BACKGROUND:Fractures of shafts of the tibia and fibula are the most common diaphyseal fractures among al long bones. The clinical significance of fibula fixation in treatment of distal third shaft fractures is controversial, and the studies are also different. OBJECTIVE:To explore the clinical significance of fibular fixation in treatment of distal third tibia shaft fractures. METHODS:A retrospective review has been performed on the clinical data of sixty-four cases with distal third tibia shaft fracture in Department of Orthopedics, China National Offshore Oil Corporation General Hospital from January 2006 to March 2010. Al cases were divided into two groups based on whether the fibula was fixed or not: fibula fixation group (n=36) and fibula non-fixation group (n=28). Union rate of fracture, bone union time and tibial valgus angle were compared between the two groups. According to Merchant-Dietz criteria, the ankle range of motion and ankle evaluation score were evaluated and compared between the two groups. RESULTS AND CONCLUSION: No significant difference in union rate of fracture, bone union time and ankle range of motion was detected between two groups. Tibial valgus angle was smaler in the fibula fixation group (5.42±1.16)° than in the fibula non-fixation group (7.54±1.90)°(P=0.006). Ankle function score was higher in the fibula fixation group (93.58±0.97) than in the fibula non-fixation group (90.57±3.92) (P=0.000). Three cases in the fibula fixation group suffered from superficial wound infection, and achieved good healing after treatment of anti-infection and changing dresses. Above results verify that fibular fixation can reduce tibial valgus angle and improve ankle joint function in treatment of distal third tibia fractures.

BACKGROUND:Core decompression with bone implantation in treatment of early avascular necrosis of femoral head may provide insufficient support for subchondral bone and increase the risk of fracture and col apse. Tantalum rod implantation can not only provide good biological support, but also promote the revascularization at necrotic regions, thus repairing the necrosis of femoral head.
OBJECTIVE:To evaluate the efficacy of core decompression, core decompression with bone implantation and core decompression with tantalum rod implantation in treating early-stage avascular necrosis of femoral head. METHODS:A total of 24 cases (28 hips) who suffered from ARCO I/II avascular necrosis of femoral head were treated with core decompression with bone implantation, and 25 cases (29 hips) who suffered from ARCO I/II avascular necrosis of femoral head were treated with core decompression with tantalum rod implantation. Al the subjects were fol owed up for 24 months. The efficacy of two different surgical methods was evaluated before and after treatment by observing the changes in Harris scores.
RESULTS AND CONCLUSION:Al involved patients were fol owed up. Harris score of core decompression with bone implantation group were increased 4.93 points at 6 months after surgery;Harris score of core decompression with tantalum rod implantation group were increased 6.89 points at 6 months after surgery. There were significant differences between two groups before and after surgery (P<0.05). After 12 months, Harris scores in the two groups were both significantly increased and the scores of core decompression with tantalum rod implantation group was higher than that of core decompression with bone implantation group (P<0.05). The overal fine/excellent rate of core decompression with tantalum rod implantation group was 83%, which was better than core decompression with bone implantation group (75%). After 24 months, X-ray score of core decompression with tantalum rod implantation group was significantly higher than core decompression with bone implantation group (P<0.05). Comparing with core decompression with bone implantation, core decompression with tantalum rod implantation can better prevent femoral head col apse, improve hip function and delay the process of osteonecrosis of the femoral head.

[Objective] To compare the efficacy of interbody fusion with cage versus corpectomy and fusion with plate in treating adjacent two-level cervical spondylosis.[Method] Sixty patients were included in this study.All patients were randomly assigned to anterior interbody fusion with cage (AIFC) group or anterior corpectomy and fusion with plate (ACFP) group. The average follow-up period was 28 months for AIFC group,and 25 months for ACFP group. [Result] The average loss of lordosis angle, the lost correction of segmental height and the scores on the criteria of 40-score method were not statistically significant between these 2 groups. The lordosis correction, operative estimated blood loss, and operative time were statistically better in the AIFC group significantly . [Conclusion] The short-term results of AIFC and ACFP in treating adjacent two-level cervical spondylosis were satisfactory. The advantages of AIFC are the elimination of donor site complications, increasing more segmental lordosis, and reducing blood loss and operative time.

