Lumbar fusion is currently the major treatment of lumbar degenerative disease, spinal instability and discogenic disease etc. Transforaminal lumbar interbody fusion (TLIF) is a novel lumbar fusion technique in recent years, and with the progress of minimally invasive spinal surgery, minimally invasive TLIF (mini-TLIF) technique has also got access to rapid development, which has more advantages compared with traditional open TLIF. The authors review the indications and contraindications, surgical method, development and advantages and minimally invasive surgical assistant instruments of mini -TLIF.

[Objective]To explore developmental history of extremity in jury and reconstruction,and to reflect the relationship of modern orthopaedic medical treatment modes to the lire nature and natural law.[Method] The author reviewed the history of organic evolution and 'human evolution,and rank the historical era of life origin,birth of cell and bone architecture,formation and development of bone and joint in living nature and final shape construction of vertebrate and human,and summarized the development of extremity injury and reconstruction after foundation of society via evolutive law.[Result]A scientific and order evolutived series that was not created at natureg please can be seen from origin of life,generation of bone and joint,evolution from high-mammal to human boing.The reason of extremity injury,idea and methods of medical treatment are correlated with the development of seciety civilization,the progress of scientific technique,and change of life style.With the great change of science and technique,life style and idea of human,reasons of extremity injury and orthopaedic diseases have also changed,but the life nature of human being is not changed with them.[Conclusion]Various kinds of techniques and methods that are used to treat trauma and bone disease only accustomize the natural process,rather than excessive intervention.The culture idea of human being,requirement of material and spirit should be developed,and the scientific research of non-protoplasm may break some rules,but the study of life science and medical idea should not disobey natural law and human nature.Suitable techniqus of integrated observation,consolation,nursing and modern techniques are still basic principles of orthopaedic treatment.Nature is forever teacher and origin of medical science.

For the past few years.the number of patients with thoracolumbar fractures increased year after year.With the improvement of surgical instruments and surgical techniques and the health care workers'in-depth study about thoracolumbar fractures,posterior approach treatment of patients with thoracolumbar fractures has achieved an encouraging progress.Now summarization of research progress about operation opportunity,posterior instrumentation and modified posterior surgery is made in this paper.

Many clinical bone nonunion or delayed union often appear in the early stage of bone healing,but they have been always found too lately.Before X-ray films of visual changes indicates salt content inbones reaching 25%,the very early changes ofclinical significance can not be observed.This paper introduces the theory of fracture healing and the definition of bone nonunionand the significance of the basic multicellular unit(BMU)and the OPG-RANKL-RANK system in bone reconstruction.Many technologies such as ultrasonic testing,vibration analysis,mechanical impedance analysis,the bone marrow cavity imaging technologiy,high-resolution CT etc.have been reported in study on the bone,as well as early diagnosis of fracture nonunion.However,the molecular level of early diagnosis is deficiency.

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.

Fractures of the clavicle are common and have been typically addressed to nonoperative treatment.However,to the comminution or complete displacement,there is a marked risk of nonunion,malunion,and poor outcome.Several treatments have been proposed,but there is no consensus about the treatment of choice.This article investigates the most common treatments and tries to find the indications for the treatments,and the new direction for the treatments of fractures of the clavicle.

[Objective]To investigate the characteristics and treatment strategy for fresh high energy fracture dislocation of tarsometatarsal joints in a retrospective study.[Method]From September 2002 to April 2008,43 patients with fresh high energy fracture dislocation of tarsometatarsal joints were treated with cannulated screw combined with Kirschner wire fixation or Kirschner wire fixation alone.There were 35 males and 8 females,with a mean age of 37.5 years(range,18 to 55 years).The injury was caused by a road accident in 15 patients,by a heavy crash in 21 patients,and by a fall from a height in 7 patients.According to the Myerson damage typing,there were 9 cases of type A,2 cases of type of B1,25 cases of type B2,4 cases of type CI and 3 cases of type C2.Eight were open injuries(6 of Gustilo-Anderson type I and 2 of type Ⅱ)and 35 closed injuries.Internal fixation were undertaken at an average of 4.6 days after injury(range,2.5 hours to 21 days).At 4-6 weeks all the patients began functional exercises after removal of the plaster casts.At 16-18 weeks all the patients began to walk with partial weigh loading after removal of the internal fixators.[Result]All the 43 patients were followed up for 26 months on average(range,13 to 38 months).No infection,breakage,loosening of internal fixator,nonunion or longitudinal arch collapse was found.According to ZHOU'S assay standard.excellent result was achieved in 26 cases,good in 14 cases,and fair in 3 cases,with excellent to good results of 95.3%.Six patients had post-traumatic arthritis,which was complicated with injured articular surface.[Conclusion]Fresh high-energy fracture dislocation of tarsometatarsal joints can be diagnozed correctly.Early diagnosis and correct classification,proper operation timing,anatomical reduction,rational internal and external fixation and timely functional training are essential for patients to achieve good clinical result.

[Objective]To observe clinical value of multi-slice spiral X-ray computed tomography(MSCT)volume rendering technique(VRT)and multi-planar reconstruction(MPR)in classification and treatment of tibial plateau fracture(TPF).[Method]From August 2005 to February 2009,49 fratures in 45 patients with TPF were treated.Their clinical data were studied retrospectively.There were 32 males and 13 females.The patients were aged from 20-65 years(mean 46 years).Four patients suffered bilateral TPF.All patients were examined with standard X-rays and 64-slice spiral CT scanner.Axial CT scans were processed with VRT and MPR.Their X-ray plain films and 64-slice spiral CT seans(including VRT and MPR)were performed to determine their fracture types and protocol.[Result]According to the VRT and MPR findings,13 fractures(13/49)classified by X-ray plain film were corrected,protocols were changed for 9 fractures(9/49),and 15 fractures(46.9%)of intereondylar eminence of the tibia and 6 fractures(28.6%)of proximal fibula were underdiagnozed.[Conclusion]MSCT(VRT+MPR)can clearly show the area and degree of tibial plateau collapse,the details of TPF and the delitescence fracture,help to determine TPF types,decrease the underdiagnosis rate and choose a rational protocol.The use of combined VRT and MPR is a supplementary means for X-ray plain film and axial CT scanning.which has great clinical value.

Iatrogenic vertebral artery injury is a rare complication in cervical spine surgeries,the consequences of which may be catastrophic.With the extensive development of cervical spine surgeries and application of diverse new internal fixations of cervical spine,there is a potential increase of risk of iatrogenic vertebral artery injury,which should be paid attention to.This article reviews the rate,cause and management etc.of iarogenic vertebral artery injury.

[Objective] To investigate the effects of pyrroloquinoline quinine (PQQ) on proliferation and expression of NF - kB of Schwann cells. [Methods] Schwann cells were cultured from sciatic nerves of SD rats in vitro. The Schwann cells were identified and purified by immunofluorescence of S-100 and Ara-C. Experimental group with was 100 nmol/L of PQQ and control group were set up. The expression of NF-kB in Schwann cells was determined by RT-PCR and Western blotting. [ Results] The expression of NF - kB were up - ragulated by PQQ in cultured Schwann cells (P<0.05).[Conclusion ] PQQ could promote the proliferation of Schwann cells and up-regulation of NF-rd3 play an important role in this process.