[Objective]To explore the operating methods and rudimental clinical effects of reconstruction of anterior cruciate ligament(ACL) with the ligament advancement reinforcement system(LARS) artificial ligaments under arthroscope.[Method]Since June of 2006,15 patients(11 males and 4 females,with an average age of 26.8 years)with acute ACL rupture have been treated with the LARS artificial ligaments.The results of preoperative Arto-scan of all patients suggested discontinuation of ACL.The average score of Lysholm on knee joint was 50 points.The operations were completed under arthroscope.Bone tunnels of the femur were located at the central point of arc on the medial surface of ectocondyle of 140 degree.Bone tunnels of tibia were located between the medial and lateral condyle on the tibial plateau、2-4 mm to summit line of fossa intercondylica.The diameter of the bone tunnels was 7.5 mm while that of LARS ligament and hollow crushing screw were 8 mm.[Result]All 15 patients were available for follow-up with an average of 18 months.No postoperative complications such as infection,ligament rupture,ligament loosening occurred.The clinical results were graded as being excellent in 8 patients,good in 5 and fair in 2 according to the Lysholm's classification.The excellent and good rate was 86.6%.[Conclusion]The anatomical reconstruction and the stability of the knee joint can be obtained after ACL reconstruction with LARS artificial ligaments.The operation under arthroscope has advantages of less-injury,rapid recovery and satisfactory curative effect.

Objective To study the mechanism and difference of fractured vertebral body’ s prevertebral height recovery following different methods of reduction. Methods A L 1 compressed fracture model was produced by modified Gepstein method with wet human spinal specimens(T11-L 3); the model was reduced by hyperextension, longitudinal extension and device reduction respectively. The measured parameters including the changes of prevertebral height, the changes of anterior longitudinal ligament strain and the changes of vertebral disc’ s height; segments including upward and downward of the fractured vertebral bodies were observed. Results The prevertebral height recovery platform stage happened in all the three methods of reduction. There is no significant difference between the prevertebral heights in the maximum experimental load; the prevertebral height increased first and stayed stationary later in the hyperextension reduction procedure; in the device reduction process, the prevertebral height stayed stationary at first and dereased later. Conclusion The prevertebral heights increase is not unlimited between different reduction process of L 1 fracture, and it is limited by spinal anatomy on the late phase of reduction. Knowing these features is useful for us to treat the patients and improve the devices.

BACKGROUND:Recent studies indicate that osteolysis surrounding prosthesis is the main reason causing artificial joint loosening.The reason and development process of osteolysis surrounding prosthesis are not fully understood.OBJECTIVE:To observe the pathological changes of limiting membrane surrounding sterile loosened prosthesis of artificial hip ioint and compare that with cicatricial tissue surrounding internal fixation.DESIGN,TIME AND SETTING:Histological observation was done at The Second Hospital of Soochow University between September 2000 and December 2005.PARTICIPANTS:Limiting membrane surrounding prosthesis of eight artificial hip joints overhauled for loosening were removed during operation for pathological examination.METHODS:Specimens were fixed with 10%formaldehyde solution and embedded with paraffin,and were cut into sections,the sections were stained by hematoxylin-eosin(HE)staining and immunohistochemistry staining.The specimens were done bacterial culture.MAIN OUTCOME MEASURES:Histopathological changes.RESULTS:Wear particles,cellular proliferation and osteolytic factors were found in the limiting membrane surrounding loosening prosthesis.The bacterial culture results of the specimens were negative.CONCLUSION:Wear particles generated in the using process of prosthesis can activate osteolytic factors produced by inflammatory cells and is an important reason leading to sterile loosening of prosthesis.

OBJECTIVE:To optimize the methanol extraction technology of tripterine in the fruit of Celastrus monospermus. METHODS:HPLC was adopted to determine the content of tripterine. Using extraction time,extraction times,solid-liquid ratio as investigation factors,extraction rate of tripterine as investigation index,orthogonal test was designed,and verification test was con-ducted. RESULTS:The optimal methanol extraction technology was as follow as 45% methanol extracting 2 h each time with sol-id-liquid ratio of 1:8 for 3 times. In the verification test,the average extraction rate of tripterine was 0.917 mg/g(RSD=2.85%, n=3). CONCLUSIONS:The optimized methanol extraction technology is stable and feasible with high extraction rate,and is suit-able for the extraction of tripterine in the fruit of C. monospermus.

