Objective To investigate the changes of hemodynamics,cardiac troponin T(cTNT) and CK-MB zymogram perioperatively in elderly patients receiving off-pump versus on-pump coronary artery bypass grafting (CABG).Methods Totally 40 elderly patients (age＞65 years) undergoing surgical revascularization in our hospital were reviewed.20 patients were received off-pump coronary artery bypass grafting (group A),20 patients received on-pump surgery (group B).The cardiac output index (CI) and systemic vascular resistance index (SVRI) of each patient were recorded at the time of preoperative (T1),surgery completion (T2) and first day after surgery (T3).cTNT and CKMB of all patients were detected perioperatively.Results The level of CI was increased after operation,whereas CI of group A in T2 was significantly higher than that of group B [(3.92±0.43) L· min-1 · m-2 & (3.81±0.52)L · min 1 · m-2,t=2.036,P＜0.05).SVRI was decreased after operation,there was no difference between the two groups during the same time (P＞0.05).The levels of cTNT and CK-MB were within normal range before operation,whereas enhanced immediately after operation and returned to normal within the 7th day.The level of CK-MB in group B after operation was higher than that in group A [(11.8±4.4)tμg/L vs.(8.4±4.3)μg/L,t=2.214,P＜0.05) ；The level of cTNT in group B at 1st day after operation was increaesd compared with that in group A [(0.23±0.12)μg/L vs.(0.l1±0.09)μg/L],t=2.189,P＜0.05).Conclusions Both off-pump and on-pump CABG could improve the cardiac output and get approving myocardial protection effects in elderly patients,the effect of off-pump CABG might be superior to that of onpump CABG comparatively.

ObjectiveTo investigate the effect of different cyclic strengths on expressions of phospholipase A2 (PLA2) and cyclooxygenase (COX) in human tenocytes.MethodsHuman tenocytes were uniaxially stretched with different stretching intensity (4％, 8％ and 12％) under 0.5 Hz for four hours.Non-stretched tenocytes were applied to the control group.The expressions of cytosolic PLA2(cPLA2), COX1 and COX2 were measured by Western blot and RT-PCR.The secretion of secretory PLA2 (sPLA2) was measured by ELISA.Results The mRNA expressions of cPLA2, COX1 and COX2 in control group, 4％, 8％ and 12％ stretch groups showed an increase trend.But protein expressions of cPLA2 and COX1 in 4％ stretch group were increased insignificantly compared with the control group (P ＞ 0.05).Protein expressions of cPLA2 and COX1 in 8％ and 12％ stretch groups were increased more significantly compared with the control group (P ＜ 0.01).The COX2 expression in 4％,8％ and 12％ stretch groups showed statistical difference compared with that in the control group (P ＜0.01) and the difference increased with stretch intensity.There was no different expression of sPLA2 between 4％ stretch group and control group (P = 0.260).However, expression of sPLA2 was increased markedly in 8％ and 12％ stretch groups (P ＜ 0.01).ConclusionsThe expressions of human tendnocytes PLA2, COX1 and COX2 in vitro are positively correlated with stretch intensity.PLA2/COX system may be a new molecule target in clinical treatment of tendinopathy.

ObjectiveTo evaluate the clinical results of minimally invasive ankle arthrodesis with percutaneous cannulated screws.MethodsBetween April 2005 and October 2010, 12 patients with the ankle arthrodesis for unilateral severe arthritis (Kellgren-Lawrence class Ⅲ) were prospectively analyzed, including 2 cases of rheumatoid arthritis, 8 cases of post-traumatic arthritis, and 2 cases of osteoarthritis. There were 7 males and 5 females with an average age of 42.0 years(range, 25-7 1). The average disease duration was 7.3 years (range, 1-21). The anterior median incision of 3.0-5.0 cm was made to explore the ankle joint.The cartilage of tibial-talus joint was completely debrided. Two guide pins were inserted from posterosuperior to anteroinferior, and cannulated screws were implanted to fix ankle joint. All patients were physically examined with an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Scales. Ankle fusion in all patients was evaluated by clinical examination, and conventional radiography including anterior-posterior, lateral and mortise views of the ankle. ResultsAll 12 patients were followed up postoperatively for an average of 21.5 months(range, 6-55), and were proved be bone union by clinical examination and radiology with a mean of 13.5 weeks (range, 9-21). The AOFAS rating scale improved from a mean of 42.8±8.6 points at pre-operation to a mean of 66.6±5.4 points at post-operation 6 months,showing significant difference(t=-3.075, P=O.012), and to a mean of 72.3±4.6 at the final follow-up, also showing significant difference with pre-operation (t=-8.595, P=-0.006). There was no infection,local skin necrosis, screw loosing, and so on. ConclusionThe minimally invasive ankle arthrodesis with percutaneous cannulated scews is a recommend procedure, with mini-invasion, short surgery time, high fusion rate, good clinical outcomes, few complications.

