Objective To detect the level of granulation tissue and expression of matrix metalloproteinase-1,3(MMP-1,3) in the tissues originated from both herniated and non-herniated intervertebral discs. Methods Forty specimens of herniated lumbar disc and twelve specimens of non-herniated one were stained with hematoxylin-eosin to determine the amount of granulation tissue, and immunohistochemically stained to detect MMP-1,3 expression. Results In specimens of sequestration and transligamentous extrusion, the amount of granulation tissue including macrophages,fibroblasts and capillary was more than that in the specimens of subligamentous extrusion and protrusion as well as non-herniated disc. Most of cells in granulation tissue and chondrocytes had MMP-1,3 expression. The expression level of MMP1,3 in sequestration and transligamentous extrusion specimens was significantly higher than that in subligamentous extrusion and protrusion, and in herniated specimens was also significantly higher than that in non-herniated specimens.There was no significant difference in the MMP1,3 expression level between the sequestration and transligamentous extrusion, between subligamentous extrusion and protrusion. Conclusion The expression of MMP1,3 was associated with the degradation and herniation of intervertebral disc. MMP1,3 may be involved in the pathogenesis of intervertebral disc degeneration and herniation.

Objective The purpose of this study was to assess isokinetic strength of lower extremities and find out weak muscles in Chinese elite fencers. Methods Bilateral peak torque of flexors and extensors of hip, knee and ankle in 26 national fencers,aged 23.1±2.36 yrs,were tested isokinetically at speeds of 60 and 240 deg/sec. Results (1)Hip: compared with 60 deg/sec,peak torques of bilateral extensors significantly decreased at 240 deg/sec (P<0.05), no significant difference in flexors(P>0.05); At two velocities, flexor peak torques in leading leg of men fencers were significantly higher than trailing one(P<0.05),no significant difference was found in women(P>0.05);Flexor/extensor torque ratio was lower than normal at two velocities in all fencers. (2)Knee: strength of flexors and extensors in 60 deg/ sec and extensor in 240 deg/sec of men fencers were significantly different between leading and trailing legs (P<0.05); No difference at two velocities were found in women fencers;knee flexor/extensor ratio of both legs were 0.56,0.54 for women and 0.6,0.67 for men respectively at 60 deg/sec;knee flexor/extensor ratio were within normal range at 240 deg/sec. (3)Ankle:men's peak torque in leading ankle of flexor and extensor were significantly higher than trailing leg at 60 deg/sec(P<0.05);no difference were found at 240 deg/sec for men and women (P>0.05); ankle flexor/extensor ratio were lower than normal at two velocities in all fencers. Conclusion (1)Bilateral asymmetry in isokinetic muscle strength exists in men fencers,but not obvious in women fencers. (2)Weak muscles for fencers were hip extensor,knee flexor,especially in leading knee and ankle extensor.

[Objective]To evaluate the short-term and long-term effectiveness of the surgical technique of one-stage one-step surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and autograft bone graft fusion in the treatment thoraco-lumbar spinal tuberculosis with kyphotic deformity.[Method]The outcome of sixty eight cases suffered from thoraco-lumbar spinal tuberculasis with kyphotic deformity between July 1998 and March 2004 managed by the surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and antograft bone graft fusion through posteroiateral costotransversectomy or kidney incision was analyzed.All cases wer given a longitudinal study follow-up for a mean of 3.3(2.2~6.3)years postoperatively.[Result]All patients showed successful autograft bone graft fusion.Among 45 cases accompanied with neurotic symptom of Potts paraplegia,25 were completely recovered,15 were partly recovered,total the ratio of recovery was 88.89% at the end of postoperative follow-up.The average immediate postoperative correction of kyphosis angle was 28.9?,the average loss of correction was only 2.7? at final follow-up.[Conclusion]The surgical technique of one-stage one-step Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debrideraent and autograft bone graft fusion is found helpful in strengthening the stability of the spine in thoraco-lumbar spinal tuberculosis with kyphotic deformity,providing successful interbody fusion and recovery of Potts paraplegia,correcting the kyphosis,and preventing progress of kyphosis.

