Two types of elbow arthroplasties are used in current clinial practice:interpositional and implant arthroplasty.Interposition elbow arthroplasty neither completely eliminates pain nor restores full function.It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis,especially those with limited elbow motion.Current implant arthroplasty has come a long way in the past three decades.Elbow implant survival data nearly approach those of knee arthroplasty.The majority of patients have significant improvement in function and marked pain relief after total elbow replacement.However,the complication rate is higher than that for total hip and knee arthroplasty,is likely inherent in the anatomic uniqueness of the elbow itself.Greater caution must be paid to prevention of the complications of total elbow replacement.This article reviews the types,indications,contraindications and results of elbow arthroplasty.

[Objective]To explore the clinical characteristic of combined posterior cruciate ligament (PCL) with posterolateral corner (PLC) injuries,and evaluate the technique and outcome of arthroscopic single bundle reconstruction of PCL and reconstruction of PLC with posterior half of biceps femoris tendon.[Method]From Dec. 2001 to Dec. 2004,14 patients (14 knees) with severe posterior and posterolateral rotatory instability were treated surgically in our department,all of them presented III degree positive results of posterior drawer test,positive varus stress test and more than 10 degree of external rotation of the affected knees compared with the intact knees.PCL tear and abnormal opening of posterolateral compartment were seen in all of the 14 knees under arthroscopy.Of them,2 knee were combined with common peroneal nerve injury.All the damaged PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy,and PLCs were reconstructed with the posterior half of biceps femoris tendon tenodesis.[Result]No severe complications occurred in early stage after operation in the 14 patients.All of them were followed up from 12 to 33 months with an average of 21.14?7.26 months.Posterior stabilities were recovered significantly,varus stress test was negative at 30 degree of flexion and full extension,less than 10 degree of external rotation compared with the intact knee in all of the patients.Lysholm score was remarkable improved from 40~60 (mean 47.1?8.25) preoperatively to 70~95 ( mean 86.79?7.23) at follow up(P

Objective To investigate the gamma (γ) passing rates for volumetric-modulated arc therapy (VMAT) dosimetric verification with different techniques.Methods A total of 12 VMAT plans for the treatment of different anatomical sites in cancer patients were chosen.The Octavius 4D system was used to measure the dose distributions in two different settings:the gantry was rotating (three-dimensional (3D) and 2D γ-analysis) and the gantry was fixed at 0°(2D γ-analysis).The γ passing rates were analyzed with 3%/3 mm and 2%/2 mm criteria, using the paired t test or Wilcoxon signed-rank test.The 2D γ passing rates for different irradiation methods were calculated.Results For the 3D and 2D dose distributions obtained at a rotating gantry angle as well as the 2D dose distribution obtained at zero gantry angle, the average γ passing rates were 96.03%, 96.98%, and 98.90% for 3%/3 mm (P=0.227, P=0.000, P=0.003);82.08%, 84.04%, and 90.90% for 2%/2 mm (P=0.379, P=0.000, P=0.000).For the 2D dose distributions obtained with different irradiation methods, the average γ passing rate was 98.99% for 3%/3 mm and 93.68% for 2%/2 mm.Conclusions The VMAT dosimetric verification based on a 3D volumetric dosimeter at a rotating gantry position can be clinically useful for delivery quality assurance (QA), and can achieve the most reliable dose calculation for VMAT, which has more referential values.

