Objective To report the technique of functional reconstruction for knee joint following destructive injury and its outcome. Methods In the period from June 1991 to April 2001, microsurgery was done for 4 cases to reconstruct functions of the damaged knees. The operations were combined with transplantation of bilateral latissimus dorsi myocutaneous flaps, emergency transplantation of latissimus dorsi myocutaneous flap, emergency transplantation of useless leg composite tissue and emergency rotation- plasty, respectively. Results All the transplants survived completely. The follow- ups, ranging from 4 to 14 years, revealed normal or nearly normal functions in all the repaired knees. Conclusion Whenever possible, a knee with destructive injury should be repaired and reconstructed, and microsurgery may offer an effective solution.

Objective To report the technique and outcome of combined transplantation of bilateral vascularized fibulas to repair the segmental femoral defect Method In the period from October 1984 to May 1992, bilateral vascularized fibula transfer was done to treat femoral defects in 9 cases, in which there were 5 cases of bone tumor, 3 cases of pathological fractures following chronic osteomyelitis and 1 case of posttraumatic bone defect The length of the transferred fibulas ranged from 12 cm to 22 cm and averaged 16.25 cm Result Except 1 case in which thigh amputation was done 6 months after operation because of local recurrence of the chondrosarcoma, all the transferred fibulas united solidly with the host bones 3-6 months after operation The repaired limbs started weight-bearing at the third to seventh postoperative month Conclusion To repair a femoral defect over 10 cm in length, combined transfer of bilateral vascularized fibulas is the treatment of choice with short therapeutic process and good results.

Objective To investigate and discuss the feasibility and clinical outcome of the minimally invasive two-incision total hip arthroplasty. Methods From February to June 2004, 17 cases of the minimally invasive two-incision total hip arthroplasty were performed. There were 7 males and 10 females with an average age of 69 years from 58 to 75 years. Preoperative diagnosis of the patients included 5 of osteoarthritis, 4 of osteonecrosis and 8 of femoral neck fracture. The operations were performed with Versys cementless prosthesis and minimally invasive instruments provided by Zimmer Company. Operation time, blood loss, length of incisions, average postoperative hospitalization, and operation related complications were analyzed. Blood transfusion was performed while hemoglobin of the patients was less than 8 g. Results The patients were followed up from 6 to 12 months with an average of 8 months. The average operation time was 95 mins (85 to 170 mins). The average blood loss was 280 ml (190 to 450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average, 400 ml). The average length of anterior incision was 5.0 cm (4.6 to 6.5 cm) and that of posterior incision was 3.7 cm (3.0 to 4.2 cm). All the patients were ambulatory the day after surgery. 11 cases were discharged 5 days and 6 cases discharged 7 days after operation. Postoperative measurement on X-ray film showed that the average angles of abduction and anteversion of acetabular cup were 46?(43? to 55?) and 21?(17? to 23?) respectively. Proximal femoral split fracture occurred in one case, in which the fluoroscopy demonstrated the femoral component was stable and well positioned, and the patient walked without weight-wear for 2 months and was found with stable prosthesis evaluated at 3 and 6 months postoperatively. None of infection, dislocation or injury of vessel and nerve happened. Conclusion Anterior and posterior two-incision total hip arthroplasty has the advantages of muscle sparing, minimally invasive, less blood loss, rapid recovery; however, this technique is time consuming, special instruments and fluoroscopy are needed.

