[Objective]To evaluate the results of treatment with arthroscope and high tibial osteotomy with fixation of staple made of retention alligation for osteoarthritis of the knee,and to discuss the indication for this technique.[Method]From March 1999 to May 2003,42 arthroscopic treatment and high tibial osteotomies were performed in 34 patients.There were 6 men(8 knees)and 28 women(34 knees,with a mean age of 54.2 years(ranged,42～67 years.The average postoperative follow-up was 36 months(ranged,16～44 months.The indications for high tibial osteteotomy were unicompartmental osteoarthritis and varus malalignment.After arthroscopic treatment,a lateral closing-wedge osteotomy was performed with fixation of staple made of retention alligation.The arthroscopic examination showed:plica synovialis in l0 knees,medial meniscus injuries in 12 knees,lateral meniscus injuries in 6 knees,articular cartilage injuries in 20 knees,body loose in joint in 7 knees,intercondylar fossa stenosis in 9 knees.Common peroneal nerve was not exposed and the periosteum opposite to the insicion position was left intact for sake of stability and acted as a hinge around which the wedge osteotomy was closed.The patients were reexamined to obtain a knee score,to make lateral andanteroposterior radiograph of the involved knee with the patient standing.[Result]During the follow-up,the patients showed satifying pain relief,improvement of joint function,correction of yams deformity.The average preoperative knee score was 53.714?6.7,The average postoperative knee score at the time of the latest follow-up was 91.02?7.7.Comparing preoperative with postoperative,there were significant differences(P

Objective To evaluate the surgical treatment of the acute posterolateral complex(PLC)injuries of knee joint and then observe the clinical outcome.Methods Twelve cases(12 knees)of acute PLC injuries were treated from May 2006 to October 2008.Patients' age ranged from 23 to 47 years old,average 31 years.There were 9 males and 3 females.Rebuild the anterior cruciate ligament(ACL)and posterior cruciate ligament(PCL)under arthroscope and then,locally suture the PLC injuries sites on those patients with PLC avulsion fraction.If there is PLC rupture,then locally suture the injury sites plus PLC reconstruction.Knee functions were evaluated by IKDC and Lysholm score.Results All patients were followed up for 12-18 months(mean,13.3 months).The preoperative range of motion was 118.00°±6.77°,which was 130.75°±3.05° after surgery.KT-1000 arthrometer measurement showed that the average posterior translation improved from(14.85+1.83)mm preoperatively to(4.18±1.88)mm postoperatively.Seven cases were normal(A grade),3 cases were nearly normal(B grade),1 abnormal(C grade),and 1 severely abnormal(D grade)according to IKDC standard.The preoperative Lysholm joint function score was 35-44,average 38.83 ±3.16,which was 79-91,average 84.92±3.73 after surgery.Conclusion To those acute PLC injuries with avulsion at the ligament extremities,locally suture should be taken.But for those with PLC rupture at the mid part of ligament,locally suture the injury sites plus PLC reconstruction helps get satisfactory outcome.

A novel Aspergillus terreus strain M11 was isolated from the compost containing cellulose and identified. The isolate grow best at 45℃ and pH2.0. It was found that the activity of the CMCase was up to 3.680IU/mL with high heat stability and the optimal reaction conditions of the CMCase were at 60℃ and pH2.0.

Objective To investigate the safety and efficacy of three column osteotomy (3-CO) procedures through previous spinal fusion site for the revision surgical treatment in severe spinal deformity patients.Methods From Oct.2010 to May 2014 in our hospital,a total of 12 severe spinal deformity patients underwent 3-CO for the revision surgical treatment.There were 7 males and 5 females with the average age of (21.8±3.8) years,ranging from 18 to 30 years.The mean time from the initial operation to the revision surgery was (10.2±4.8) years (ranging from 3 to 17 years).The reasons for revision were:curve progression in 7 patients,neurologic deficit in 2 cases,implant failure in 1 patient and pseudarthrosis in 2 patients.The coronal parameters including major Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),and the sagittal parameters including global kyphosis curve and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at last followup,respectively.The operation time,intraoperative blood loss and complications were recorded.The paired t test was used to evaluate the difference among pre-revision,post-revision and last follow-up.Results The average operation time was (451.7±83.1) min (range,320-600 min) and the average blood loss was (4 016.7± 1 080.0) ml (range,2 700-6 000 ml).The average follow-up time after revision operation was (35.4±9.8) months (range,24-49 months).The coronal Cobb angles of pre-revision and post-revision were 83.8°±23.3°and 34.6°± 13.7°.The average correction rate was 60.1％ ±8.8％.At last follow-up,the average coronal Cobb angle was 34.9°±13.8°,there was no significant loss of correction.The pre-revision and post-revision values of global kyphosis were 99.1°±13.3°and 38.7°±7.8° with a mean correction rate of 60.8％ ±6.7％.At the last follow-up,the average global kyphosis was 39.3°±7.5°and no loss of correction was found.For the C7PL-CSVL and SVA,pre-revision (30.3± 17.1) mm and (40.1±31.1) mm were corrected to (14.3 ±7.6) mm and (19.1± 12.3) mm immediately after revision operation,respectively.At final follow-up,the average C7PL-CSVL and SVA were(14.1 ± 7.6) mm and (19.6± 12.1) mm,the correction was well maintained.Obviously,two patient's neurological status improved from Frankel C before revision surgery to Frankel E.Complications were encountered in five patients (41.7％),including SEP signal changed in 1 patient (8.3％),transient neurologic deficit after revision surgery in 1 patient (8.3％),cerebrospinal fluid leak in 1 patient (8.3％),and pleural effusion in 2 patients (16.7％).During the follow-up time,there was no patient experienced pseudarthrosis,implant failure,infection or significant loss of correction.Conclusion Based on results of this study,it was concluded that 3-CO procedures through previous spinal fusion sites could obtain satisfactory and safety results in severe spinal deformity revision surgery.However,it is a technique-demanding procedure with more blood loss,longer operative time and higher risk of perioperative complications.