Objective To investigate the feasibility of detector array in Monaco modeling for MLC parameters adjustment.Methods One parameter was fixed, and then the other parameter was changed.The γ pass rates of the test beams, namely 3ABUT, 7SegA, and FOUR L, were assessed to determine the values of leaf transmission and leaf offset.A total of 12 tumor cases from different anatomical sites were randomly selected.Two-dimensional dose verification (rack angle zero) of Step& Shot and dMLC plans as well as three-dimensional dose validation of VMAT plan were performed using Octavius 4D system.The γ pass rates were analyzed at a standard of 3%/3 mm.Meanwhile, the point dose verification for these three plans was analyzed to obtain the dose deviations.Results The values of leaf transmission and leaf offset were 0.0105 and-0.08 mm, respectively.The average γ pass rates (%) of Step& Shot, dMLC, and VMAT plans were 88.59±2.94, 87.81±3.28, and 87.45±2.24 before adjustment and 98.45±1.23, 98.9±1.01, and 96.03±1.66 after adjustment.In addition, the average dose deviations (%) according to the point dose verification were 0.85±0.75, 0.95±0.39, and 0.98±0.40 before adjustment and 0.97±0.57, 1.08±0.76, and 0.86±0.45 after adjustment.Conclusions Octavius detector 729 ionization chamber array is a feasible and reliable device in Monaco modeling for MLC parameters adjustment.

Objective To assess the correlation of newly fracture and spinal sagittal parameters.Methods From March 2011 to December 2014,80 patients of osteoporosis vertebral compression fracture treated by PVP as observation group were studied.The whole-spine anteroposterior view and lateral view XRay Photographes of the patients were taken,the sagittal parameters such as Pelvic index (PI),sacral slope (SS),pelvic tilt (PT),thoracic kyphotic angle(TK),lumbar lordotic angle(LL),the C7/SFD ratio were recorded.The whole cases were divided into two groups according to the presence of new fracture or not after the last followup of one year,the index of two groups were compared,and the risk factors of newly vertebral compression fractures were analysed.Results There were no statistically significant difference in gender,age,body mass index,BMD,PI,TK,LL between the two trea ted groups (P＞0.05);there were statistically significant difference in SS,PT and the C7/SFD between the new vertebral fracture group and the control group (P＜0.05).The analytic results of Logistic regression model showed that the smaller SS,larger TK and C7/SFD were risk factors of newly vertebral compression fractures.Conclusion The newly occurred vertebral compression fractures,after the primary treatment of PVP,are associated with changed spinal sagittal parameters.

BACKGROUND:Recent report addressing new vertebral fracture after vertebroplasty or bal oon kyphoplasty has increased gradual y. It remains controversial whether new vertebral fracture is induced by bone cement augmentation or osteoporosis.
OBJECTIVE:To observe new vertebral fracture after conservative treatment and bone cement augmentation for osteoporotic vertebral compression fractures, analyze the relationship between new vertebral fracture and spinal sagittal parameters, and explore the risk factors for new vertebral fracture.
METHODS:From June 2011 to December 2014, 160 patients with osteoporotic vertebral compression fractures in thoracic and lumbar vertebrae were selected from the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Col ege. According to therapeutic regimen, the patients were divided into two groups. The observation group (n=80) received vertebroplasty or kyphoplasty. The control group (n=80) underwent conservative treatment. At 1 day after surgery in the observation group and after walking in the control group, patients were subjected to anteroposterior and lateral X-ray in the entire length of the spine. Bone mineral density, number and location of new vertebral fractures and sagittal parameters during fol ow-up were recorded and compared between groups. After final fol ow-up, according to the appearance of new vertebral fracture, patients in both groups were assigned to two subgroups. The difference in above indicators was compared between the two subgroups. The relationship between new vertebral fracture and spinal sagittal parameters was analyzed.
RESULTS AND CONCLUSION:(1) There were no statistical y significant differences in gender, age, body mass index, bone mineral density, pelvic index, sacral slope, pelvic tilt, thoracic kyphotic angle, lumbar lordotic angle, C7/sacro-femoral distance ratio and occurrence rate of new fractures between the two treated groups (P>0.05). (2) There were no statistical y significant differences in gender, age, body mass index, pelvic index, and lumbar lordotic angle between new vertebral fracture group and non-fracture group. There were statistical y significant differences in bone mineral density, sacral slope, pelvic tilt, thoracic kyphotic angle and the C7/sacro-femoral distance between the new vertebral fracture group and the control group (P<0.05). (3) Results confirmed that new vertebral compression fractures after vertebroplasty, Kyphoplasty or conservative treatment for osteoporotic vertebral compression fractures were definitely associated with osteoporosis and spinal sagittal imbalance.

