Objective To introduce a new surgical procedure for the treatment of axillary nerve injury:neurotization from one of triceps branches of radial nerve to one of axillary branches Methods To study the anatomical relationship between the nerve branches to triceps and the axillary nerve branches to deltoid muscle by anatomical dissection as well as to measure the diameters of the nerve branches,and to complete the performance in clinic in six patients and follow up for 6～16 months Results The branches to long head of triceps of radial nerve were near to branches of axillary nerve and the difference among the nerve branches are little in diameter,and there were 5 patients who got M4 recovery of the muscle strength and 1 patient M3 Conclusion The new surgical procedure is easy to manipulate,with a satisfactory result,and is suitable for the partial brachial plexus injury patient with axillary nerve dysfunction but the radial nerve function formal

Objective To treat upper and middle trunks or C 5～7 avulsion of brachial plexus by neurotization using a part of median nerve and ulnar nerve Methods All patients were divided into 2 groups according to the surgical procedures Eleven cases were involved in the first group The phrenic nerve was chosen to anastomose with musculocutaneous nerve or through a sural nerve graft and the spinal accessory nerve was anastomosed with suprascapular nerve Eleven cases from 1997 were classified into the second group A part of the fascicles of median nerve was transferred to coapt with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to harvest with axillary nerve The cases were followed up from 0 5 to 3 years and the clinical outcome was compared between the two groups Results There were 2 cases(16 6%)who got the recovery of M 4 strength of biceps muscle in the first group and 7 cases(63 6%)in the second group,and the difference was statistically significant( P

Objective To observe the distribution of circum-patella nerve fibers in the soft tissue to provide experimental evidence,which is significant in denervation for Total Knee Arthroplasty (TKA).Methods Patella specimens were collected from 4 cadavers (2 cases of diabetic foot,lcase of lower extremity arterial occlusive,and 1case of car accident),all 4 of which were resected soft tissue with a dimension of 0.5cm × 0.5cm and full depth thickness around patella more than 0.5cm for histology and morphology observation.The nerve fibers histology and morphology were observed in all resected specimens with HE staining and silver-gilt glycine staining in the same field of microscopic vision.Results Anatomy found that the vascular network form skins directly involved in the patella nourish hole area and in the 10,2,4,7 clock point have found that blood vessels into the patella.There have a large number of nerve fibers near to the patella under the microscope,but there were no significant difference in the nerve fibers region distribution of all specimens.There were some into patella nerve fiber paths in side of patella soft tissue,which lied in 7,11 and 13 clock point,but outside no this phenomenon.The distribution of circum-patellar nerve fibers were described as distribution of regional concentration,which lied in much more 5,6,7 clock points and 10,11,12,1,2,clock points,in which the quadriceps tendon and patellar tendon have more than the others.In the 13 clock point,the fascia and periosteum of nourish hole area were also found in a large number of nerve fibers,and there were laminar distribution in different soft tissue layers,which were collected much more in synovial layer,fat pad,tendon near to patella.Conclusion There are much more nerve fibers near to the patella and some into patella nerve fiber paths in the medial side and nourish hole area.Nerve fibers distribution of circum-patella can be described as laminar distribution and regional concentration ,which is more in the centre,bottom more than top,outside more than inside,the bipolar more than the others.The patella denervation operation by reducing the number of peripheral nociceptors to achieve desensitization is feasible in TKA.

Objective To determine the prevalence of pain beyond the osteoporotic vertebral com-pression fracture (OVCF) in patients undergoing percutaneous vertebral augmentation and the response of pain to the treatment. Methods A retrospective study of 104 patients undergoing percutaneous vertebral augmentation (pereutaneous vertebroplasty and pereutaneous kyphoplasty) was performed to examine the lo-cations and severities of pain beyond the OVCF before and after operation. The Visual Analog Sscale (VAS,10-point scale) and Activities of Daily Living (ADL, 5-point scale) were used. Results Of the 104 patients, 48 (46.2%) suffered pain beyond the OVCF. The pain was firstly located in the sacrococeygeal region and buttocks (26.0%), secondly in the abdomen and sub-xiphoid process (10.6%) and thirdly in the flank, ribs and chest (9.6%) . For all the cases, the mean VAS score decreased from 8.9±0. 8 before vertebral augmentation to 2.9±1.4 after augmentation (t=37.410, P=0.000), and the mean ADL score decreased from 4.1±0.6 before operation to 2.0±0.7 after operation (t=25.331, P =0.000) . For the patients suffering pain beyond the OVCF, the mean VAS score decreased from 8.8±0.9 before vertebral augmentation to 2.8±1.5 after augmentation (t=23.722, P=0.000), and the mean ADL score decreased from 4.2±0.7 before operation to 2.0±0. 7 after operation (t=15.373, P=0.000). The decreases in VAS and ADL scores were not affected by the pain. Conclusion The pereutaneous vertebral augmentation can effectively relieve the pain beyond the OVCF.