Objective To evaluate the incidence of and risk factors for syphilis seroconversion amomg drug addicts during methadone maintenance treatment (MMT).Methods A retrospective study was performed on drug addicts receiving MMT at MMT clinics in Maanshan,who were seronegative for syphilis before the treatment and followed up by serological tests for syphilis for more than two years.The incidence of and risk factors for syphilis seroconversion during the two years of follow up were analyzed in all the subjects.Results A total of 161 drug addicts were included in this study,of whom,15 experienced seroconversion for syphilis with the average seroconversion rate being 4.66 per 100 person-years.The seroconversion tended to occurr in the early stage of MMT.Both Chi-square analysis and multivariate logistic regression analysis showed that syphilis seroconversion was independently associated with nonuse of condoms during the last sexual behavior before receiving MMT.Conclusions Interventions should be undertaken as early as possible to promote safe sexual behaviors among drug addicts at methadone clinics,and to promote condom use is especially important for blocking sexual transmission of diseases.

Objective To investigate the key points of treating elder patients with hip fractures by hemiarthroplasty.Methods Clinical data of 138 elder patients with hip fractures undergone hemiarthroplasty between January 2008 and December 2010 were analyzed retrospectively.There were 43 males and 95 females at mean age of 82.8 years(range,75-103 years).Injury causes included fall from height(n=98),contusion(n=32)and sprain(n=8).There were 84 patients with femoral neck fractures(33 patients with Garden type Ⅲ,51 with type Ⅳ)and 54 patients with intertrochanteric fractures(three patients of Jensen-Evans type Ⅱ,six with type Ⅲ,25 with type Ⅳ,18 with type V,two with type R).Follow-up evaluation was performed using Harris scoring system.Results The ambulation period was average 4.5 days(range,3-12 days).Follow-up was average 24.4 months(range,10-45 months),which presented no loosening,subsidence or infection of prostheses.Due to additional trauma postoperatively,one patient suffered from prosthesis dislocation and two from fractures of distal prosthetic femoral shaft.Harris score at six months postoperatively was average 86.8 points(range,52-100 points),with excellent results in 42 patients,good in 59,fair in 19 and poor in five,with excellence rate of 80.8％.Conclusion With full accomplishment of peri-,intra-and post-operative measures,hemiarthroplasty is a suitable choice for treating hip fractures in the elderly patients.

Objective To discuss the operation skills and clinical effects of C-arm fluoroscopy in arthroscopic reconstruction of anterior cruciate ligament(ACL)with the Ligament Advancement Reinforcement System(LARS)artificial ligaments.Methods The study involved 36 patients with acute ACL rupture treated with the LARS artificial ligaments from June 2006.There were 25 males and 11 females,at age range of 22-51 years(average 28.3 years),involving 19 left knees and 17 right knees.The results of preoperative MRI of all patients suggested discontinuation of ACL,with average score of Lysholm on knee joint for 50.The operation was completed under arthroscope.While the locations of the femoral tunnel portal and the tibial tunnel exit were mainly determined by the C-arm fluoroscopy.The diameter of the LARS artificial ligament was 7.5 mm while that of the interference screw 8 mm.Results All 36 patients were followed up for a mean duration of 18 months(9-20 months).The average Lysholm Score was 52 preoperatively and 92 at the 12th week after operation.The clinical results were graded as excellent in 23 patients,good in nine and fair in four according to the Lysholm's classification,with excellence rate of 89%.Conclusions Arthroscopic reconstruction of anterior cruciate ligament with LARS artifical ligament under C-arm fluoroscopy takes advantages of convenient operation,accurate location and satisfactory clinical effect.