BACKGROUND:Sagittal imbalance induced by vertebral osteoporotic fractures has not been paid enough attention in previous studies.
OBJECTIVE:To assess the correlation of osteoporotic vertebral compression fracture and spinal sagittal imbalance.
METHODS:Sixty patients with old osteoporotic vertebral compression fracture, who were treated in the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Colege from February 2013 to August 2015, were enroled in this study as the observation group. Sixty healthy old people from physical examination center were enroled as the control group. The whole-spine anteroposterior and lateral X-ray films were taken in both groups. The number and the location of fractured vertebrae were recorded. Sagittal parameters of both groups including thoracic kyphotic angle, lumbar lordotic angle, T1-spinopelvic inclination angle and the C7plumb line/sacro-femoral distance (PL/SFD) ratio were measured and compared among groups. The observation group was dividedinto three subgroups according to the number of fractured vertebrae,i.e., single-vertebrae fracture subgroup, double-vertebrae fracture subgroup and above triple-vertebrae fracture subgroup. The C7PL/SFD ratio of the three subgroups was compared. The correlation between the number of fractured vertebrae and the C7PL/SFD ratio was analyzed.
RESULTS AND CONCLUSION:(1) The thoracic kyphotic angle of the observation group was bigger than that of the control group (P< 0.05). The lumbar lordotic angle of the observation group was smaler than that of the control group (P< 0.05). The absolute value of the T1-spinopelvic inclination angle of the observation group (-1.81±1.48)° was smaler than that of the control group (-3.35±1.22)° (P< 0.05). The C7PL/SFDratio of the observation group was significantly bigger than that of the control group (P< 0.05). (2) In the observation group, there were 4 cases of single-vertebrae fracture, 25 cases of double-vertebrae fracture and 31 cases of above triple-vertebrae fracture. Significant differences in the C7PL/SFD ratio were determined among subgroups (P< 0.05). The number of fractured vertebrae was positively correlated with the C7PL/SFD ratio; the correlation coefficient was 0.747. (3) Results indicated that osteoporotic vertebral compression fracture can change spinal local sagittal alignment. Multiple compression fractures of vertebrae can cause spinal sagittal imbalance. The gravity center of human body shifts forward. The number of fractured vertebrae was positively correlated with the range of shift forward.

Objective To evaluate the effects of respiratory on dose distributions in threedimensional conformal radiotherapy (3 DCRT) and intensity-modulated radiotherapy (IMRT).Methods The dose distributions were measured with a PTW 2D-ARRAY seven29 placed on a home-made moving platform to simulate the respirator.Dosimetric comparisions for 3DCRT and IMRT plans were performed by means of Gamma analysis with 3％ and 3 mm,respectively.Dose distribution measured for static treatment plans.Results The respiratory could reduce the target does and conformal index.The r pass rate (3％3 mm in 3 DCRT was greater than it in IMRT ((53.58 ± 0.74) ％,(30.71 ± 1.00) ％,t =57.91,P ＜ 0.01).The failed points were mainly near the field edge,but located in the whole target volumes for IMRT plans.Conclusions It is undesirable to use IMRT techniques for tumors with large motion amplitude.3DCRT can give a reliable dose distribution by reasonably selecting the PTV margin.

