the procedure handles cervical instability immediately.Posterior surgical approach can be used to settle dislocation and interlocking of the articular process directly,but the intervertebral disc injury should be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process.Combined anterior and posterior surgical approach can be applied to treat fracture and dislocation of lower cervical spine and intervertebral disc injury concurrently but has high risk and large operation wound.

Objective To describe a new technique with mini-open reconstruction of lateral ligaments of ankle with partial tendon of its peroneus brevis and evaluate its effect in treatment of chronic lateral ankle instability. Methods A total of 11 cases of chronic lateral ankle instability;at mean age of 27.6 years(16-42 years),were treated with mini-open reconstruction of the lateral ligaments of the ankle with partial tendon of its peroneus brevis.The mean delay between the initial episode of ankle sprain and the surgery was 10.3 months(4-32 months).Postoperatively,all cases were examined with MRI,stress X-rays and comparative stability of bilateral ankle inspection at clinical follow-up.The function of the ankle were evaluated bv American Orthopaedic Foot & Ankle Society (AOFAS)score and ankle-hind foot scale. Results The average duration of follow-up was 17.5 months(12-37 months).The mean AOFAS ankle-hindfoot score was 88.3 points(72-96 points)at the time of the latest follow-up,including excellent result in 6 cases(55%),good in 4(36%)and fair in 1(9%).MRI results showed that the ruptured lateral collateral ligaments of the ankle were repaired and remodeled very well in all patients.There was no recurrence of the ankle instability or other complications. Conclusion Mini-open reconstruction of the lateral ligaments of ankle with partial tendon of its peroneus brevis is safe and effective for treatment of chronic lateral ankle instability.

Background It is well known that diabetic retinopathy(DR) involves in complex pathogenesis.Worse outcome of brain ischemia with hyperglycemia is mediated by mitogen-activated protein kinases (MAPK).However,the effect of phosphorylation of MAPK signal pathway on DR needs further investigation.Objective This study was to explore the the possible role of extracellular signal-regulated kinase1/2(ERK1/2)in DR.Methods Sixty SPF SD rats aged 8-weeks were grouped into the control group and diabetes group.Diabetic models were established by intraperitoneal injection of streptozotocin (STZ) (60 mg/kg) dissolved in citric acid buffer.Blood glucose level was more than 16.7 mmol/L were used as the diabetic group.The equivalent amount of citric acid buffer was injected in the same way in the rats of the control group.The rats were sacrificed and retinas were isolated in 4 weeks and 12 weeks after modeling.The morphology of rat retinas was examined by hematoxylin and eosin staining.The relative expression levels of phosphorylated-ERK1/2 and glial fibrillary acidic protein (GFAP)(absorption,A value) in rat retinas were detected by immunohistochemistry.Results Blood glucose levels of rats were significantly higher than those in the diabetic group compared with the control group at both 4 and 12 weeks after modeling(t=14.174,13.771,both at P＜0.05).In addition,the body weight was significantly lower and the drinking was much more in the rats of the diabetic group in comparison with the control group in 12 weeks(t=8.670,18.725,both at P＜0.05).Twelve weeks after modeling,the decrease of retinal thickness,swelling of outer plexiform layer and decline of number of retinal ganglion cells,rods and cones were seen under the optical microscope.The relative expression levels of GFAP in the retinas were 3 197.1 ±13.1 and 7 202.0±56.8 in the diabetic group at the 4 and 12 weeks,which were significantly higher than those in the control group (2 152.8 ± 16.1 and 2 337.0±8.6) (t =6.327,16.417,both at P＜0.05).In 12 weeks after modeling,the relative expression level of phosphorylated-ERK 1/2 was significantly higher in the diabetic group compared with the control group (2 850.6±2.4 versus 1 274.6± 1.3),showing a significant difference between them (t =12.771,P ＜ 0.05).Conclusions Phosphorylation of ERK1/2 signal transduction pathway is involved in the STZ-induced DR through mediating the activation of Müller cells and inducing the apoptosis of photoreceptor and ganglione cells.

BACKGROUND: Conventional hemodialysis mainly for cleaning uremic micro molecule substance, such as urea nitrogen or creatinine; however, few hemodialyses can clean uremic middle molecule substances (MMS). With prolonged dialysis duration, MMS accumulates in vivo and induces a series of complications. OBJECTIVE: To compare the efficiency of adsorptive dialysis (hemoperfusion unites hemodialysis) and conventional hemodialysis in cleaning uremic MMS. METHODS: Totally 60 maintenance hemodialysis patients were averagely divided into the adsorptive dialysis group and conventional hemodialysis group. First of all, hemoperfusion apparatus and dialyser were connected in series to take the adsorptive dialysis in the adsorptive dialysis group (hemoperfusion apparatus were equipped before dialyser). 120 minutes later, the hemoperfusion apparatus was toke off and continues to hemodialysis for 120 minutes. Duration of conventional hemodialysis was 240 minutes. Changes in clinical symptoms and levels of liver function, kidney function, serum electrolytes, hemocytes and uremic MMS were observed prior to and after treatment. RESULTS AND CONCLUSION: Adsorptive dialysis could remove the MMS notably. Compared with the conventional hemodialysis group, a single 120 minutes treatment could decrease MMS significantly (P < 0.05). The platelet levels were obviously decreased in the adsorptive dialysis group after treatment (P < 0.05), which were significantly different from the conventional hemodialysis group (P < 0.05). There was no significant difference in liver function, kidney function or serum electrolytes concentration. But related symptoms, such as the skin itch, sleep disorders and myalgia, were relieved more or less.