Objective:To modify Ganodermalucidum polysaccharides(GLP) with sulfate and observe the protective effect of Ganodermalucidum polysaccharide sulfate (GLPS) on the cerebral ischemia reperfusion injury in the rats,and to investigate its mechanism.Methods:GLP was modified by sulfation to obtain GLPS.A total of 100 SD rats were randomly divided into sham operation group, model group, GLP group (40 mg·kg-1·d-1), GLPS group (40 mg·kg-1·d-1) and nimodipine group (1 mg·kg-1·d-1).The cerebral ischemia reperfusion models were established by middle cerebral artery occlusion method in the rats.The neurologic deficit score and the content of water in brain tissue of the rats with cerebral ischemia reperfusion injury were detected and the activities of superoxide dismutase(SOD) and the levels of malondialdehyde (MDA) were detected.The levels of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB),tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) in the brain tissue homogenate were detected by ELISA.Western blotting method was used to detect the protein expression levels of HSP70 and p-Akt in the brain tissue of the rats.Results:Compared with model group, the neurological function scores of the rats in GLP group and GLPS group were decreased(P<0.01),the water contents in brain tissue were decreased(P<0.05), the SOD activities were increased and the MDA levels were decreased(P<0.05), and the levels of NF-κB, TNF-α, IL-1 and IL-6 were decreased(P<0.05);the effect in GLPS group was significantly better than that in GLP group(P<0.05).The results of Western blotting method showed that the p-Akt protein expression levels in the brain tissue of the rats in GLP and GLPS groups were increased compared with model group (P<0.05);compared with model group, the HSP-70 protein expression level in the brain tissue of the rats in GLPS group was increased(P<0.01),but the effect in GLP group was not obvious.Conclusion:Sulfation can significantly improve the protective effect of GLP on the cerebral ischemia reperfusion injury in the rats and its mechanism may be related to regulating the HSP70/PI3K/Akt signaling pathway and inhibiting the inflammatory reaction damage to the nerve cells of reperfusion.

Objective To evaluate retrospectively the hemiarthroplasty in the treatment of severe comminuted intraarticular fractures of the proximal humerus.Method Thirty one patients suffered from severe comminuted intraarticular fractures of the proximal humerus were treated with shoulder hemiarthroplasty through Thompson approach from March 2000 to October 2004.The results were graded into the excellent,the good,the fair and the poor according to the scoring system-modification for hemiarthroplasty(SSMH) of Los Angeles California,USA(UCLA) basing on shoulder paining,functional status muscle strength and range of motion.Rusults The average operative time cost 65 minutes(ranged from 40 to 90 minutes),average amount of bleeding during operation were 280 ml(ranged from 200 to 350 ml).The patients exercised early postoperatively.After an average duration of 14.1 months of follow-up(ranging from 5 to 42 months),there were no infection and/or nerve damage occurred postoperatively,and the position of the prosthesis was confirmed to be excellent,moreover no lessening prosthesis,prosthesis dislocation,and/or prosthesis milieu fractures occurred radiographically.The outcomes of the treatment were excellent in 13,good in 14,fair in 3 and poor in 1 out of the 31 cases. The rate of both the excellent and the good were 87.10%.Conclusion Shoulder hemiarthroplasty is a preferable technique in the treatment of severe comminuted intraarticular fractures of the proximal humerus.

Primary hyperparathyroidism (PHPT) is a disorder of calcium metabolism, which is characterized by elevated blood calcium and PTH urine calcium, which is easy to involve multiple systems. The disease is mainly caused by a benign adenoma of parathyroid tissue, a few of which are parathyroid hyperplasia or parathyroid adenocarcinoma. As awareness of physical examination increased, the proportion of asymptomatic PHPT patients gradually increased. The disease can be cured by surgical resection of the parathyroid gland, most of which is a real good prognosis, but a few of them are complex and difficult to diagnose and treat. At present, there continue to be many controversies about the diagnosis and treatment of PHPT.This article is a review of the progress in the diagnosis and treatment of PHPT.

