ObjectiveTo identify the reasons of missed diagnosis with ankle sprains by analyzing OAR in order to guide the rational use of OAR.MethodsOutpatient with sprained ankles were recruited from the surgical clinic in Sichuan Luzhou Medical College from Mar.2005 to Mar.2010.OAR was used for clinical diagnosis of ankle sprains.The accuracy of OAR diagnosis was examined within 24 h and at 15 d by X-ray.ResultsIn the 105 cases of ankle sprain,16 cases was diagnosed of fractures by OAR.X-ray results showed I case of missed diagnosis,with the rate of missed diagnosis of 6.2％.While both OAR and X-ray diagnosed 21 cases in 50 patients with sprained foot fractures,with a rate of missed diagnosis of 0.Conclusion OAR diagnosis for ankle sprains and fractures has high success rate although with the possibility of missed diagnosis which needs attention clinically.

Objective To investigate the efficacy of normative ankle balance training on chronic ankle instability (CAI).Methods Ninety patients were randomized into control group (17 males,28 females;13-26 years,mean 19.6 years) and experiment group (18 males,27 females;14-27 years,mean 20.3 years) according to the random number table.There were 19 left ankles and 26 right ankles injured in control group,and 19 left ankles and 26 right ankles injured in experiment group.Patients in control group only completed routine muscle strength training.Besides the routine muscle strength training,balance training (rubber band,spongy cushion,balance pedal,rubber balance ball and jump ball) were added in experiment group.The two groups were compared with respect to foot and ankle disability index (FADI),anterior,posterior-median and 45° to posterolateral direction reach distance of star excursion balance test (SEBT) and visual analogue score (VAS).Results After training,comparison of experiment and control groups showed significant differences in FADI (35.16 ± 3.23 and 22.33 ± 1.36),SEBT distance in posterior median direction [(78.59 ± 7.22) ％ and (71.89 ±7.11)％],SEBT distance in 45° to posterolateral direction [(75.79 ± 8.27)％ and (68.95 ±8.03) ％] and VAS [(3.01 ± 0.91) scores and (3.42 ± 1.02) scores] (P ＜ 0.05).For intragroup comparison,FADI,SEBT and VAS in experimental group showed significant differences before and after training (P ＜ 0.05),but only FADI in control group differed significantly before and after training (P ＜0.05).Conclusion Normative balance training can improve CAI patients' self-feelings of dynamic balance and instability with satisfactory therapeutic efficacy,and is worthy to be popularized.

BACKGROUND:Both microfracture and osteochondral transplantation are effective tools in the clinical treatment of articular cartilage defects.
OBJECTIVE: To observe the implementation results of microfracture and osteochondral transplantation in the treatment of articular cartilage defects.
METHODS:The clinical data of 50 cases (50 knees) of articular cartilage defects were retrospectively analyzed. There were two groups according to surgical repair methods: autogenous osteochondral transplantation+ microfracture in observation group (n=25), and microfracture in control group (n=25). Patients in the two groups were folowed up for over 24 hours to compare the Hospital for Special Surgery scores, clinical efficacy, adverse effects and complications.
RESULTS AND CONCLUSION:The number of patients whose Hospital for Special Surgery score was > 85 points and 60 to 85 points in the observation group was significantly larger than that in the control group (P< 0.05), and the total treatment effective rate of patients in the observation group was significantly higher than that of the control group (92%vs. 60%,P < 0.05). No complications occurred in both two groups. These findings indicate that osteochondral transplantation has better implementation results in the treatment of articular cartilage defects than microfracture.

Orthopedic implants are commonly clinically used to treat intertrochanteric fracture.The treatment efficacy is related with their biocompatibility and biomechanical characteristics.This paper compared various biological,physical,and chemical reactions between implants and host and analyzed the problems based on the clinical practices.

