Spinal cord plasticity includes spontaneous neuronal plasticity and task-dependent plasticity which was respectively driven by spinal cord injury and special treatment.Spontaneous plasticity occurred at neuronal and synaptic sites,displaying various forms of axonal sprouting,unmasking of relatively ineffective functional connections and modification of synaptic efficacy.Task-dependent plasticity demonstrated reactivation of central generator pattern and functional reorganization of extensive spinal circuits.Exploration,induction and guidance of spinal cord plasticity will help determine the most optimal treatments and expand therapy methods to further promote function recovery of patients with spinal cord injury.

Nonunion of longbones is a significant consequence in treating fractures, which is not easy to treat. Thes reviewed the basic knowledge and main progress regarding the cause, pathogenesis, pathophysiology of nonunion, and the methods that may be applied to the treatment of nonunion especially those non-operative one.

Necroptosis is a newly discovered form of programmed cell death, which is activated by the binding of death receptors and their ligands and executed through specific path ways. At present, this form of cell death has been proved to be involved in a variety of diseases,such as cancer, autoimmune diseases, traumatic brain injury and brain ischemia-reperfusion injury.

Objective To evaluate the interobserver reliability and intraobserver reproducibility of the subaxial cervical spine injury classification system (SLIC) and identify its guidance on clinical treatment of spinal cord injuries. Methods Thirty consecutive patients with subaxial cervical injury ad-mitted into our hospital between December 2007 and July 2008 were enrolled in this study and underwent neurological examinations followed by X-ray, CT, and MRI examinations. SLIC was evaluated in aspects of fracture morphology, disco-ligamentous complex (DLC) status and ncurologic status. According to the morphology in image, the fractures were classified into normal, compression, burst, distraction and trans-lation/rotation. According to injury severity, DLC was sorted into intact, indeterminate and disrupted types. Neurologic status was classified into intact, nerve root injury, complete/incomplete spinal cord in-jury and continuous spinal cord compression. The clinical and radiographic data of 30 patients with subax-ial cervical injury were evaluated prospectively by four groups of surgeons to count SLIC scores and decide treatment based on SLIC scores. The evaluation was done again three months later. Cohen' s unweighted kappa coefficients were calculated for the key parameters of each classification system ( morphology, neurologic status, DLCstatus, total score, and proposed management) to analyze the reliability and repreducibility of SLIC. Based on SLIC, the treatment method was selected and the neurological function recovery and the complications observed. Results The interrater Kappa statistics of all subgroups ( morphology, DLCstatus, total score, proposed management) were within the range of moderate to substantial reliability (0.47-0.69). Kappa coefficient was 0.83 for neurologic status, with high reliability. There was no statistical difference upon Kappa values in two evaluations. The interrater Kappa statistics of all sub-groups ( morphology, DLCstatus, total score, proposed management) were within the range of moderate to substantial reproducibility (0.53-0.78). Kappa coefficient was 0.89 for neurologic stares, with high repreducibility. The recovery rate of neuroiogie function was 79.2%. There was no aggravation of neurological status, with low incidence of complications. Conclusions SLIC has advantages of high reliability and reproducibility, simple use, exact evaluation and can facilitate decision-making in treatment of subaxial cervical spine injures.

Objective To explore the effect of surgical treatment of low back pain patients with Modic change or high intensity zone(HIZ) on MRI of the lumbar spine .Methods 32 cases with intervertebral disc herniation underwent posterior lumbar inter-body fusion and 17 cases with lumbar discogenic pain underwent radiofrequency ablation from March 2011 to July 2012 were retro-spectively reviewed .For intervertebral disc herniation patients ,all patients were divided into two groups :groupⅠ (no with Modic changes group)and groupⅡ(with Modic changes group) ,according to the Admission MRI .GroupⅡ was sub-divided intoⅡa(Mod-ic type Ⅰgroup) andⅡb(Modic type Ⅱgroup) .For lumbar discogenic pain patients ,all patients were divided into group A (without HIZ group) and group B(with HIZ group) .The VAS and ODI scales at the preoperative and follow-up were recorded and analyzed . Results The postoperative scores of VAS and ODI of all the patients were improved ,and the difference was statistically significant (P<0 .05) .For intervertebral disc herniation patients ,three groups have no statistically significant difference (P>0 .05) .For lum-bar discogenic pain patients ,the improvement rate of VAS (low backpain) of A was better than that of B ,and the difference was sta-tistically significant(P<0 .05) ,but the differences of VAS (leg pain) and ODI scores weren′t statistically significant (P>0 .05) . Conclusion Posterior lumbar interbody fusion is effective for lumbar disc herniation patients with Modic changes ,and can obtain good clinical effect .For lumbar discogenic pain patients with high intensity zone on MRI ,radiofrequency ablation can cause clinical symptoms get some relief ,but the effect is poor .