Objectivc To investigate the protective effect of simvastatin on retinal ganglion cells (RGC) after optic nerve crush (ONC).Methods Together 50 Kunming mice were randomly divided into normal group,sham group,ONC group and simvastatin protection group.The mice in the normal group were untreated,the sham group was treated with the exposure of the optic nerve without injury,the ONC group mice underwent ONC operation on the left eyes,followed by intravitreal administration of equilibrium solvent [50 mg · mL-1 ethanol plus 1 mol · L-1 NaOH,which were activated by 1 mol · L-1 HC1 (pH 7.2)],and the simvastatin protection group was intravitreally injected different concentrations of simvastatin (0.5 g · L-1,1.0 g · L-1,1.5 g · L-1) after ONC operation.Brn3a immunofluorescence staining,HE staining and toluidine blue staining were used to detect the apoptosis of RGC and pathological changes of optic nerve.Results On day 7 after operation,in the ONC group,the apoptosis of RGC was observed obviously,with the survival rate dropping to (35.1 ± 3.9) ％,and the thickness from the retinal ganglion cell layer to outer nuclear layer was decreased from (123.13 ± 1.04) μm to (97.48 ± 2.33) μm,which was significantly thinner than that in the control group (P ＜ 0.01);moreover,the fibrous bundle of optic nerve disappeared,and the neuroglial cells were clustered into groups,as well as the axons showed swelling and serious degeneration,but after intravitreal injection of 1.0 g · L-1 simvastatin,the survival rate of retinal ganglion cells increased to (76.3 ± 3.7) ％ (P ＜ 0.05),and the aforementioned thickness was increased to (111.39 ± 4.06) μm,which was statistically significant when compared with the ONC group (P ＜ 0.01).The degeneration of optic nerve was improved,and the structure of neuroglial cell axons and the nerve fibers became normal.Conclusion Simvastatin can reduce the optic nerve degeneration and improve the survival rote of retinal ganglion cells.

OBJECTIVETo reconstruct 3D shape of edentulous jaw by using improved measurement system and to analyze the precision of this method.

METHODSStandard edentulous jaw models were measured with a improved measurement system by cutting and scanning layer-by-layer, and the 3D shape of the models was reconstructed by image processing with specialty software. Ten cubic plaster modes were reconstructed by the same way, data of every border before and after reconstruction were measured and analyzed.

RESULTSData of edentulous jaw models were obtained. The errors in ten cubic before and after reconstruction were not significantly different (P > 0.05), data measured in horizontal plane were not significantly different (P > 0.05), and data measured in altitude direction were significantly different (P < 0.01), data measured after reconstruction were less than before, the error was (0.09 +/- 0.08) mm.

CONCLUSIONThe improved cutting and scanning measurement system can be fit for the 3D reconstruction of stomatognathic system with high precision.

Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Jaw, Edentulous ; Reproducibility of Results ; Software ; Stomatognathic System ; Tomography, X-Ray Computed

Objective To evaluate the clinical performance of the crowns made by Cerec2 computer aided design and computer aided manufacture(CAD/CAM)system.Methods Twenty four teeth were restored with Cerec2 CAD/CAM crowns.Eight years after delivery of the prostheses,the all-ceramic crowns were evaluated using modified standard of California Dental Association quality evaluation system.Patients filled out a satisfaction questionnaire at the same time.And Kaplan-Meier analysis was carried out.Results Three out of 24 restorations were rated as failure.Kaplan-Meier analysis showed that the success rate of Cerec2 crowns eight year following delivery was 88%.Conclusions Crowns made by Cerec2 CAD/CAM system can survive in oral condition and function well for 8 years.

