New techniques have always been emerging in clinical treatment to greatly promote the development of orthopaedics. We must be aware that while we are trying to command the innovations to benefit the patients we should take care to prevent their possible complications. In order to popularize the new techniques actively and safely, we shall first study them carefully. It is necessary that we spare no pains reviewing all the literature concerning them, objectively evaluate their advantages and disadvantages, and have a good command of their indications before we can put them into practice, especially those that have been used abroad. Moreover, we should also develop our skills in practicing the new techniques. We can not only learn from the practice but also make our creative contributions to the improvement of their clinical outcomes in spite of difficulties.

[Objective]To study the role of hIGF-1 gene on collagen type Ⅱ expression of degenerative intervertebral disk.[Method]Twenty-four male New-Zealand rabbits intervertebral disk degenerontion(IVDD) models were done according to reference and randomly divided into Ad-CMV-hIGF-1,hIGF-1 growth factor and PBS group.Twenty five microlitre the second generation Ad/CMV-hIGF-1(T=80?109 PFU/L),hIGF-1 growth factor(100 ?g/L)and PBS were respectively injected into L4、5,L5、6 intervertebral disk under fluoroscopic guidance.One,two,four and eight weeks post-operation,rabbits were sacrificed,intervertebral disk samples were harvested.Total proteins of equal mass intervertebral disks were extracted,isolated in SDS-Polyacrylamide gel electrophoresis(SDS-PAGE)and transferred to polyvinylidene difluoride(PVDF)Millipore.The hIGF-1 growth factor expression were indentified with Western blot.Collagen type Ⅱ gene fragments were amplified with RT-PCR,and relative expression was done with GAPDH as intern control.[Result]The hIGF-1 interest protein existed at 7.6 Kilo-Dalton.At one week after injection,its expression quantities were almost equal between Ad/CMV-hIGF-1 and hIGF-1 growth factor group.At two week after injection,it obviously declined in hIGF-1 growth factor group.At four week after injection,it still expressed in Ad/CMV-hIGF-1 group.At eight week after injection,it did not express in theree groups.Collagen type Ⅱ mRNA relative expressions increased significantly from one to four weeks after injection,declined slightly at the end of eight weeks in Ad/CMV-hIGF-1 group.However,they appeared to decrease continuously in the other two groups with time.At the corresponding phases,those in PBS group were the lowest.[Conclusion]Ad/CMV-hIGF-1 could successfully infect degenerative intervertebral disk.The hIGF-1gene expression could last four weeks and could stimulate collagen type Ⅱ synthesis in Ad/CMV-hIGF-1 group.

[Objective]To determine whether discectomy resulted in improvement in low back pain(LBP)associated with lumbar disc herniation. [Method]Two hundred and one consecutive single-level lumbar discectomy were followed up,one hundred patients underwent microendoscopic discectomy(MED group) and 101 patients were treated with conventional open discectomy(COP group).Outcomes were assessed using Visual Analog Scale(VAS) and patient satisfaction.The changes in LBP were compared between the MED group and COP group.The effects of severity of low back pain before surgery on the improvement of back and leg pain were also determined.The mean duration of follow-up was 45 months.[Result]The mean VAS leg pain significantly decreased from 70.02?15.80 before operation to 7.73?12.13 at final follow-up.A significant improvement was also noted in LBP,the mean VAS LBP score was 43.61?26.18 before surgery and 16.89?14.73 at the time of final follow-up.The important improvement in LBP and leg pain was seen in 70.1%～78.1% and 97.0% patients respectively.Improvements in back pain and leg pain were correlated(r= 0.1656,P=0.0304).The rate of important improvement of low back pain was greater in MED group than in COP group.The rate of important improvement in LBP was similar in the patients of a preponderance of LBP,a preponderance leg pain and an equivalence of LBP and leg pain,the patients with a preponderance of LBP showed a lower rate of important improvement in leg pain than the others.[Conclusion]Discectomy for relief of sciatica of lumbar disc herniation provides effective relief of LBP.The MED is more likely effective as a surgery way to relief LBP.Furthermore,it certified that the severe LBP maybe a negatively predictive factor for the follow-up outcome of leg pain.