Objective To analyse the causes of non-union and delayed union in distal femur and assess the clinical outcomes of retrograde intramedullary interlocking nail(RIIN). Methods Between June 1995 and December 1998, 15 cases of non-union and delayed union of distal femur were treated with RIIN. There were 9 males and 6 females, the average age of the patients was 34.5 years(range 23 to 46 years). At surgery, the failed implants were removed in all 15 cases, bone graft was performed in 10 cases, closed reaming was done in 5 cases. 11 patients also received knee adhesion release operation. The X-ray examination and KSS knee functional score were used to evaluate the results. Results The average duration of follow-up was 14.5 months. All patients achieved solid bone union at an average of 6.4 months. There were no malunion, infection and refracture in this series. According to the KSS rating system, the average range of motion(ROM) was 93.5 degrees, increased by 28 degrees(42.7％ ) compared with the preoperation ROM. The average knee score was 96 points. The excellent result was obtained in 13 cases, good in 2 cases. The average knee function score was 90.5 points. Conclusion The main reasons for non-union and delayed union were improper selection of the indications and use of implants. Retrograde intramedullary interlocking nail is one of the effective alteratives for treatment of distal femur non-union and delayed union. It can provide a stable and reliable fixation which is of benefit for early functional exercise. Bone grafting, closed reaming technique and knee joint adhesion release should be considered in order to enhance the bone healing and the improvement of knee ROM and function.

Objective To observe the patency and the rate of arterial spasm in different time periods following segmental hydrolic dilation during the course of tissue transplantation; also the influence of arterial dilation to arterial structure was studied with histological examinations. Methods Fifty seven patients with thumb or finger defects were treated with thumb reconstruction using thumb nail flap free transplantation in 41 cases, thumb reconstruction using free transplantation of the second toe in 6 cases and 10 cases had finger reconstruction using the second and third toe free transplantation. Following complete tissue isolation, and prior to vascular anastomosis, heparin+normal saline was injected into the dorsal pedal artery, the first metatarsal artery and the digital artery of the big toe or the second for segmental dilation with the pressure of 300 mmHg. The dorsal pedis arteries were taken for histologic studies after hydrolic dilation. Results 1)The temperature of transplanted tissues were 0.16 ℃ higher than the health side. 2)The immediate arterial patency rate was 100% after anastomosis and the rate of spasm was 0. Vascular crisis took place in one case 24 hours after the operation, and was relieved after removal of the hematoma. There was one failure due to the extensive thrombosis formation in the capillaries. 3)Histologic study showed: there were 15% of the arterial endothelium exfoliated following hydraulic dilatation, resulting in looseing of the internal elastic membrane, a basically normal muscular layer of different thickness; without hydraulic dilatation, 7% of the arterial endothelial cells exfoliated, with homogeneous thickness of the internal elastic membrane and intact muscular layer. Conclusion 1)Segmental hydrolic dilation is one of the effective methods to prevent and treat vascular spasm and it is a safe and effective method to increase the successful rate of free tissue transplantation. 2)Hydrolic dilation within a certain range(300 mmHg) had no obvious effect on arterial structure.

Objective To construct and identity pSIREN-HIF-1α/shRNA expression vector in order to make foundation of gene therapy for further exploration of RNA interference to nasopharyngeal darcinoma. Methods According to HIF-1αcDNA gene sequence in the gene bank (NM_001530/NM_181054), a pair of 60 nt oligonucleotides each containing the sites of restriction endonuclease at both ends,were designed and synthesized by Reynolds design principles. Oligonucleotides were annealed and ligated with linedrized RNAi-Ready pSIREN-RetroQ-ZsGreen.Transfected into JM109, the recombinants were finally sequenced and identified by 1%agarose gel electrophoresis. Results The size of the target gene fragment amplified by PCR was 470 bp and in accordance with the expected result.pSIREN-HIF-1α was successfully constructed and identitfied by 1%agarose gel electrophoresis.Sequence analysis of inserted fragment revealed the same sequence as synthesized shRNA Oligonucleotides. Conclusion pSIREN-HIF-1α /shRNA expression vector has been successfully constructed, and can make the foundation of research using liposome packaging transfectiing nasopharyngeal darcinoma cell for the next step .