Objective To describe a new technique with mini-open reconstruction of lateral ligaments of ankle with partial tendon of its peroneus brevis and evaluate its effect in treatment of chronic lateral ankle instability. Methods A total of 11 cases of chronic lateral ankle instability;at mean age of 27.6 years(16-42 years),were treated with mini-open reconstruction of the lateral ligaments of the ankle with partial tendon of its peroneus brevis.The mean delay between the initial episode of ankle sprain and the surgery was 10.3 months(4-32 months).Postoperatively,all cases were examined with MRI,stress X-rays and comparative stability of bilateral ankle inspection at clinical follow-up.The function of the ankle were evaluated bv American Orthopaedic Foot & Ankle Society (AOFAS)score and ankle-hind foot scale. Results The average duration of follow-up was 17.5 months(12-37 months).The mean AOFAS ankle-hindfoot score was 88.3 points(72-96 points)at the time of the latest follow-up,including excellent result in 6 cases(55%),good in 4(36%)and fair in 1(9%).MRI results showed that the ruptured lateral collateral ligaments of the ankle were repaired and remodeled very well in all patients.There was no recurrence of the ankle instability or other complications. Conclusion Mini-open reconstruction of the lateral ligaments of ankle with partial tendon of its peroneus brevis is safe and effective for treatment of chronic lateral ankle instability.

Objective To investigate effects of acute normovolemic hemodilution (ANH) used in coronary artery bypass graft (CABG) surgery in elderly patients.Methods 60 elderly patients (aged ≥65 years) received CABG surgery under cardiopulmonary bypass,of which 30 patients using ANH techniques and 30 patients without ANH techniques.Results All patients were revascularized completely with stable surgical procedure,no serious complications and no operative mortality were found.Oxygen supplying was balanced with demanding,without tissue hypoxia.Indicators of the myocardial protective effect,coagulation,liver function,kidney function,glucose metabolism,negative nitrogen balance,and postoperative drainage volume were not significantly different between the two groups (P＞0.05).Allogeneic blood transfusion volume was significantly lower in study group than in control group[(0.9±0.9)U vs.(2.5±1.2)U,t=2.704,P＜0.01].Conclusions The ANH technique used in CABG operation in appropriate elderly patient is feasible and safe,with satisfactory clinical results.

Objective To retrospectively analyze the clinical results of peroneal tendon insertion and reconstruction with suture anchors in the treatment of avulsion fractures of the fifth metatarsal base.Methods Five patients (three males and two females) with the fifth metatarsal base fractures were in zone 1, with average seven days of duration before surgery. The result of radiological examination confirmed that all fractures were in zone 1 of the fifth metatarsal base, with some small, comminuted and obviously displaced pieces. After removal of the small comminuted fracture pieces, the peroneal tendon insertion was dissociated and sutured to the fifth metatarsal base by suture anchors (5 mm in diameter) with line. The feet were immobilized by plaster in the vagus position. The patients began to walk with weightbearing six weeks after operation. Results All patients were followed up for at least six months, which showed no deformity of the feet. The function of forefoot valgus and abduction restored to normal. There was no any loss in muscle force compared with the normal side. Conclusions Peroneal tendon insertion and reconstruction by suture anchors is very helpful to solve the problem in the fixation of the small fracture fragments. The function of the peroneal tendon recovers very well. The surgery has the advantages of easy manipulation and small area of dissection, without requirement of secondary surgery.