[Objective]To study the stresses value and distribution of the facet joint of the normal L4、5 segment model and that of the denucleated lumbar segment model. [Method]A finite element model of the intact L4、5 segment was developed through Ansys software.The property of nucleus pulposus was changed to be negligible to model lumbar discectomy through anterior approach.Then the finite element model of the denucleated lumbar spine segment was created.The inferior end plate of L5 was fixed.Models were subjected to 6 Nm flexion,extension or right rotation moment in combination with 400 N axial compression preload.Forces were applied to the superior L4 end plate.Stresses value and distribution of the lumbar facet joint were analyzed under different loading conditions.[Result]Finite element models of the intact L4、5 segment and the denucleated lumbar spine segment were created.The facet joint was treated as a three dimensional contact,linear frictionless problem.The facet joint was composed of the inferior and superior facet surface and ligamentous structure.Both facet joints,especially the left of the intact model produced larger stresses in right rotation.Comparing with that of the intact model,stresses of the facet joint of the denucleated model increased in flexion,extension and right rotation.[Conclusion]The region of contact of each facet joint varies according to different loading conditions.So does the stresses value and distribution.The facet stresses of the lumbar segment increase in flexion,extension and rotation after discectomy.

Objective To investigate the efficacy of percutaneous endoscopic laser-assisted discectomy (PELD) on L5S1 herniated nucleus pulposus by posterior paramedian trans-interlaminar approach (PEILD). Methods 168 consecutive patients underwent PEILD between May 2002 and December 2003, and were analyzed retrospectively. All cases were operated in outpatient department under local anesthesia in Wooridul Spine Hospital of Korea. Of the 168 cases, 92 were males, and 76 females with a mean age of 42.8 years (range,18 to 73 years ). The classification of herniated disc position related to spinal canal and pedicle, was central in 22, para-central in 120, foraminal in 23, and extraforaminal in 3. The average of iliosacral distance was 38.6 mm. "C" arm fluoroscopy was needed during operation. All of the patients were given conservative management for 6 to 8 weeks without relief of radiculalgia. The AP film was used to make sure to have enough working interlaminar space of posterior percutaneous approach for L5S1 herniated nucleus pulposus. Results The operative time was 30 to 90 mins with an average of 45 mins, and the mean hospitalization was 1.3 days. The average follow-up duration was 8.3 months (range, 5 to 19 months), and the patients were evaluated at 2 day, 2 week, and 1, 2, 6 and 12 month respectively. The clinical results were assessed by MacNab criteria, there were excellent in 43.5%, good in 47.0%, fair in 4.8%, and poor in 4.8%, and successful rate was 90.5%. 8 cases showed incomplete removal of the pathological disc on postoperative MRI without changes of symptoms and signs, then open laminectomy and microdiscectomy (OLM) were performed, including 4 of foraminal type, 3 of extraforaminal type and 1 of central type. 1 case displayed discitis, which was improved one month later by intravenous antibiotics, immobilization and bedrest. 26 cases showed transient postoperative paresthesia, improved by conservative treatment. Conclusion L5S1 disc herniation can be effectively treated with percutaneous endoscopic laser discectomy through posterior paramedian trans-interlaminar approach, which is easier for the patients with higher iliac spines.

Objective To introduce a new technique about reconstruction of anterior cruciate ligament(ACL) by transplantation of autogenous hamstring and fixation with a crossbar(Transfix Ⅱ) under arthroscopy and explore its effect on short term. Methods 72 patients with ACL injury were treated with ACL reconstruction by transplantation of autogenous semitendinous and gracilis tendon, fixed by a crossbar in femur end and a bio-absorbable interface screw in tibial tunnel. 2 cases of meniscus neoplasty, 31 partial meniscectomy, 8 large partial meniscectomy, 16 cartilage trimming, and 15 medial collateral ligament neoplasty, as well as 1 patellar tendon neoplasty were performed simultaneously. Pre- and post-operative knee joint function and stability as well as X-ray photograph were evaluated according to the Lysholm scoring scale system. The reliability of the fixation and its short-term effect were analyzed. Results 65 patients were available for follow-up with the duration from 8 to 36 months. The function of knee joint improved greatly. 8 cases had positive finding in physical examination. The average pre- and post-operative Lysholm score were 56?6.3 and 91?4.8, respectively(P

[Objective]To study the intervertebral disc degeneration induced by bilateral zygopophysial joint resection in New Zealand rabbits.[Method]Forty-five New Zealand rabbits were randomly divided into 3 groups:group A,L_(4) and L_(5) inferior articular processes were en bloc excised,L_(5) and L_(6) superior articular processes were retained;its L_(6、7) and L_(3、4) as self-control group B;L_(3) to L_(7) paravertebral muscles were stripped and took L_(4、5),C_(5、6) as control group C.At one,two,four and eight months postoperatively,anterior-posterior and lateral X-ray film abnormal signs,including intervertebral space wedging,osteophyma formation at the edge of vertebral body and cartilage end plate celcification,were examined and counted.[Result]In the group C,cartilage end plate calcification,seldom intervertebral space narrowing,rare osteophyma formation at the edge of vertebral body and no lumbar spinal kyphosis were found in some rabbits.In the group A,cartilage end plate calcification began to found in the early stage on the L_(4、5) and L_(5、6),as time went on to the 8~(th) month postoperatively,almost all rabbits were found intervertebral space narrowing,osteophyma formation of vertebral space narrowing,osteophyma formation of vertebral body and cartilage end plate calcification.Conform kyphosis of L_(5、6) were also occurred at some rabbits.There was significant difference between group A and group C,but no difference with group B.[Conclusion]Radiological changes of L_(5、6) intervetevbral disc degeneration can be induced by excision of L_(5) and L_(6) zygopokhysial joint of rabbit.