Objective To observe the analgesic effect of COX-2 inhibitors combined with PCA in treatment of the pain after total knee arthroplasty(TKA)and explore novai method for pain control after TKA. Methods This study was,a double blind,controlled,randomized,placebo-controlled,parallelgroup and single center study and obtained the consent of the Medical Ethics Committee of Chongqing Medical University.Inclusion criteria:the patients with severe trauma or degenerative knee,at age of 58-75 vears.ASA Ⅰ or Ⅱ, tolerance of the intravenous anesthesia.The same solvent formula of PCA was routinely prepared based on body weight after TKA.Intravenous injection of 40 mg Parecoxib plus 2 ml normal saline or injection of only 2 ml normal saline was done when closing the incision.which was recorded and prescribed by the researcher A.The same reagent waft,used continually every other 12 hours till48 hours.Celecoxib or placebo capsules was not usod orally at 72 hours until two weeks later.The knee ioint function was observed preoperatively and at days 3,7 and 15 after TKA. Results The study was completed in 60 patients including 30 patients in the group treated with Parecoxib and Celecoxib sequential therapy and 30 patients in placebo-control group.There was no statistical difference in aspects of general condition in both groups(P>0.05).There was no statistical difference in aspect of preoperative knee score between two groups(P>0.05).The analysis showed statistical difference in the knee function score at days 3.7 and 15 after operation(P<0.05 or0.01).Conclusions The COX2 inhibitors combined with PCA has definite analgesic effect on the pain after TKA,which positively correlates with early modified HSS evaluation of TKA.

The current development of medical sciences focuses simply on the progress of natural sciences,while neglects the combination with humanities and social sciences,which leads to the absence or lack of medical humanistic spirit.This paper analyzes the absence of medical humanistic spirit contrasted by the rapid development of medical high-tech,the manifestations and reasons for the absence of medical humanistic spirit,and proposes to strengthen the humanistic quality of medical science education in order to solve problems brought by absence of medical humanistic spirit.

Objective To observe the effect of bone marrow-derived mesenchymal stem cells (bMSCs) on graft healing within a bone tunnel after anterior cruciate ligament (ACL) reconstruction in rabbits.Methods The study involved 24 New Zealand white rabbits undergone ACL reconstruction with an autologous ipsilateral gastrocnemius tendon graft.Both hindlimbs were included.In one hindlimb,graft coated with fibrin glue compound by bMSCs was employed (bMSCs group).Whereas in the contralateral hindlimb,graft coated with fibrin glue without cells was employed (control group).At postoperative 2,4,6 and 8 weeks,specimens were harvested to have a biomechanical test of tensile strength and stiffness of tendon-bone interface.Results Tensile strength and stiffness of tendon-bone interface in both experiment and control groups presented a rising trend with the prolong of repair time.In contrast,significantly higher tensile strength and stiffness of tendon-bone interface were observed in experiment group since the 6 weeks (P ＜ 0.05).Conclusion bMSCs transplantation significantly enhances the early tensile strength and stiffness at tendon-bone interface after ACL reconstruction in rabbits and improves the graft healing within a bone tunnel.

Objective To use estimation of physiologic ability and surgical stress (E-PASS) to assay operative risks in patients with hip fracture and to discuss its application value.Methods Sixtyfour patients with hip fractures were subjected to the retrospective review.There were 38 males and 26 females,at mean age of 54.3 years (range,19-84 years).The operative risk was assayed by E-PASS and postoperative complications as well as case fatality were detected and compared.Results Postoperative complications developed in 16 patients (25％).E-PASS score was significantly higher for the patients with postoperative complications than in those without [(0.64 ± 0.31) points vs (0.22 ± 0.31) points,P ＜ 0.05].Incidence of complications was significantly lower for patients with a E-PASS score ＜ 0.6 than for those with a E-PASS score ＞ 0.6 (19％ vs 50％,P ＜ 0.01).There were 2 deaths among 16 patients with a E-PASS score ＞ 0.6.The remaining 48 patients with a E-PASS score ＜ 0.6 obtained satisfactory recovery.Conclusion E-PASS is effective for predicting operative risk and is instructive for surgery decision in treatment of hip fractures.