Objective The present was to report the methods of arthroscopic reconstruction of poste-rior cruciate ligament by a two-strand semitendinosus tendon autograft and evaluate its clinical results.Method From June1998through June2002,28cases had undergone arthroscopic restoration of a torn pos-terior cruciate ligament,including22female and6male patients with an average age of21years(range,18to31years).The time-interval between the sustained injury and the surgery was25days to3months.The causes of injury of posterior cruciate ligament were sport activity in6cases,traffic accident in18cases and fall down in4cases.All of the patients suffered from knee pain,knee laxity and atrophy of quadriceps femoris.The posterior drawer test was positive in26cases preoperatively,in which6cases were associated with positive anterior drawer test.The Lachmans test was positive in all of28cases preoperatively.The piv-ot shift test was positive in12cases preoperatively.The concomitant injuries consisted of anterior cruciate ligament injury in6cases,meniscal tear in8cases and medial collateral ligament injury in5cases.Results Follow-up period extended from27to48months (mean,33months).According to the international knee documentation committee(IKDC)activity grades,grade D were26cases,and grade C were2cases preoper-atively,while postoperatively,grade A were9cases,grade B16cases,and grade C3cases at the last fol-low-up.The clinical assessment judging by Lysholm knee functional scoring system,the average scores be-fore operation was65.5?3.6;however the scores increased to an average of92.7?3.6postoperatively.Con-clusion Arthroscopic reconstruction of injured posterior cruciate ligament using hamstring tendon transfer passes through the tunnel more smoothly than the bone-patellar tendon-bone because of no bone blocks,furthermore,the tunnel disappears after the screw is absorbed to avoid the impact of the ligament the inside tunnel and prevent the tunnel extending gradually to cause the ligament laxity and knee instability.The at-tachment of the tendon on the outlet of tibial tunnel and the rigid anchoring of ligament on the outlet of femoral tunnel could provide enough strength for constructed posterior cruciate ligament.So the patients could begin postoperative rehabilitation as soon as possible and recover functional activity earlier.

Objective To study the effects of the monomers of ginsenoside Rb1 (GSRb1) on the concentrations of intracellular calcium in ischemic neurons of rats.Methods Hippocampus neurons from embryo of rats were cultured in vitro, then placed into normal extracellular fluid (normal control group), simulated ischemic extracellular fluid (ischemia group), simulated ischemic extracellular fluid without calcium (ischemia without calcium group) and simulated ischemic extracellular fluid with different concentration of GSRb1. The fluorescence intensity of intracellular calcium in each group was measured by laser scanning confocal microscope technique, and the corresponding percentage was calculated by comparison with normal control.Results Compared with normal control group, fluorescence intensity of intracellular calcium increased by ( 73.5?10.31)% in ischemia group, ( 4.5?2.58)% in ischemia without calcium group,( 20.2?3.41)%, ( 13.6?2.98)%,( 10.5?3.62)% and ( 12.7?4.51)%, respectively, in simulated ischemic extracellular fluid with different concentration of GSRb1 groups (20, 40, 60 and 80 ?mol/L). The decreases of fluorescence intensity of intracellular calcium in simulated ischemic extracellular fluid with different concentration of GSRb1 groups were significantly different compared with ischemia group (all P

BACKGROUND: How to effectively treat recurrent osteoporotic vertebral compression fractures in the elderly over 65 years has become an issue of attention in the clinic. OBJECTIVE:To evaluate the clinical efficacy of percutaneous vertebroplasty with polymethylmethacrylate bone cement for treating elderly recurrent osteoporotic vertebral compression fractures. METHODS:Twenty-four patients with elderly osteoporotic vertebral compression fractures were divided into polymethylmethacrylate bone cement group (minimaly invasive group) and conservative treatment group on a voluntary basis (n=12 per group). Visual analog scale score for low back pain, Oswesty dysfunction index, ratio of the anterior/posterior margin height of the injured vertebra, Cobb angle and adverse reactions were compared between the two groups before and after treatment. RESULTS AND CONCLUSION:The 12-month folow-up was completed in al the patients. There was one case of bone cement breakage during treatment in the minimaly invasive group and one case of lower limb deep venous thrombosis in the conservative treatment group at 1 month after treatment. Compared with the conservative treatment group, the visual analog scale score, Oswesty dysfunction index, and Cobb angle were significantly lower, but the ratio of the anterior/posterior margin height of the injured vertebra was significantly higher in the minimaly invasive group at 3 days, 1, 3, 6 and 12 months after treatment (P < 0.05). These findings indicate that percutaneous vertebroplasty with polymethylmethacrylate bone cement for elderly recurrent osteoporotic vertebral fractures can strive for short-term pain relief and long-term recovery of the vertebral height and spinal Cobb angle, thereby significantly improving patient’s quality of life.