BACKGROUND: As it results in minimal trauma and physical influence or interference, and a better curative effect, the minimally invasive surgery is preferred in clinic. However, the perioperative stress reaction of minimally invasive surgery needs further study.OBJECTIVE: To evaluate the levels of neurohormone, C-reactive protein (CRP) and the changes of resting energy expenditure (REE) resulted from the operative stress reaction due to minimally invasive surgery in arthroscopy on knee joint.DESIGN: Controlled observation and analysis.SETTING: Department of Orthopaedics, Affiliated Hospital of Xiangnan University and Department of Orthopaedics,Xiangya Hospital of Central South University.PARTICIPANTS: Sixteen patients with meniscal lesions in knee and 26 with cruciate ligament injury, which were closed injury, were selected from the Department of Orthopaedics of Affiliated Hospital of Xiangnan University and Xiangya Hospital of Central South University between January 2003 and April 2004. Meniscal lesions were diagnosed according to the physical examination, drawer test combined CT and MRI examination, and the patients were in accordance with the indication of arthrotomy; cruciate ligament injury according to the physical examination, grinding test combined CT and MRI examination. Those with open injury, body multiple injury, combined injury and emergency operation were excluded. Ten patients with meniscal lesions and 12 with cruciate ligament injuries underwent minimally invasive surgery on knee joint as minimally invasive surgery group (MIS). The others were given traditionally invasive surgery on knee joint as the traditional group. The informed consent was obtained from the patients.METHODS: Fasting venous blood was taken on the morning of 1 day before, and 1 and 3 days after operation, which was analyzed within 2 hours after sampling. ①All hormones were quantitatively assayed. Serum insulin was determined by competitive radioimmunoassay (RIA); growth hormones levels by double-antibody RIA; serum cortisol by competitive RIA; CRP by nephelometry, respectively. ②Energy metabolism detection: The energy consumption was assessed by indirect calorimeter on the morning of 1 day before, 1 day and 3 day after operation, respectively. All the detection was performed by medical graphics critical care monitor desktop analysis system. Based on the indirect calorimeter theory,REE and respiratory quotient (RQ) were figured out.MAIN OUTCOME MEASURES: ①Concentrations of insulin, growth hormones and cortisol of patients at 1 day before, 1 day and 3 day after operation; ②Resting energy consumption, RQ and CRP of patients at 1 day before, 1 day and 3 day after operation.RESULTS: Totally 42 patients were involved in the result analysis. ①On the third postoperative day, the insulin levels of the traditional group were lower than those before operation [(12.4±1.1), (17.5±2.2) mlU/L, P ＜ 0.05]; On the first postoperative day, the levels of growth hormone of the traditional group were significantly higher than the MIS group [(2.8±0.9), (5.3±2.4) μg/L, P ＜ 0.05], and on the third day after operation, the levels of the MIS group were remarkably increased compared with those before operation [(1.4±0.5), (1.0±0.3) μg/L, P ＜ 0.05]; the cortisol levels of the traditional group on the first postoperative day were higher than the MIS group [(1.12±0.25), (0.59±0.11) μmol/L, P ＜ 0.05]. ②REE levels of the traditional group and MIS group on the first day after operation were(1437.8±415.9) and (1223.8±179.9) K,higher than those before operation [(1 186.4±297.4), (1 160.7±158.6) K, P ＜ 0.05]; on the first and third days after operation, REE levels of the MIS group were higher than the traditional group [(1 223.8±179.9), (1 151.7±150.8) K;(1 437.8±415.9), (1 329.4±350.5) K, P ＜ 0.05]. ③RQ of the traditional group and MIS group on day 1 after operation were all (0.8±0.05), lower than that before operation (0.9±0.11, 0.9±0.15, P ＜ 0.05). ④On the first and third days after operation, CRP of the MIS group were lower than the traditional group [(14.8±2.5), (34.37±7.5) mg/L; (64.1±14.4),(93.87±12.7) mg/L, P ＜ 0.05], but higher than that before operation [(8.0±0.11) mg/L, P ＜ 0.05].CONCLUSION: Minimally invasive surgery on knee joint results in less trauma, low stress reaction and slight influence on metabolism of patients, moreover, it benefits the restoration of stress hormones, nitrogen balance and energy metabolism.

OBJECTIVE: To retrospectively evaluate the effect of locking compression plate (LCP) combined with scaled cancellous bone graft on postoperative nonunion of humeral shaft fracture. METHODS: A total of 19 cases with postoperative nonunion of humeral shaft fracture were collected from Department of Orthopaedics, Affiliated Hospital, Xiangnan University between August 2005 and January 2009. There were 12 males and 7 females, aging 28-59 years with the mean age of 36 years. All patients were treated with LCP fixation combined with scaled cancellous bone graft. The key points of the operation were as follows: beck-median or lateral approach, protection of the radial nerve and ulnar nerve, removal of the cicatrix, reopening of humeral canal, and limited periosteum striping. For minimally invasive plate osteosynthesis technique, length of LCP was appropriate, 3-4 locking screws at least were used on either stump, and double cortices were penetrated with locking screws and treated with scaled cancellous bone graft. RESULTS: All the fractures healed with a mean period of 7.2 months (from 6 to 8 months). Two cases showed temporary radial nerve palsy after the operation, which gradually recovered 3 and 6 weeks, respectively after appropriate treatment. Shoulder and elbow functions were somewhat impaired in 7 cases, but the dysfunction could not influence daily living. Infection, screw loosening, blade plate breakage, and other complications were not found. CONCLUSION:The integrity of locking screws and plate prevents screw breakage and plate loosening. The combination of autoallergic cancellous bone graft and scaled decorticating technique can improve healing of humeral shaft fracture.