[Objective]To study the methods and clinical results of infrared fluoroscopic navigation guiding system guided operations for the treatment of thoracolumbar fracture and analysis the common problems in the treatment of thoracolumbar fracture.[Method]A retrospective analysis was carried out in 56 cases with thoracolumbar fracture and dislocation from March 2003 to December 2006.There were 36 males and 20 females,ranging from 18-56 years(average 35 years).Segments involved:T11 10 cases,T12 13 cases,L1 21 cases,L29 cases,L3 3 cases.According to the classification of AO:there were 26 cases of type A,17 cases of type B,13 cases of type C.According to the classification of ASIA:there were 11 cases of type A,18 cases of type B,13 cases of type C,8 cases of type D,6 cases of type E,among which 35 cases had neurological disfunction symptom.Operation were performed under the suspection of computer assisted navigation system,32 cases underwent posterior decompession approach,withAF transpedicular screw internal fixation in thoracolumbar spine.Fifteen cases underwent anterior approach spondylectomy with bone graft and plate internal fixation.Other cases underwent conservative treatment.The vertebral stabilization and the struction of the three columns were reconstructed.[Result]The mean operati on time was 200 min,ranging from 160 to 300 min.The mean blood loss during operation was 1 000 ml ranging from 800 to 2 000 ml.All patients were followed up for 6 to 36 months(10 months on average).Neurological status improved to A ASIA grade in 4 cases,B grade 5 cases,C grade 11 cases,D grade 14 cases,E grade 22 cases.[Conclusion]The patient had remarkable improvement in clinical relief.In order to achive the best effect in the treatment of thoracolumbar fracture,correct treatments of primary trauma and injury type and appropriate management are necessary for the treatment of thoracolumbar fracture.Also,computer assisted navigation system enhances accuracy and further improves the safety of spine surgery.

[Objective]To discuss axonal regeneration and functional recovery after rat's spinal cord injury with transplantation of human cord blood mononuclear cells(HCMNCs).[Method]Thirty injured spinal cord models of Wistar rat were made with Impactor ModelⅡat T10 and then divided into 3 groups randomly and evenly(DMEM control,HCMNCs grafted 3 days post injury and HCMNCs grafted 14 days post injury).Hindlimb functional recovery of rats in each group was evaluated by BBB locomotor functional scale.HE,immunohistochemistry staining,and BDA anterograde tracing were used to observe the axonal regeneration in the lesion site.[Result]Compared with control group,grafted HCMNCs exerted larger effect on promoting nerve regeneration and functional recovery.Rats in the group of HCMNCs grafted 14 days post-injury had better functional recovery than those in HCMNCs grafted 3 days post-injury group.Statistic difference existed among three groups(P

[Objective]To study the relationship between the existence and types of mediopatellar plica versus the chondral injury of the medial femoral condyle.[Method]Data were collected retrospectively from the photographic recording of arthroscopies performed from January 2004 to July 2008.Seventy-six knees were found with mediopatellar plica as the study group.Modified Sakakibara classification and the chondral injury(using the Outerbridge classification) of medial femoral condyle were recorded.Eighty knees without mediopatellar plica were randomly collected as controls.The correlation of mediopatellar plica and the cartilage injury on the surface of the medial femoral condyle was investigated.[Result]Patients with mediopatellar plica had a significantly higher incidence rate(89.5%) of medial femoral condyle cartilage lesion,in comparison with patients without mediopatellar plica(61.3%)(P=0.001).In the study group,a 64.3% proportion of the group with Sakakibara A mediopatellar plica was found to have cartilage lesion in the medial femoral condyle.The proportion of the group with Sakakibara BCD mediopatellar plica was found to be 95.2%,significantly higher than that in first group(P=0.004).The severity of cartilage injury in the medial femoral condyle was positively correlated with patient age(r=0.271,P=0.019) and the severity of the pathologic change of the mediopatellar plica(r=0.611,P=0.000).[Conclusion]According to this observation,the cartilage injury in the medial femoral condyle is more commonly found in patients with mediopatellar plica knees.A shelf-like appearance of the medial plica can increase the incidence of the cartilage injury.The severity of cartilage injury was positively correlated with patient age and the severity of the pathologic change of the mediopatellar plica.

[Objective]To investigate the effect of chondroitinase ABC(ChABC) after spinal cord injury(SCI) in adult rats,and to evaluate the significance of treatment. [Methods]Forty adult Wistar rats were divided into two groups: the control group(group A),the chondroitinase ABC group(group B).The thoracic T10 spinal cord injury model was made by impactor model II manual.After SCI,group B animals received ChABC treatment,while group A animals only received blank saline.The locomotor functions(BBB score) and the neuroelectrophysiological changes(SEP&MEP) of the rats were evaluated.Twelve weeks after SCI,biotinylated dextran amine(BDA) was injected into the cerebral cortex to trace the corticospinal tracts(CST).Then two weeks after the tracing,the animals were killed and the spinal cord frozen sections were made.The tissue sections were processed with Cy3 fluorescence stain,HE stain and anti NF-200 immuohistological stain.The section images were analyzed by Image Pro Plus image analyzing software.All the statistics were performed by SPSS 13.0 software.[Results]At 4 weeks after SCI,group B had obvious higher BBB scores than control group(P