Objective To compare and the advantages and disadvantages of 3 methods of bone grafting in the posterior treatment of thoracolumbar burst fracture.Methods A retrospective analysis was conducted of 258 thoracolumbar burst fractures treated with posterior short-segment fixation from March 2013 to March 2015 at Orthopedic Department One,Foshan Hospital of Traditional Chinese Medicine.Of them,87 were treated with transpedicular bone grafting (group A),87 with laminar and intertransverse process bone grafting (group B) and 84 with small joint turnover plus bone grafting (group C).The 3 groups were compared in terms of cobb angle,loss of correction,bony fusion,internal fixation failure,and Oswestry disability index (ODI).Results The 3 groups were comparable due to insignificant differences in the preoperative general data between them (P ＞ 0.05).The cobb angles in the 3 groups at one week after operation (4.9° ± 1.0°,4.8° ± 0.6° and 4.8° ± 0.6°) and at the final follow-up (6.1 o ± 1.5°,14.5° ± 3.7° and 15.3° ± 4.1 °) were significantly smaller than those before operation (27.5° ± 4.9°,27.6° ± 4.6° and 27.6° ± 4.2°) (P ＜ 0.05).The cobb angles in groups B and C at the final follow-up were significantly larger than those at one week after operation (P ＜0.05).At the final follow-up,both the cob angles and the loss of kyphoplasty correction in groups B and C were significantly larger than in group A (P ＜ 0.05).The fusion rate in group A (100％) was significantly larger than in group B (80.5％) and C (76.2％).There were no significant differences between the 3 groups in the rate of internal fixation failure (0,1.1％ and 2.4％) (x2 =2.108,P=0.348).The ODI for the 3 groups at 6 months after operation (28.5 ± 4.1,28.7 ± 3.9 and 28.8 ± 3.7) and at the final follow-up (10.7 ± 2.6,11.0 ± 2.7 and 11.4 ± 3.1) were all significantly lower than the preoperative values (94.3 ± 0.7,94.4 ± 0.9 and 94.4 ± 0.8) (P ＜ 0.001).In all the patients,the ODI at the final follow-up was significantly lower than that at 6 months after operation(P ＜ 0.001).Conclusions In the treatment of thoracolumbar burst fractures,all the posterior approach plus transpedicular bone grafting,posterolateral bone grafting and reversed bone grafting plus short segmental internal fixation can effectively restore vertebral height and result in a high rate of fusion.Although the latter 2 methods of bone grafting are effective,they may be disadvantageous in leading to long-term loss of vertebral height and kyphosis correction.

OBJECTIVETo study mosaicplasty a as method of autogenous osteochondral transplantation in the treatment of cartilaginous defects.

METHODSThe technique involves obtaining small cylindrical grafts from the non-weight bearing periphery of the femur at the patellar femoral joint, and transporting them to the prepared recipient site by arthroscopy.

RESULTSFifteen patients with defects cartilaginous received mosaicptasty osteochondral grafting. Follow up for 12 to 21 months (mean 15 months) showed good results.

CONCLUSIONThe treatment is indicated for patients with focal cartilaginous defects under the age of 45.

Adult ; Arthroscopy ; Bone Transplantation ; methods ; Cartilage, Articular ; injuries ; transplantation ; Female ; Follow-Up Studies ; Humans ; Male

OBJECTIVETo compare the inter- and intra-observer reliability of the GATA and SMU classification systems for spinal tuberculosis and assess the clinical value of SMU classification.

METHODSOne hundred patients with spinal tuberculosis treated in our hospital from January 2004 to December 2011 were randomly selected for analysis, including 54 males and 46 females with a mean age of 45 years (range, 16-68 years). All the patients had X-ray, CT and MRI examinations. Five observers experienced in spinal tuberculosis independently assigned the classification using the GATA and SMU classification systems, and the assignment was repeated 3 months later to test its reproducibility. Kappa value was used to determine the intra- and inter-observer reliability.

RESULTSFor GATA and SMU classification systems, the inter-observer percentage of agreement averaged (59.9∓4.84)% (κ=0.412∓0.058) and (81.6∓6.06)% (κ=0.753∓0.068), and the intra-observer percentage of agreement was (75.6∓5.27)% (κ=0.624∓0.078) and (89.8∓2.28)% (κ=0.862∓0.037), respectively.