Objective To compare the therapeutic results between low-molecular-weight heparin therapy and combined therapy of low-molecular-weight heparin and Shuxuetong for deep venous thrombosis (DVT) after lower extremity fracture.Methods Forty-two patients with DVT from 1,037 patients with lower extremity fracture treated from December 2010 through November 2012 were included in the study.There were 31 males and 11 females,aged from 26 to 82 years (mean,63 years).The patients were assigned to administration of 4,250 IU low-molecular-weight heparin subcutaneously,twice daily (Group A,n =19)and 4,250 IU low-molecular-weight heparin subcutaneously,twice daily plus shuxuetong to 6 ml intravenously,once daily (Group B,n =23) according to the random number table.A period of treatment was a week.Color Doppler sonography was performed to detect DVT.Results Longest course of treatment was 3 weeks.In Group A,the results were recanalization in 2 patients with mean time of 2.50 weeks,significantly effective in 3 patients with mean time of 2.67 weeks,effective in 7 patients with mean time of 3 weeks,and invalid or worse in 7 patients with mean time of 3 weeks.Whereas in Group B,the results were recanalization in 7 patients with mean time of 1.86 weeks,significantly effective in 12 patients with mean time of 1.83 weeks,effective in 3 patients with mean time of 3 weeks,and invalid or worse in 1 patient with mean time of 3 weeks (P ＜ 0.05).Conclusion Low-molecular-weight heparin plus Shuxuetong is effective in treatment of DVT after lower extremity fracture and hence can be as an option in clinical application.

Objective To explore the clinical characteristics,diagnosis,treatment and outcomes of anti-N-methyl-D-aspartate receptor(anti-NMDAR) encephalitis in children.Methods Six children diagnosed as anti-NMDAR encephalitis were recruited at the Department of Neurology,Capital Institute of Pediatrics,from December 2011 to April 2013.The data of clinical characteristics and laboratory examinations were retrospectively analyzed.All the children had long-term follow-ups and the prognosis was assessed.Results (1) Age and course of the disease at the time of the admission:the mean age of the 6 patients (2 female) was 3 years and 5 months,ranging from 2 years and 2 months to 6 years and 8 months.The course of the disease at the time of the admission ranged from 15 to 80 days,with a mean time of 39 days.(2)Clinical characteristics:5 cases had afebrile convulsion and 1 case had speech impairment at the onset of disease.Convulsion occurred in all the 6 cases,4 cases of whom had persistent convulsion,and 5 cases had impaired consciousness.All the 6 cases exhibited aphasia,and complicated with mental or emotional abnormalities,irritability or shouting.Five cases developed into sleep disorders such as sleep deprivation.Five cases had limb and facial involuntary movement,in which 2 cases had stereotyped action.Prominent autonomic nervous dysfunction including hidrosis was found in 1 case.(3) Laboratory examination:cerebrospinal fluid test was normal in 6 cases,and 1 case had slightly increased white blood cell level.Specific anti-NMDAR antibody was positive in serum and/or cerebrospinal fluid in the 6 cases.Electroencephalograph of the 6 cases showed slow wave background during lucid interval,and 5 cases had interictal epileptiform discharges.The skull MRI showed cerebral atrophy 4 cases,and 2 cases of them were complicated with encephalomalacia.No tumor was found in the patients.(4) Treatment and follow-ups:6 cases received gamma globulin or methylprednisolone or other immunotherapy.Three cases received combined therapy with Rituximab,1 case received plasmapheresis,and 1 case received Cyclophosphamide.Follow-ups lasted for 2 to 31 months.Three patients had clinical recovery,and varying degrees of neurological complications were found in 3 cases.Conclusions (1) Anti-NMDAR encephalitis is common in children.(2) The specificity of its clinical symptoms is not strong.The incidence of convulsion is high,and different degrees of consciousness disorders may occur in some of the severe patients.Degeneration of language function and emotional changes can be observed.Most pediatric patients have abnormal movement,and the symptoms of automatic nervous system are not prominent.(3) The disease can be confirmed by the specific anti-NMDAR antibody in the spinal fluid or plasma.(4) The time of clinical recovery is long,and an early immunotherapy is associated with a better prognosis.