Objective To introduce a new modified Bristow operation with mini-open incision and evaluate jts clinical outcomes in treatment of recurrent anteroinferior shoulder dislocation. Methods A total of 11 patients with recurrent anteroinferior shoulder dislocation were treated with modified Bristow op-eration with mini-open incision.The anterior skin incision with 3-5 mm was made to explore the coracoid process with"moving window"technique.Then.the coracoid process and its short head of biceps were os-teotornjed.transferred and fixed on the anteroinferior potion of scapular neck through the rotator cuff inter-space.All patients were followed up for an average period of 15.8 months(6-48 months)by using modified Rowe score. Results The average operation time was 45 minutes(40-65 minutes).The modified Rowe 8core ranged from 80 to 95 points.excellent in all patients, with SUCCESS rate of 100% and without any re-currence or complication. Conclusions Compared with traditional operation.the modified Bristow oper-ation has smaller incision,less trauma.shorter operation duration and better clinical results.

Objective To evaluate the clinical results of proximal humeral internal locking sys-tem(PHILOS)self-locking plates in treatment of proximal humeral fractures. Methods There were 35 patients including 19 males and 16 females(at mean age of 53.5 years,ranging from 29 to 92 years)with proximal humeral fractures treated with PHILOS plate.According to the Neer's classification sys-tem,there were two-part fractures in 19 patients,three-part fractures in 15 and four-part fractures in 1.Surgery was performed with PHILOS serf-locking plate via dehopectoral approach.All patients were fol-lowed up for mean 18.9 months(6-46 months)and evaluated by using Constant score and X-rays. Re-suits X-rays proved that all fractures got good reduction and complete healing during 8-12 weeks.The latest Constant scores was mean 89.5 points(82-94 points).There were no complications including plate loosing.humenral head necrosis or gleno-humeral ioint osteoarthritis. Conclusion PHILOS plate is a good choice for treatment of proximal humeral fractures because of its advantages including easy operation,stable fixation,good clinical results and few complications.

Objective To investigate the clinical outcome of arthroscopic percutaneous cannulated screw fixation with subtalar fusion in the treatment of post-traumatic subtalar arthritis. Methods The study involved 12 patients (five males and seven females) with severe post-traumatic subtalar arthritis admitted to our hospital from April 2006 to December 2009. The patients were at age range of 28-68 years ( mean 45.6 years). All patients had the history of conservative treatment but failed in pain alleviation.Then, the percutaneous cannulated screw fixation plus subtalar fusion was selected. The ande and hind foot of all patients were evaluated preoperatively and postoperatively by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Imaging assessment was carried out by X-ray examination.Results The patients were followed up for mean 21.2 months (range 6-48 months), which showed thatthe mean AOFAS ankle-hindfoot scale was increased from (54.67 ± 5.28 ) points (range 43-61 points)preoperatively to (89.17 ±3.56) points (range 78-95 points) at final follow-up, with excellence rate of 93%. Eleven patients got good fusion with the mean time of 12.4 weeks (range 9-15 weeks). Only one patient had nonunion, with the pain in the lateral malleolus. The subtalar joint of the patient got union after plaster immobilization for three months, which was proved by X-ray examination. Conclusions The arthroscopic percutaneous cannulated screw fixation and subtalar fusion can acquire good clinical outcomes and hence is a recommended procedure for post-traumatic subtalar arthritis.

OBJECTIVE: To examine the biomechanical effect of lumbar discectomy and disc replacement on compressive load in proximal adjacent segment, to understand the characteristics of the prosthesis and effects in spine after artificial disc replacement (ADR), and to evaluate long-term clinical effect in adjacent segments. METHODS: Complete human cadaveric ligamentous lumbar spine specimens were used to make 3 models: an intact sample, a discectomy sample, and a sample of ADR after the discectomy. The compressive load in proximal segment above the injury segment was measured separately in various loading cases on the 3 models. RESULTS: The changes of intervertebral loads in the adjacent segments made the compressive load increase in the proximal segment after the discectomy. The compressive load in the proximal segment was lower in the ADR group than that in the injury group. There was no significant difference between the ADR group and intact group. CONCLUSION Discectomy increases the compressive load in the proximal segment, while ADR reduces it, showing the same compressive load level with the intact model in the proximal segment. Changes of compressive loading in adjacent level segments after discectomy and ADR, may be the cause of abnormal stress distribution and movements of adjacent segments, and be of benefit for the disc replacement.
Adult ; Biomechanical Phenomena ; Cadaver ; Diskectomy ; methods ; Humans ; Intervertebral Disc ; surgery ; Lumbar Vertebrae ; physiology ; surgery ; Models, Biological ; Prosthesis Implantation ; Weight-Bearing ; physiology