[Objective]To retrospectively analyze the therapy comparison between the unilateral hinged external fixator assisting the internal fixation, soft tissue repair and reconstruction and routine surgery for elbow instability of fracture dislocation.[Method]A total of 117 cases of elbow fracture dislocation were collected from Jan. 2001 to Jun. 2005. Some patients were treated by unilateral hinged external fixator, and others were treated by routine surgery and casting external fixation.The JOA assessment was applied for the pain, function, arc of motion, articular instability and deformity of elbow joint before surgery and after operational follow-up. [Result]Eighty-six cases were followed up by telephone and mail appointment.The average follow-up time was 18.6 months (from the range of 8 months to 30 months).The function and arc of motion of two group patients were assessed by JOA in post-operational follow-up, showing statistical significant difference (P0.05). The total assessment score between two groups indicates statistical significant difference.[Conclusion]The operation in combination with unilateral hinged external fixator for treating elbow instability of fracture dislocation will enhance lateral stability of elbows, guaranteen early safe elbow function exercises, facilitate stable environment for ligaments healing,suggesting a good subsidiary operational method.

[Objective] To study the clinical significance of the changes of 100 cases C-reactive protein(CRP)values and erythrocyte sedimentation rates(ESR)in patients with primary osteoarthritis before and after total hip and total knee replacement.[Method] A prospective study was designed to observe the changes of CRP leves and ESR in patients with primary osteoarthritis before and at 1~7 days,2 weeks,1,2,3,6,12 months after total hip and total knee arthroplasty.Ninty-two cases received follow-up.There are 35 males and 57 females with average of 64.7 years,ranging from 37 to 92 years.Sixteen had cementless total hip replacement(THR),32 had hybrid THR,7 had cemented THR and 37 underwent cemented to tal knee replacement(TKR).[Result]In both groups serum CRP level increased rapidly after surgery,peaking at day 2(THR 216.7 mg/L,TKR 257.3 mg/L),and dropping gradually to pre-operative values at the end of the first month in THR patients and at the end of the second month in TKR patients.ESR peaked at day 5 and 6 respectively after operation in THR and TKR patients(THR 93.2 mm/h,TKR 95.7 mm/h),dropping to pre-operative values at the end of the third month in THR patients and at the end of the ninth month in TKR patients.[Conclusion]Serum CRP levels changed more rapidly than ESR and returned to normal more rapidly.CRP and ESR values tended to be higher in TKR than in THR patients.CRP can reflect the status of inflammation.Dynamic observation can help diagnoze early infection.

[Objective]To determine the incidence and factors associated with pyrexia after total knee replacement(TKR).[Method]A retrospective review of 200 patients in departments of orthopaedics of our hospital and West China hospital who underwent TKRs from August 1998 and April 2006 was performed.The clinical,surgical and follow-up data were abstracted from the patients' records and were analyzed with SPSS 12.0.[Result]There was a statistically significant increase of the mean temperature post-operations,which remained significant throughout the first 7 days after surgeries(P

Objective To compare the effect of clustered acupuncture of the scalp combined with constraint induced movement therapy (CIMT) with that of conventional acupuncture of the body points plus conventional rehabilitation intervention after cerebral infarction using blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods Thirty acute cerebral infarction patients with hemiplegia were equally divided into two groups at random.The test group received the clustered acupuncture of the scalp combined with CIMT,while the control group received the body point acupuncture plus conventional rehabilitation intervention.Before and after two weeks of treatment,blood oxygenation level-dependent functional magnetic resonance imaging at 3.0 T was performed during a passive digital opposition movement.The volume and intensity of the activated areas were compared.Fugl-Meyer assessment (FMA) was carried out as well.Results The most pronounced activation appeared in the contralateral somatosensory motor cortex for both groups.There was no significant difference in average FMA scores between the two groups before the treatment,but after the treatment the averages were significantly different.An increase in activated volume and intensity in the contralateral SMC was observed in both groups after the treatment,but the test group showed a much larger change in both activated volume and intensity.Conclusion The clustered acupuncture of the scalp combined with CIMT can achieve a more significant improvement in functional recovery after acute cerebral infarction than conventional acupuncture of the body points plus conventional rehabilitation intervention.Such combined therapy is worthy of application in clinical practice.

The peak level of growth hormone (GH) stimulated by insulin tolerance test (ITT) is thegold standard for diagnosis of growth hormone deficiency in adults.This study was aimed to explore the factors influencing GH response to ITT in 50 healthy adults.The results showed that the nadir or decreased amplitude of blood glucose was not related to GH peak level.In multivariable analysis,the GH level stimulated by ITT was negatively associated with body mass index(P＜0.01),but there was no any association with age,gender,and waist circumference.