Objective To investigate effects of acute normovolemic hemodilution(ANH) used in on-pump coronary artery bypass graft(CABG) surgery.Methods 60 patients had received CABG surgery under cardiopulmonary bypass,of which 30 patients using ANH techniques and 30 patients using no ANH techniques.A series of index were observed and compared between the two groups after operation.Results All patients had been revascularized completely with stable surgical procedure,no serious complications,no operative mortality.Oxygen supplying was balanced with demanding,without tissue hypoxia.Indicators of myocardial protective effect,coagulation,kidney function,degree of systemic inflammatory reaction and postoperative drainage volume were not significantly different between the two groups(P ＞ 0.05).Allogeneic blood transfusion volume of the study group was significantly lower than that of the control group [(1.1 ± 0.8) U vs.(2.3 ± 1.1) U,P ＜ 0.05].Condusion The ANH technique used in CABG operation on appropriate patient is feasible and safe,with satisfactory clinical result.

Objective To investigate the clinical outcome of arthroscopic percutaneous cannulated screw fixation with subtalar fusion in the treatment of post-traumatic subtalar arthritis. Methods The study involved 12 patients (five males and seven females) with severe post-traumatic subtalar arthritis admitted to our hospital from April 2006 to December 2009. The patients were at age range of 28-68 years ( mean 45.6 years). All patients had the history of conservative treatment but failed in pain alleviation.Then, the percutaneous cannulated screw fixation plus subtalar fusion was selected. The ande and hind foot of all patients were evaluated preoperatively and postoperatively by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Imaging assessment was carried out by X-ray examination.Results The patients were followed up for mean 21.2 months (range 6-48 months), which showed thatthe mean AOFAS ankle-hindfoot scale was increased from (54.67 ± 5.28 ) points (range 43-61 points)preoperatively to (89.17 ±3.56) points (range 78-95 points) at final follow-up, with excellence rate of 93%. Eleven patients got good fusion with the mean time of 12.4 weeks (range 9-15 weeks). Only one patient had nonunion, with the pain in the lateral malleolus. The subtalar joint of the patient got union after plaster immobilization for three months, which was proved by X-ray examination. Conclusions The arthroscopic percutaneous cannulated screw fixation and subtalar fusion can acquire good clinical outcomes and hence is a recommended procedure for post-traumatic subtalar arthritis.

Objective To introduce a new modified Bristow operation with mini-open incision and evaluate jts clinical outcomes in treatment of recurrent anteroinferior shoulder dislocation. Methods A total of 11 patients with recurrent anteroinferior shoulder dislocation were treated with modified Bristow op-eration with mini-open incision.The anterior skin incision with 3-5 mm was made to explore the coracoid process with"moving window"technique.Then.the coracoid process and its short head of biceps were os-teotornjed.transferred and fixed on the anteroinferior potion of scapular neck through the rotator cuff inter-space.All patients were followed up for an average period of 15.8 months(6-48 months)by using modified Rowe score. Results The average operation time was 45 minutes(40-65 minutes).The modified Rowe 8core ranged from 80 to 95 points.excellent in all patients, with SUCCESS rate of 100% and without any re-currence or complication. Conclusions Compared with traditional operation.the modified Bristow oper-ation has smaller incision,less trauma.shorter operation duration and better clinical results.

Objective To evaluate the clinical results of proximal humeral internal locking sys-tem(PHILOS)self-locking plates in treatment of proximal humeral fractures. Methods There were 35 patients including 19 males and 16 females(at mean age of 53.5 years,ranging from 29 to 92 years)with proximal humeral fractures treated with PHILOS plate.According to the Neer's classification sys-tem,there were two-part fractures in 19 patients,three-part fractures in 15 and four-part fractures in 1.Surgery was performed with PHILOS serf-locking plate via dehopectoral approach.All patients were fol-lowed up for mean 18.9 months(6-46 months)and evaluated by using Constant score and X-rays. Re-suits X-rays proved that all fractures got good reduction and complete healing during 8-12 weeks.The latest Constant scores was mean 89.5 points(82-94 points).There were no complications including plate loosing.humenral head necrosis or gleno-humeral ioint osteoarthritis. Conclusion PHILOS plate is a good choice for treatment of proximal humeral fractures because of its advantages including easy operation,stable fixation,good clinical results and few complications.