BACKGROUND:Local injection with simvastatin can induce osteogenesis, significantly increase the bone mineral density and mechanical strength of femoral neck and femoral condyle of rats with osteoporosis and analyze effects of local injection of simvastatin on trabecular bone of the femoral condyle.
OBJECTIVE:To explore the effects of local injection of simvastatin on trabecular bone of the femoral condyle of osteoporotic rats and provide experimental basis for the application of simvastatin in clinical topical treatment of osteoporosis.
METHODS:Eighteen female Sprague-Dawley rats received bilateral ovariotomy at 3 months, and were used to produce rat models of osteoporosis. They were assigned into three groups. Experimental rats received 5 and 10 mg simvastatin by single injection into right femoral cavity. Control rats received blank vector. The rat models were sacrificed at 1 month after injection and specimens were col ected. Right femoral condyles were taken out for bone histomorphometric analysis by Micro-CT.
RESULTS AND CONCLUSION:One month post-injection, Micro-CT scanning results revealed that cortical bone thickness, trabecular bone density and connection rate were significantly better in the simvastatin group than those in the control group. Results indicated that single injection of smal-dose simvastatin obviously promoted rebuilding of trabecular bone of condyles of femur, improved microstructure of skeleton, strengthened local skeleton, prevented and treated osteoporosis, and provided a further basis for the prevention and treatment of osteoporosis, especial y for osteoporotic fractures.

Objective To investigate the effect of transplantation of human umbilical cord blood CD34+cells on spinal cord injury. Methods CD34+cells were separated from fresh human umbilical cord blood by magnetic cell sorting. Ninety-six female Wistar rats were injured at T10 by IMPACTOR MODEL-Ⅱ, and then randomly assigned to three groups:Cyclo?sporin A (CsA)+Dexamethasone (Dex) treated group (Ⅰ, n=32), local transplantation of cells+CsA+Dex treated group (Ⅱ) at the first day after operation (DAO 1, n=32), local transplantation of cells+CsA+Dex treated group (Ⅲ) at DAO 6 (n=32). BBB locomotor scoring system was used to assess the recovery of the lower limbs. The survival and neural differentiation of transplanted cells at the injury site were observed by double immunofluorescence. The tissue vitality at the injury site was ob?served by 2,3,5-triphenyl-2H-tetrazolium chloride (TTC) staining, and the blood vessel density was observed by infusing mixture of Chinese ink and glutin followed by HE staining. Results BBB score at DAO 8-56 was significantly higher inⅡgroup than that of other two groups (P<0.05). TTC staining showed that the proportion of decreased vitality area was signifi?cantly smaller inⅡgroup than that of other two groups (P<0.01). The result of gelatin ink perfusion showed that the blood vessel density at the injury site was significantly bigger inⅡgroup than that of other two groups (P<0.01). There were more survival transplanted cells inⅡgroup than those of III group (per visual field, 7.51 ± 1.00 vs 5.51 ± 0.89,t=6.051, P<0.01). All the transplanted cells didn’t differentiate into neural cells. Conclusion Human umbilical cord blood CD34+cells can promote the recovery of the lower limbs after spinal cord injury by repairing blood vessels to increase tissue vitality at the in?jury site in rats.

Objective To evaluate the clinical results of the anterior cruciate ligament (ACL) reconstruction by bone-patellar tendon-bone(BPB) transplantation and fixation with absorbable interface screws under arthroscopy. Methods From December 1999 to June 2003, 32 patients with ACL injuries underwent BPB transplantation. There were 22 males and 10 females, and the average age was 32.5 years (ranged from 20-45 years). The lesions were left knees in 18 and right knees in 14, including 8 acute and 24 chronic injuries. The BPB for reconstructing the ACL was harvested from the anterior approach mini-invasively; the implants were fixed with the absorbable interface screws under arthroscopy. The associated injuries were treated simultaneously. All the patients were encouraged to rehabilitate with the continuous passive motion (CPM) and other physical therapies earlier after operation. Results All the patients were available at follow-up; the average duration of follow-up was 32 months (ranged from 6-40 months). Before operation, anterior drawer test positive in 32, Lachman test positive in 20 and pivot shift test positive in 16, were changed into negative. The patients were evaluated according to Lysholm knee scoring scale and the modified Lysholm knee score, the functional results of knee joint were classified as excellent in 24, good in 7 and fair in 1, and the average knee score was 52.1?5.6 and 98.7?3.6 before and after operation respectively, the difference was of statistical significance(P