Objective To explore surgical opportunity and management of high-energy Pilon fractures.Methods Twenty-five cases of the high-energy Pilon fractures were treated with anatomic type plate one-staged or ses of type III fractures.8 cases were open fractures and 17 cases were close fractures.8 cases open fractures and 6 cases close fractures were treated with anatomic type plate one-staged.11 cases close fractures with serious soft tissue swell were treated two-staged delayed.The combined fibular fractures were fixed accordingly.All cases were followed up for 32 months after operation in average( range 17 to 76 months).Results According to Mazur's criteria,the surgical result was evaluated as excellent in 10 patients,goed in 11 ,fair in 3 and poor in 1.Postoperative complication ineluded infection in 2 cases,necrosis of skin in 1 case and traumatic arthritis of the ankle joint in 2 cases.Conclusion In order to get a satisfactory result,it is important to choose the right timing of surgery and correct procedure in high-energy Pilon fracture.

BACKGROUND: It was thought that there was no regeneration capacityin central nerves. Recent research shows that regeneration capacity of injured neural axons and recovery of some neurological functions can be achieved by changing local surroundings after spinal cord injury (SCI).OBJECTIVE: To probe into whether the transplantation of fetal olfactory ensheathing cells (OECs) in recovering the neurological functions of patients with chronic SCI is safe, feasible, and effective.DESIGN: Auto-control observation before and after surgery.SETTING: Neurological Research and Treatment Center of Beijing Xishan Hospital; Second Department of Neurosurgery in Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences; Second Department of Neurosurgery in Naval General Hospital.PARTICIPANTS: A total of 171 patients with chronic spinal cord injury were selected from the Second Department of Neurosurgery in Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences and the Second Department of Neurosurgery in Naval General Hospital betweenNovember 2001 and February 2003, of which there are 147 patients with complete injury and 24 ones with incomplete injury. Post-injury period ranged from 0.5 to 18 years. Process of treatment is discussed and permitted by relevant Medical Ethics Committees. Cells were obtained from voluntary donors and patients agreed to receive the treatment.METHODS: ① Fetal olfactory bulbs were cultured for 12-17 days after being digested into single cells. ② Fetal OECs were transplanted into sites rostral and caudal to the epienter. ③ Neurological functions of all patients 2-8 weeks before and after operation were evaluated according to the scoring standard of ASIA.MAIN OUTCOME MEASURES: ① Status of functional recovery in spinal cord of patients after transplantation of OECs. ② Harmful events and side effects.RESULTS: A total of 171 patients were involved in the analysis of results.①Status of functional recovery in spinal cord of patients with OECs transplantation: Partial neurological functions of 171 patients rapidly recovered,whose motor function score increased from (34.5±20.3) points before operation to (42.0±20.0) points (P ＜ 0.001) after operation, score of light touch increased from (47.2±24.0) points to (61.8±23.0) points (P ＜ 0.001) after operation,score of pain sense increased from (48.6±23.5) points to (64.0±22.8) points (P ＜ 0.001). ②Harmful events and side-effects: Early manifestations of spinal cord injury induced by infection in surgical area of one patient aggravated; two patients suffered from serious pulmonary infection,one patient from thalamic hemorrhage. Three patients mentioned above died of serious respiration and circulatory failures.CONCLUSION: OEC transplantation can rapidly promote partial neurological function of patients with chronic SCI, while the mechanism needs further observing.

ObjectiveTo determine whether transplanting olfactory ensheathing cells(OECs)is effective in controlling or re.versing the deterioration caused by amyotrophic lateral sclerosis(AtS). MethodsUetwcen February 2003 and April 2006,327 pa-fients(241 males and 86 females)with probable or definite ALS(diagnosed according to the El Escorial criteria)received dle oECstransplantation.Their ages ranged from 20 to 84 years(51.6±11.1 years).The duaration of sympltoms before surgical trealment wit84.8months to 13 years(2.9±2.0 years).OECs were cultured and.injected into palllological regions of the spinal cord and/or bilateralcoroila radiata of the brain;the patients were divided into three groups,group A(cord only,n=29),group B(cord and brain,,n=6),and group C(brain only,n=292)based on the transplant sites.ResultsThe patient's neurological function was assessedboth before and at4 weeks after transplantation by using the Amyolrophic Lateral Sclerosis Functional Rating Scale(ALSFRS)of the ALSCNTF Trealment Study(ACTS).The$cores were increased from 17.2±8.6 pre-operation to 20.1±9.7 post-operation in group A(P<0.05),from 24.2 4-6.8 to 25.7±6.6(P>0.05)in group B,and from 20.3±8.6 to 22.0±9.4(P<0.001)in group C.There were no significant difference inincreased ALSFRS scores amongthe three groups(P>O.05).The total improvement rate of neurological function was 77.1%(252/327).The result of electramyographic examination showed that spontaneous potential diminishedand/or disappeared,the amplitude of the motor unit action potential decreased remarkably andthe numbers of motor unitaction potentialgreatly increased in 261 cases(79.8%).Sixteen patients(4.9%)experienced the various complications including headache.short-term fever,seizure attack,central nerve system infection,pneumonia,respiratory failure,urinary tract infection,heartfailure,and pos-sible pulmonary embolism;of them,there were 4 deaths(1.2%). ConclusionThese preliminary results suggest that the OECs trasplantafion is effective in controlling or reversing the physiological deterioration caused by ALS.