[Objective]To study whether intervertebral disk degeneration can be induced by destroying bilateral zygapophysial joints of New-Zealand rabbit.[Method]Thirty male New-Zealand rabbits were randomly divided into operation group on the bone and operation group on the soft tissue.In operation group on the bone,L4 and L5 inferior articular processes were en bloc excised,L5 and L6 superior articular processes were retained.In the operation group on the soft-tissue,Only L3 to L7 paravertebral muscles were stripped.In operation group on the bone,L4、5 and L5、6 intervertebral disks acted as experimental group;L3、4 and L6、7 acted as self-control group.In the operation on the soft tissue,L4、5 and L5、6 acted as experimental control group.One,two,four and eight months post-operation,histological and ultrastructure organizations of intervertebral disks of New-Zealand rabbits were performed.[Result]The normal rabbit discs formed a very complex system,with an outer anulus fibrosus surrounding a central nucleus pulposus in which collagen fibers aligned parallelly and intervertebral disk cells distributed evenly.Collagen fibers derangly aligned and intervertebral disk ceils declined with time post-operation.At the end of four months post-operation,many degenerative cells were found in the study group,which features as irregular cell contours,swelling chondrosome,rough endoplasmic reticulum,and condense nucleus located in the cellular nucleus.Eight months after operation,many dead cells were found.Cytolysosomes increased,cellular nucleus became twisted,rough endoplasmic reticulums swelled,and chondrosome became vacuolization.Dead intervertebral disk cells were located in nidi which were made of multilayer degenerative collagen fibers.[Conclusion]Histological changes of intervertebral disk degeneration can be induced by destroying L4、5 and L5、6 zygapophysial joints of New-Zealand rabbit.

Objective To evaluate the variation of the blood flow in anterolateral femoral head by ligating different amount of extracapsular arteries. Methods Thirty six hips of 18 mongrel puppies were divided into A、 B、 C、 D and E groups. In group A, only one peripheral artery was ligated randomly. In groups B, C, D,and E, 2, 3, 4, and 5 peripheral arteries were respectively ligated. The blood flow in anterolateral femoral head in 18 mongrel puppies was measured before and after the ligation of the arteries by using of Hydrogen clearance technique. Results 1) The average blood flow in anterolateral femoral head was (0.1397?0.0515) ml?min-1?ml-1. 2) The mean blood flow in the anterolateral femoral head was slightly decreased after one to two of the extracapsular main arteries were ligated but there was no statistical difference. However, the mean blood flow was decreased significantly after more than three arteries were ligated. Conclusion 1) Hydrogen clearance technique is a quite simple, economic and reliable method for estimation of blood flow perfusion in various tissue. 2) The efficiency of blood supply of the anterolateral femoral head in puppies depends at least upon three of the major extracapsular arteries.

Objective To introduce the use of artificial lumbar intervertebral disc replacement for the treatment of lumbar disc degenerative diseases and lumbar disc herniation accompanying evident disc space narrowing. Methods Thirty-one cases(37 discs) of artificial lumbar disc replacement were performed using SB Charite Ⅲ from April 1998 to April 2000. Among them, disc degenerative diseases were seen in 16 cases (18 discs), disc herniation accompanying evident disc space narrowing in 13 cases (17 discs), recurrent disc herniation in 2 cases. Results All the cases were followed up from 17 to 41 months(mean, 26 months) . The clinical outcomes were excellent in 23 cases, good in 6 cases, fair in 2 cases. The mobility of the operated level had 4.0? anterior flexion and 5. 1? posterior extension after operation and 9. 1? on total mobility. Meanwhile, the operated intervertebral space got an average of 4. 2 mm higher than that before the surgery. Because of technical problem, a slight displacement of the core occurred in one case without any clinical symptoms and signs. Conclusion Artificial disc replacement is a new operation for the treatment of lumbar disc degenerative diseases and disc herniation accompanying evident disc space narrowing.