This study was aimed to explore pharmacological effects of epimedium pubescen flavonoid (EPF) on biomechanical properties among ovariectomized rats. Sixty female Sprague-Dawley (SD) rats (aged 2-month-old) were randomly divided into six groups (n = 10), which were the sham control group (Group A), the model group (GroupB), the standard group (Group C), the treated 1 group (Group D), the treated 2 group (Group E), and the treated 3 group (Group F). Except the sham control group (Group A), rats in other groups had been ovariectomized. All rats were given the same feedstuff. Meanwhile, Group C was given calcium 75 mg·kg-1 combined with VitD3 21 IU·kg-1 by gastrogavage every day for 4 months; Group D was given EPF 75 mg·kg-1; Group E was given EPF 150 mg·kg-1;Group F was given EPF 300 mg·kg-1. At the end of the 4th month, all rats were sacrificed. Bones, which included tibia, femur and humerus of both sides and all lumbar vertebra bodies, had been taken out. Measurement was made on the elastic modulus, maximum loading capability, maximum stress, potential energy of deformation, and structural rigidity of biomechanical properties of the fourth lumbar vertebra body (LV4); the maximum loading capability, bone break load, potential energy of deformation, structural rigidity of the structural dynamics properties of the femur com-pact bone; the elastic modulus, maximum stress, maximum inherent strain, bone break stress, and bone break strain of the mechanical properties of a material of the femur compact bone in the experimental rats. The results showed that compared with Group B, the elastic modulus, maximum loading capability, maximum stress, potential energy of deformation, and structural rigidity of LV4; the maximum loading capability, bone break load, potential energy of de-formation, structural rigidity of the structural dynamics properties of the femur compact bone; the elastic modulus, maximum stress, maximum inherent strain, and bone break strain of the mechanical properties of a material of the fe-mur compact bone were obviously increased in Group A, D, E and F (P< 0.05). Group C had increasing tendency. There were no statistical differences among Group A, C, D, E and F. Group D, E, and F had increased with EPF dose-dependently. However, there were no statistical differences among them. There were no statistical differences on bone break strain of the mechanical properties of a material of the femur compact bone among Group A, C, D, E, and F. It showed that ovariectomization reduced the biomechanical properties of vertebra bodies, structural dynamics properties of the femur compact bone, and the mechanical properties of a material of the femur compact bone. The application of EPF can effectively prevent and treat the decreasing of biomechanical properties of ovariectomized rats, so as to keep them in a relatively higher level.

Objective:To prepare the velvet antler polypeptide-collagen/chitosan composite materials,and to investigate its promotive effect on cicatrization of mandibular defect and possible mechanism.Methods:The collagen and chitosan solution were mixed.The composite material was prepared by glutaraldehyde crosslinking method.The microstructure of the composite material was observed by transmission electron microscope (SEM).The unilateral mandibular defect models of 36 rabbits were established.The rabbits were divided into experiment and control groups,and each group was divided into 4-,8-and 12-week subgroups,and there were 6 rabbits in each sub group.The rabbits in experiment group were implanted with velvet antler polypeptide-collagen /chitosan composite materials and the rabbits in control group were treated.4,8 and 12 weeks after operation,the histology of bone defect and peripheral nerve reconstruction of the rabbit models were detected by CT;the expression of vascular endothelial growth factor (VEGF) in bone tissue of the rabbits was detected by immunohistochemistry;the ultrastructure of bone defect was observed by SEM.Results:The structure of composite materials had layered folds and the inner diameter of the stent became larger and mainly dominated by sheet structure,which was the ideal structure of biological materials.4 weeks after operation,the new bone was formatted in experiment group,most of the new bone like-tissue materials were degraded,and the VEGF expression showed an increasing trend;8 weeks after operation,the trabecular bone in the bone defect of the rabbits in experiment group was increased obviously and the expression of VEGF was decreased.12 weeks after operation,the new bone formation and the density in experiment group was consistent with the normal tissue,and the expression level of VEGF returned to normal.At each the point after operation,the degree of bone defect healing and bone formation rate in experiment group were obviously prior to control group.Conclusion:Velvet antler polypeptide-collagen /chitosan composite material has the promotive effect on the fracture healing of mandibular defect of the rabbits and its possible mechanism may be related to promoting the expression of VEGF.