ObjectiveTo make a comparison between microsurgical lumbar discectomy(MSLD) and microendoscopic discectomy(MED) in terms of methods,feathers,and effectiveness for lumbar disc herniation (LDH).MethodsA prospective clinical review was conducted.From January 2006 to December 2009,900patients with single segment lumber disc herniation were randomly divided into the MSLD group and the MED group.There were 450 patients in each group.Comparison would be made in terms of the length of skin incision,the operative time,amount of bleeding,incidence of complication,duration of hospitalization,the time of recovery to ordinary work or life,pre- and post-operative assessment based on the criteria of visual analogue scales (VAS),and the Oswestry disability index(ODI).ResultsThe mean lengths of skin incision were (3.8±1.1) cm and (2.4±0.7) cm for MSLD and MED respectively; the operative time were (51.0±14.2) min and (62.0±16.3) min; and the blood loss were (60±35) ml and (106±43) ml,which showed a significant difference(P＜0.05).There was no significant differences in terms of the hospitalization time and the time of recovery to ordinary work or life between the two groups (P＞0.05).The results of VAS and ODI of two groups also showed no significant difference at final follow-up (P＞0.05).As for the complications,the incidence of dural tear,acute hematomas of sacrospinalis,nerve roots and cauda equina injury and recurrence in MSLD group were much lower than that of MED group (P＜0.01).There was no incidence of wrong segment,greater artery injury,or postoperative infection in each group.ConclusionThe clinical effects of both minimal invasive methods are satisfactory.However,MSLD has advantages of simpler maneuvering,shorter learning curve,and less complication than MED.

BACKGROUNDDisability and death following hip fracture is becoming more common as the population ages. Previous reports have focused on the selection of internal fixation methods and the analysis of the perioperative therapeutic results in the Chinese population. Few studies have focused on factors influencing medium and long term survival after surgery for hip fracture. We conducted a retrospective study on the factors influencing survival one year after hip fracture surgery in our elderly Chinese population to provide a reference for improved treatment and to enhance efficacy.

METHODSRecords from patients undergoing treatment for hip fracture at our hospital from October 2009 through June 2011 were retrospectively reviewed. Through telephone follow-up, the health condition of each patient was surveyed, and the 1-year postoperative mortality was analyzed. The patients' age, gender, fracture type, pre-injury health condition, mobility, complications, surgical timing, surgical types, methods of anesthesia, and postoperative complications were analyzed. Univariate and multivariate regression analysis was performed on relevant influencing factors.

RESULTSA total of 184 patients had complete data and were followed-up for 12-23 months (average, 16.5 months). There were 30 deaths (16.3%) at one-year. Univariate analysis revealed that factors such as age, gender, fracture-type, number of co-existing diseases, complications such as chronic obstructive pulmonary disease or sequelae of stroke, American society of Anesthesiology (ASA) scores, anesthesia methods, pre-injury activity, and post-operative complications were significantly different between survival versus mortality groups (P < 0.05). Multivariate regression analysis revealed that age, ASA score, pre-injury mobility and combined chronic obstructive pulmonary disease were independent risk factors for death.

CONCLUSIONFull consideration of medium-/long-term risk factors in the treatment of hip fracture in the elderly, selection of appropriate anesthesia and treatment methods, and improved pre-surgical health conditions would reduce postoperative mortality and enhance surgical efficacy.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Hip Fractures ; mortality ; surgery ; Humans ; Male ; Middle Aged ; Regression Analysis ; Retrospective Studies

OBJECTIVESTo investigate the relationships among rotational alignment reference axes of distal femur and tibial mechanical axis, and determine the safest rotational alignment reference axis.

METHODSDigital photos were taken of 30 cadaveric lower extremities with knee in extension and flexion at 90 degrees , angles were measured among tibial mechanical axis and a line perpendicular to clinical epicondylar axis, a line perpendicular to surgical epicondylar axis, Whiteside's line and femoral mechanical axis. Statistical analysis of relationships among those axes were performed.

RESULTSThe angles among the tibial mechanical axis and a line perpendicular to the clinical epicondylar axis, a line perpendicular to the surgical epicondylar axis, Whiteside's line and femoral mechanical axis were 0.6 degrees varus, 3.9 degrees varus, 0.2 degrees valgus and 3.0 degrees varus respectively. The angle between the femoral mechanical axis and the tibial mechanical axis was significantly larger than the angles among the tibial mechanical axis and a line perpendicular to the clinical epicondylar axis, the Whiteside's line (P < 0.05). There was no significant difference compared with the angle between a line perpendicular to the surgical epicondylar axis and the tibial mechanical axis. Angles of the clinical epicondylar axis, the surgical epicondylar axis and the Whiteside's line between knee extension and flexion were 2.3 degrees valgus, 0.9 degrees varus and 3.1 degrees valgus respectively.

CONCLUSIONThe surgical epicondylar axis rather than the clinical epicondylar axis or the Whiteside's line is the safest femoral rotational alignment reference axis intraoperatively.

Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Femur ; anatomy & histology ; surgery ; Humans ; Knee Prosthesis ; Rotation ; Tibia ; anatomy & histology ; surgery