ObjectiveTo analyze the clinical outcome of locking plate and hemiarthroplasty in treatment of Neer three- and four-part proximal humeral fractures.Methods A totalof 63 consecutive patients aged over 55 years with Neer three- and four-part proximal humeral fractures were treated surgically from June 2006 to June 2010.In the retrospective study,36 patients were treated by open reduction and locking plate fixation ( locking plate fixation group) and 27 patients treated by hemiarthroplasty (hemiarthroplasty group).Clinical outcomes including operation time,blood loss,visual analog scale ( VAS),Constant-Murley score and complications were evaluated.ResultsThe average 19.7 months follow-up showed complication rate of 28％ in the locking plate group,including one patient with varss malunion,one with axillary nerve injury,one with humeral head necrosis,one with heterotopie calcification and four with impingement syndrome.The complication rate was 24％ in the hemiarthroplasty group,including two patients with tuberosity nonunion,one with tuberosity migration,one with impingement syndrome and one with joint semiluxation.The mean Constant-Murley score of three-part fractures in the locking plate group was ( 76.5 ±5.8) points,better than (69.2 ±7.2) points in the hemiarthroplasty group (P ＜0.05 ).While the two groups showed no significant differences with regards to operation time,blood loss and visual analog scale (VAS).As for the four-part fractures,the mean operation time was shorter and the mean blood loss was less in the hemiarthroplasty group compared with the locking plate group (P ＜0.05),while there were no obvious differences in VAS score and Constant-Murley score between the two groups. Conclusions Both locking plate and hemiarthroplasty are the reliable methods for the three- and four-part proximal humeral fractures.The patients' age,bone quality,fracture type,comminution degree and evaluation of osteonecrosis possibility,are critical for surgery decision.

Objective To compare the clinical efficacy of extramedullary fixation system,intramedullary fixation system and hip arthroplasty in treatment of intertrochanteric fractures in the elderly.MethodsThe retrospective study involved 184 patients treated between January 2007 and January 2011,which were assigned to dynamic hip screw (DHS) group (n =99),locking plate group (n =19 ),intramedullary fixation group (n =25) and joint replacement group (n =41 ).There were 80 males and 104 females,at age range of 60-99 years,mean (72.4 ± 3.9) years.According to the modified Evan classification,the fractures included type Ⅰ A in 20 patients,type Ⅰ B in 21,type Ⅱ in 75 and type Ⅲ in 68.The preoperative conditions,postoperative weight-bearing time,fracture heating time,hip function and complications were comparatively studied among four groups.ResultsThe patients were followed up for 7-22 months (mean 12 months).The four groups showed no significant differences regarding the gender,age,fracture types and medical complications.The postoperative weight-bearing time of the joint replacement group was significantly shorter than that of the other three groups,with statistical significance.The fracture healing time was insignificantly different among the four groups.The postoperative complications were found in 24 patients (13％),including 11 patients in the DHS group,six in the locking plate group,five in the intramedullary fixation group and two in the joint replacement group.Harris score was the highest in the joint replacement group,with statistical significance in comparison with the other three groups. ConclusionsIntramedullary fixation should be the treatment of choice for the patients with unstable,or severe osteoporosis fractures and with intolerance of joint replacement.Artificial bipolar femoral head replacement is suitable for the elderly patients with unstable or severe osteoporosis fractures,capability of walk or tolerance of operation.

Objective To investigate the initial effect of LARS artificial ligaments arthroscopically in reconstruction of ipsilateral anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL).Methods A total of 21 patients (13 males and 8 females,at average age of 31.5 years) received ACL and PCL restoration using LARS artificial ligaments since June 2006.Preoperative MRI exactly confirmed them as ACL and PCL ruptures.Lysholm score on knee joint was (47.6 ±6.7) points.Surgery had reconstruction of PCL prior to ACL under arthroscope.Results All patients were followed up for average 42 months (range,36-49 months),which showed no infection,ligament rupture,ligament loosening,or other postoperative complications.At postoperative 3 years,Lysholm score was (90.8 ± 3.7) points and International Knee Documentation Committee (IKDC) score was normal in 14 patients,near normal in six,and abnormal in one,with excellent-good rate of 95％.Conclusions LARS artificial ligaments can attain anatomical reconstruction and stability of the knee joint in treatment of ACL and PCL ruptures.Meanwhile,arthroscopic surgery shows superiorities of micro-wound,rapid recovery and satisfactory curative effect.