Objective To explore the influence factors for the functional improvement after the fetal olfactory ensheathing cell (OEC) transplantation for chronic spinal cord injury(SCI). Methods The olfactory bulbs were harvested and trypsinized down to single fetal OEC. They were cultured for 12-17 days prepared for use. From November 2001 to December 2003, a total of 300 patients volunteered for the fetal OEC transplantation, among whom 222 suffered from complete chronic SCI and 78 suffered from incomplete chronic SCI. The procedures were performed on the patients with a disease course ranging from 6 months to 31 years (average 3.1 years) after their injuries. The fetal OEC was transplanted by the form of injections into the spinal cord at the upper and lower ends of the injury site. All the patients were assessed by the ASIA standard before the transplantation and 2-8 weeks after the transplantation. The influence factors including age, sex, duration after the injury, and injury degrees and levels were compared with those in the functional improvement after fetal OEC transplantation. Results The partially-improved neurological functions assessed by the ASIA standard were indicated by the motor scores increasing from 39.1±20.6 to 45.9±20.3 (P<0.001), the light touch scores from 51.7±24.9 to 63.4±23.0 (P<0.001), and the pin prick scores from 53.0±24.2 to 65.3±22.7(P<0.001). There was no significant difference in the functional improvement of the motor, light touch, and pin brick when compared with the age, sex, duration after the injury, and the injury degrees and levels. The motor scores and light touch scores at the cervical level were higher than the scores at the thoracic level. Conclusion The fetal OEC transplantation can partially improve the neurological functions quickly in treatment of the chronic spinal cord injury. All the influence factors except the motor scores and light touch scores, which were higher at the cervical level than at thoracic level, have no impact on the functional improvement after the fetal OEC transplantation.

BACKGROUND:Vertebral compression fracture is a common disease in the current orthopedic field.However,the occurrence of re-fracture in neighboring vertebrae after surgery is a problem that cannot be ignored,which has a serious impact on the normal life of patients. OBJECTIVE:The aim of this study is to establish four postoperative models with different recovery heights using computed tomography images.By using finite element analysis,we derived the stresses on the neighboring vertebrae at different recovery heights and further explored the importance of postoperative recovery of the height of the injured vertebrae. METHODS:A finite element model of the thoracolumbar spine(T11-L3)was established and validated,on the basis of which four postoperative finite element models of L1 with different recovery heights of 100%,80%,60%,and 40%were constructed,in which the cement capacity varied with the recovery height.The specific models are as follows:Model 1 was the postoperative model with normal recovery height,and the cement capacity was 8.3 mL.Model 2 was the postoperative model in which 20%of the anterior height of the L1 was removed and the posterior convexity angle became 10.41°,and the cement capacity was 6.9 mL.Model 3 was the postoperative model in which 40%of the anterior height of the L1 was removed and the posterior convexity angle became 20.17°,and the cement capacity was 4.7 mL.Model 4 was a postoperative model with 60%of the L1 anterior height removed and the posterior convexity angle changed to 28.85°,with a cement capacity of 3.6 mL.For evaluation of the postoperative model,we applied a moment of 7 Nm and an axial force of 500 N.The followings were recorded and analyzed:peak stresses in the L2 upper endplate and T12 lower endplate;peak stresses in the L2 and T12 cancellous bone. RESULTS AND CONCLUSION:(1)The highest peak stresses for each condition of the L2 upper endplate,T12 lower endplate,L2 cancellous bone,and T12 cancellous bone occurred in Model 1 and Model 4.In particular,the T12 lower endplate,except for the posterior extension condition,the anterior flexion,left and right lateral bending,and left and right rotation conditions all reached their highest peak stresses in Model 4,with stresses of 50.3,33.1,44.9,34.3,and 31.9 MPa.(2)Based on the peak stresses in the adjacent vertebral endplates and cancellous bone,after excluding Model 1 and Model 4,the minimum peak stresses for most of the conditions appeared in the Model 2,and the minimum peak stresses appeared in the Model 2 in 66.6%of the cases,especially in the upper endplates of the L2 and cancellous bone except for the posterior extension condition,the minimum peak stresses all appeared on the Model 2.(3)Therefore,controlling the recovery height at about 100%and 40%of the original height was a dangerous recovery height,which had a greater impact on the neighboring vertebrae.Controlling the recovery height at about 80%of the original height may be a more ideal choice.With a recovery height of about 80%of the original height,the adjacent vertebrae are subjected to less stress,thus reducing the risk of re-fracture of the adjacent vertebrae in the patient.