CONCLUSIONThe SMU classification system of spinal tuberculosis has a higher inter-observer and intra-observer reliability than the GATA classification system, but its clinical value needs to be further tested in future clinical trials.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Reproducibility of Results ; Tuberculosis, Spinal ; classification ; diagnosis ; Young Adult

Objective:To investigate the therapeutic effect of modified sural neuro-fasciocutaneous perforator flap in reconstruction of foot and ankle soft tissue defects.Methods:Sixteen patients undergoing the modified flap for foot and ankle reconstruction were included in this study between June, 2016 and June, 2018. The 16 patients were 11 males and 5 females with an average age of 32.5 (range 21 to 51) years. Ten defects were in heel and 6 in ankle and dorsal side of foot. A "Z" -shape skin incision was performed to explore the perforator vessels. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A relaying island perforator flap was used to close the donor site without skin graft. Follow-up was carried out through outpatient service, telephone follow-up and Wechat photo transmission.Results:The patients were followed-up for 12 to 18 months. All flaps survived completely without complications. The colour, texture and apperance of the flaps were good. The area of the flaps ranged from 12 cm×5 cm to 30 cm×15 cm. The diameter of the pedicle ranged from 1 to 2 cm. No complication occurred in the donor sites. A relaying perforator island flaps were used in 10 cases for donor site closure and without a skin graft. All cases were satisfied with appearance and function at the final followed-up.Conclusion:It is possible to use the modified sural neuro-fasciocutaneous perforator flap to repair foot and ankle soft tissue defects. A relaying island perforator flap can be used as a relaying flap to cover the donor site without skin graft.

Objective:To evaluate the clinical effect of the modified transfer of the proximal interphalangeal joint (PIPJ) from the second toe in the treatment of a finger PIPJ defect.Methods:A total of 13 patients with finger PIPJ defects caused by traumatic injury were enrolled from May, 2017 to March, 2020. All the PIPJ defects had primary traumatic repairs. The causes of injury: 5 patients were caused by strangulation, 4 by chainsaw, 2 by strangulation and 2 by crushing. Of which, 7 patients had index finger injury, 3 middle fingers and 3 ring fingers. The operations were carried out 3-7 months after the first stage of treatment. The grafting of the PIPJ of the second toe with modified vascular anastomosis were performed. The ipsilateral second toe was taken in 10 patients, and the contralateral second toe in 3 patients. The grafted joints all carried observation skin islands, with an area of 1.0 cm×1.5 cm-1.0 cm×2.0 cm. All the secondary bone defects in the donor site of the toe were reconstructed with iliac bone grafts, and the length of the iliac bone strips was 4.0-6.0 cm. At the same time, the island flap on the fibular side of the great toe was removed and repaired at the donor site, with an area of 1.1 cm×1.6 cm - 1.1 cm×2.1 cm. Early postoperative rehabilitation was performed. The patients were followed-up through outpatient visits, telephone and WeChat interviews.Results:All the 13 finger PIPJ and donor site island flaps survived. Bone healing were observed in all patients with the healing time in 8-12(average 10) weeks. Three patients with severe adhesion of joint and tendon were treated with secondary release. All the patients were followed-up for 10 - 18 months without degeneration of PIPJ. Active range of motion of PIPJ ranged: 45°-90° in flexion and 0°-10° in extension, the average motion activity was 66.3°. Seven patients were in excellent, 4 in good and 2 in fair, according to the function assessment proposed by the Society of Hand Surgery of Chinese Medical Association. The appearance on donor site was good and the walking was normal in the longterm follow-up. Only one linear scar was left in the ilioinguinal donor site without obvious discomfort.Conclusion:It was possible to use the modified transfer of the PIPJ from the second toe in the treatment of a finger PIPJ defect. An iliac bone graft and an island flap of the first toe transfer can preserve the appearance and function of the toes.

Objective:To scientifically measure and morphologically evaluate the anatomical shape of the skin in the first web space based on cadavers, and to guide the design of flap in this area.Methods:Sixteen human cadavers fixed with 10% formaldehyde without injury or deformity on the hand were selected in the Department of Hand Surgery, the Third Hospital of Suqian. According to the characteristics of the first web area, marker points were selected for measurement and morphological observation. Morphological characteristics of the first web with thumb radial abduction(r) or palmar abduction(p) were measured and compared. The t-test was used for statistical analysis. P<0.05 was considered statistically significant. According to the results of measurement, standardised shapes and parameters of the skin were obtained for flap repair of defect of the first web. Results:When the thumb was in palmar abduction, the maximum distance [a(p)] of the first web of female(F) and male(M) was 5.78/8.42 cm(F/M), and the skin [S(p)] was 17.09/23.63 cm 2(F/M), both were significantly greater than the distance [a(r)] at 4.86/6.28 cm and the area of skin area [S(r)] at 14.39/20.15 cm 2 when thumb was in the radial abduction position( P<0.05). There was no significant difference in the length of [b(r)] and [b(p)] alone the long axis of flap between palmar and radial abductions(7.54/9.38 cm and 7.34/9.74 cm, respectively) of the thumb( P>0.05). It was found that the area of first web was not shaped as a symmetrical spindle, but an irregular quadrilateral inclined to the index finger. Conclusion:Design and measurement of a flap for the first web space should take the maximum palmar abduction of a thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and characteristics in the region.