Objective　To elucidate the influence of osteoporosis on the fracture healing in ovariectomized rat.　Methods　Twenty-four female 8-month-old SD rats were randomized into two groups: sham-operated (sham) (12 rats) and bilaterally ovariectomized (OVX) (12 rats). Three months later, a femoral fracture model was ostablished in both groups. We observed the healing process by transmission elcctron microscopy(TEM) at 3, 7,14, 21, 28, and 42 days after fracture.　Results　TEM findings, showed that the types of fracture healing cells, their ultrastructural changes and functional state were almost identical in both groups till 21 days after fracture. In the OVX group, the calcified cartilage was not absorbed and replaced by new woven bone. A lot of dead chondrocytes were found to be embedded in a calcified chondroid matrix in 28 days after fracture. After this period, osteoclastic bone resorption was aggravated and accompanied by osteocytic osteolysis during 28－42 days of fracture healing.　Conclusions　Osteoporosis greatly affects the fracture healing in the later period of healing. It is demonstrated that endochondral bone formation is delayed and osteoclastic bone resorption increased which was aggravated by osteocytic osteolysis during the period of bone callus remodeling.

Objective　To elucidate the influence of osteoporosis on the fracture healing in ovariectomized rat.　Methods　Twenty-four female 8-month-old SD rats were randomized into two groups: sham-operated (sham) (12 rats) and bilaterally ovariectomized (OVX) (12 rats). Three months later, a femoral fracture model was ostablished in both groups. We observed the healing process by transmission elcctron microscopy(TEM) at 3, 7,14, 21, 28, and 42 days after fracture.　Results　TEM findings, showed that the types of fracture healing cells, their ultrastructural changes and functional state were almost identical in both groups till 21 days after fracture. In the OVX group, the calcified cartilage was not absorbed and replaced by new woven bone. A lot of dead chondrocytes were found to be embedded in a calcified chondroid matrix in 28 days after fracture. After this period, osteoclastic bone resorption was aggravated and accompanied by osteocytic osteolysis during 28－42 days of fracture healing.　Conclusions　Osteoporosis greatly affects the fracture healing in the later period of healing. It is demonstrated that endochondral bone formation is delayed and osteoclastic bone resorption increased which was aggravated by osteocytic osteolysis during the period of bone callus remodeling.

Objective:　To analyze the causes of distal femoral nonunion and delayed union and assess the outcome of the corresponding treatment, retrograde intramedullary interlocking nail (RIIN). 　　Methods:　From June 1995 to December 1998, 15 patients (9 males and 6 females) with distal femoral nonunion and delayed union were treated with RIIN. The average age of the patients was 34.5 years (23-46 years). Bone grafting was performed in 10 patients, closed reaming was done in the other 5 patients. Correction osteotomy was performed in 2 patients, and intra-articular release of knee adhesion in 11 patients. X-ray examination and knee society clinical rating system (KSS) were used to evaluate the results. 　　Results:　All fractures were followed up for at least 9 months with average follow-up duration of 14.5 months (9-33 months). Solid union was documented in all patients at 6.4 months on average. There were no infections or malunions in this series. Based on the final follow-up data, acceptable functional range of motion (ROM) of over 90° was achieved in most patients. The average ROM was 93.5° with significant improvement of 28° (42.7%, P＜0.05) compared with the preoperative ROM. The average knee score was 96. Excellent ROM emerged in 13 patients. The knee function score was 90.5 on average. 　　Conclusions:　The main causes of distal femoral nonunion and delayed union are improper indications and improper use of the implants. RIIN is an effective alternative for treatment of distal femoral nonunion and delayed union because it can provide a stable and reliable fixation which is beneficial for early functional exercise of knee. Bone grafting, closed reaming and intra-articular release of knee adhesion should be considered in order to enhance the bone healing and improve ROM and the knee function.

Adult ; Blood Coagulation Factors ; analysis ; Blood Coagulation Tests ; Female ; Humans ; Injury Severity Score ; Leg Injuries ; complications ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; adverse effects ; methods ; Platelet Count ; Probability ; Prognosis ; Retrospective Studies ; Risk Assessment ; Surgical Flaps ; Venous Thrombosis ; blood ; diagnosis ; epidemiology