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.

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.

Objective To observe the effect of treating acute spinal cord injury in rats by transplantation of autologous activated Schwann cells(AASCs). Methods Unilateral saphenous nerves were ligated directly, free it and culture Schwann cells 1 week later using the tissue clot method. Nerve growth factor(NGF) and brain-derived neurotrophic factor(BDNF) in medium were detected in different periods. 90 female Wistar rats[(200?30) g] were randomly assigned to 3 different study groups as follows: control group A(n=30): 20% DMEM injection; research group B(n=30): autologous Schwann cells(ASCs) transplantation; research group C (n=30): AASCs transplantation. The cells were purified before transplantion to the injuried T10 spinal cord site of rats (New York University type weight drop apparatus, NYU). The recoveries of the lower extremity were observed using Basso-Beattie-Bresnahan(BBB) locomotor scoring system and somatosensory evoked potential and motor evoked potentials(SEP & MEP). And then observe the coticospinal tract(CST) using the biotinylated dextran amine(BDA) tracing. Results BBB score was higher in research group than the control group 4 weeks after injury, the statistical difference was significant(P

[Objective]To discuss the anatomy and etiology of cubital tunnel syndrome.[Method]The clinical data and surgical findings of sixty five cubital tunnel syndrome cases were analyzed,and the per-operative electromyogram results of twenty five cases were studied.[Result]Hypertrophy of arcuate ligament resulted in compression and abrasion of ulnar nerve in sixty patients;we found that the ulnar nerve conduct velocity decreased(the average speed was 27.97 m/s),motional amplitude also decreased(the average voltage was 1.95 mv),and latent period prolonged(the average time was 5.41 ms)after pre-operative electromyogram.[Conclusion]The major etiology of cubital tunnel syndrome is chronic injury with sustained compression of ulnar nerve around elbow joint.Careful physical examination of ulnar nerve function and pre-operative electromyogram will help us to diagnose the cubital tunnel syndrome.Cubital tunnel syndrome should be differentiated from tardy ulnar nerve palsy of other sites.

Objective An investigation of the effectiveness of treatment of spinal cord injuries(SCI) from the point of view of the transforming factor. Methods Animal model of SCI was made by modified Allens method. Mixed grafts of Schwann cells(SCs) modified with nerve growth factor(NGF) and brain derived neurotrophic factor(BDNF) genes along with fetal spinal cord cell suspension(FSCS) were transplanted into SCI site after 1 month and 3 months. Immunocytochemical staining was conducted for neurofilament(NF), glial fibrillary acidic protein(GFAP), myelin basic protein(MBP), 5 hydroxytryptamine/serotonin(5 HT), NGF, BDNF and the results analyzed with image pattern analysis. Pathological changes of spinal cord tissues were observed with light and electronic microscopy. Results These findings demonstrate the advantages of using mixed grafts of NGF and BDNF genetically modified SCs with FSCS in SCI in the rat: 1) They can be well integrated with the host and survive, 2) FSCS plays the role of bridging and mesomerism, 3) SCs can act as canal tubes and guides for the axons, 4)NGF and BDNF may stimulate the growth of axons and salvage the injuried neruron. Conclusion Mixed grafts of SCs genetically modified with NGF and BDNF genes along with FSCS may be effective measures for the treatment of SCI.

Objective The investigation was to evaluate the efficiency of the frozen shoulder treated by hydraulic distention and manipulation under dynamic arthrography of shoulder joint ,and analyze the in-fluencing factors on the outcome.Methods One hundred patients with frozen shoulders were enrolled the prospective and controlled study,who were divided into two groups randomly.Fifty patients were treated by the hydraulic distention and manipulation under dynamic arthrography of shoulder joint (GroupⅠ),and fifty patients were treated by NSAIDs administration(GroupⅡ).The relationship of clinical results with the amounts of injected fluid during hydraulic distention and manipulation,the range of motion,the visualized rate of the vagina synovialis of long head of biceps brachii tendon and subacromial bursa,and releasing de-gree of joint adherence were observed.The patients consisting of forty-two males and58females aging from42to74years were assessed at two time-intervals.The short term follow-up period ranged from3to6months,and final follow-up from10to21months.Results The clinical results was significantly difference between GroupⅠand GroupⅡdepending on daily activity and range of motion(P

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

[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