BACKGROUND: Lumbar spondylolysis is typically caused by a stress fracture of the bone, especially for who over-train in activities. Besides, there is hereditary that can make one more susceptible to the defect. The treatment methods include conservative management and surgery, both with their own indications, advantages,disadvantages and prognosis.OBJECTIVE: To summarize the range of application, advantages and disadvantages of each treatment method of spondylolysis.METHODS: PubMed, CNKI, and VIP databases were retrieved using the keywords of spondylolysis, isthmic spondylolisthesis, treatment/therapy in English and Chinese, respectively. The articles were grouped based on the treatment method after skimming the abstract, and then the indications, operative principles, and advantages/disadvantages were recorded.RESULTS AND CONCLUSION: Surgeries of spondylolysis are classified as interbody fusion, Buck's method, Scott's fusion, pedicle screw-hook system, memory alloy plates for internal fixation, segmental fusion and mini-invasive treatment. Among which, Buck's methods and pedicle screw-hook system are widely accepted. Additionally, minimally invasive treatment becomes more and more prevailed.

Objective To explore mechanics condition in artificial knee joint replacement tibial prosthesis with different shaft body shapes implanted into tibia in different inclination angle,and discuss which shaft shape in tibial prosthesis is suitable in different inserted angle.Methods Finite element model of tib-ial prosthesis with cylindrical handle,square taper shank,columns taper shank,ladder airfoil cross wing shape with column wing handle were built and assembled with bone cement and polymer polyethylene pad.The finite element software ANSYS15.0 was used to analyze the variation of stress and strain of all kinds of body shape handle prosthesis in tilting to 0° and 3°,6°under the working condition of the existing literature data.Results Different stress and strain changes were observed in the finite element models of tibial prosthesis with different shaft shapes in tilting to 0°,3°,and 6°.Conclusions For the different tibial prostheses of 6 kinds of shaft shapes,when placed in tilting to 3°,prosthesis with cylindrical taper shank and column wing were suitable to be chosen; and when placed at 0°,prosthesis with ladder airfoil handle should be avoided to use,because of stress concentration easily could lead to a fractured in bone cement; Placed in the lean 6° level,prosthesis with cylindrical,square taper shank,cylindrical handle taper shank and column wing handle were suitable to be chosen.

Objective To discuss the clinical effects of open reduction and internal fixation with locking compression plate(LCP)to treat elderly women with comminuted distal radius fracture.Methods 32 elderly women(35 sides)with comminuted distal radius fractures were treated by open reduction and internal fixation with LCP from March 2002 to October 2004 in our department.Their mean age was 65 years old.According to AO classification,11 sides were type A3,15 sides type C2 and nine sides type C3.Volar approach was used in 32 sides and dorsal approach in three sides.Bone graft was applied for five sides.Results The follow-up period was 10 to 41 months(mean 21.5 months)and the union period was three to five months.According to Dienst criteria of joint functions,the result s showed that 13 sides were excellent,19 sides good,two sides fair and one side poor.Complications included wound dehiscence and superficial infection in five sides and median nerve injury in two sides.Conclusion The LCP method in this study is one of the good options to treat elder women with comminuted distal radius fractures.

Objective To explore a reasonable treatment for intertrochanteric hip fractures in the aged patients by comparing the fixation effects of cannulated compression screws and intramedullary fixation nails. Methods From January 1998 to December 2004, in our department 123 old patients with intertrochanteric hip fracture were fixed with cannulated compression screws or intramedullary nails. They were followed up and their complete clinic data kept. According to the Evans classification, of the 51 patients who received treatment with cannulated compression screws for their anterograde intertrochanteric hip fracture, 14 were type Ⅰ , 24 type Ⅱ , 10 type Ⅲ and three type Ⅳ , while of the 72 patients who received treatment with intramedullary nailing, 10 were type Ⅰ , 12 type Ⅱ , 28 type Ⅲ , 14 type Ⅵ , and eight retrograde intertrochanteric hip fractures. A retrospective comparison was made between the old patients treated with the two different fixation devices in terms of operative time, blood loss, transfusion, average hospitalization time, intraoperative and postoperative complications, functional recovery one year postoperatively and treatment expenses. Results The differences between the two groups in operative time, blood loss, transfusion, treatment expenses were of statistical significance (P0.05). Conclusions Cannulated compression screws should be chosen for old patients with anterograde intertrochanteric hip fractures of Evans types Ⅰ & Ⅱ or of Evans types Ⅲ & Ⅳ who are at a high risk, in a poor health or severely osteoporotic state. For patients with unstable Evans types Ⅲ & Ⅳ or with retrograde intertrochanteric hip fractures, intramedullary nails are suitable.

[Objective]To investagate the anatomic features in the approach to the brachial plexus in neck in order to make the exposure of brachial plexus more convenience and safer.[Method]Neck of six embalmed adult cadavers were made serial sectional specimens,which was observed to identify the border,composition and anatomic relation of fat layer between the superficial and deep layer of cervical fascia in the posterior triangle of neck with the brachial plexus.[Result]There was no branches of superficial cervical plexus in the fat layer between the superficial layer and deep layer of cervical fascia below the middle neck,in which there was no important structures except omohyoid muscle and transverse cervical artery.The deep layer of cervical fascia was dense and was directly superficial to the brachial plexus.[Conclusion]Exposure of brachial plexus in the neck would be more safe and convenience upon the understanding of anatomic relatiowship between cervical fascia and brachial plexus.