Objective To investigate technical points,risks and advantages of primary total knee arthroplasty (TKA) through subvastus approach.Methods The study involved 68 patients of similar basic conditions who were treated by TKA between September 2008 and August 2010,including 34 patients treated through subvastus approach (Group A) and 34 patients treated through traditional medial parapatella approach (Group B).Clinical parameters between groups were comparatively studied after operation.Results All patients were followed up for 6-25 months (mean 8.7 months).Alignment of lower extremities in both groups was restored.Group A showed significant differences from Group B in aspects of postoperative drainage volume [(124 ± 32.4) ml vs (182 ± 41.3) ml,P ＜ 0.05],requirement of lateral retinacular release (7％ vs 23％,P ＜0.01),time before patients being capable of having active straight-leg-raising movement [(1.3 ± 0.7) d vs (3.2 ± 0.6) d,P ＜ 0.05],and time away from patients being able to bend their leg up to 90° [(3.1 ± 0.6) d vs (5.3 ± 0.5) d,P ＜ 0.05].Conclusion Primary total knee arthroplasty through subvastus approach can hardly intervene in extension knee apparatus and in blood circulation around patellas,promote rapid recovery of knee function and achieve satisfactory early outcomes.

BACKGROUND:The outcomes of SL-Plus? stem in primary total hip arthroplasty have been proved good, but whether SLR-Plus? revision stem can obtain a good outcome in revision hip arthroplasty needs more studies. OBJECTIVE:To observe the clinical results of revision hip arthroplasty with Zweymül er SLR-plus ? stem. METHODS:Revision hip arthroplasty of 41 hips in 39 patients was performed from November 1997 to May 2013 using SLR-plus ? stem. There were 26 hips (male) and 15 hips (female). They were at the age of 34-73 years old, 53 on average. In the 41 hips, 36 cemented and 5 uncemented femoral prostheses were used. Prosthetic changes on radiographs were observed. In accordance with Brooker classification, heterotopic ossification was classified to record the region and incidence of heterotopic ossification. Hip joint function was evaluated using Harris Hip Score, and survival rate of the prosthesis was analyzed. RESULTS AND CONCLUSION:A total of 31 patients (33 hips) were fol owed up for 1 to 16 years. The mean preoperative Harris hip score of 34 (range, 13-64) points improved to 85 (range, 55-94) points at the time of final fol ow-up. 32 hips (97%) had an excellent result. A 1 mm width radiolucent line was found in 1 femoral component without any symptom. Osteolysis and migration were seen in 1 hip, which needed re-revision. Heterotopic ossification developed in 9 hips, including 2 hips of Brooker grade 1, 4 hips of grade 2 and 3 hips of grade 3. No re-infection was found. Kaplan-Meier survivorship was 92%with radiographic loosening as the end point. Results demonstrated that the SLR-Plus? stem has sufficient immediate and long-term stability, which is reliable for patients undergoing hip revision surgery.

Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period.Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months.Results: The size of the flap ranged from 6.6 cm2 to 28.18 cm2 and the rate of flap failure was 13.6％. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series.Conclusions: For soft tissuedefect of delayed open tibial fracture Type HIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for anysecondary manipulation; and ③ to use serial debridementto diminish flap failure.

Objective To compare the changes of some blood indices after treatment of intertro-chanteric fractures with conventional and minimally invasive dynamic hip scres (DHS) internal fixation so as to understand the influence of minimally invasive technique on physiology of the organism. Meth-ods The elderly patients with intertrochanteric fractures in our department from July 2004 to May 2006 were divided randomly into two groups, ie, conventional DHS internal fixation group(Conventional group, 52 patients)and the minimally invasive DHS internal fixation group(Minimal invasion group, 54 patients). A comparison was done on data including white blood cells (WBC), hemoglobin (Hb), e-rythrocyte sedimentation rate (ESR). C reactive protein (CRP) and creatine kinase (CK) as well as re-cessive blood loss. Results The indices including transfusion, blood loss, recessive blood loss, ESR and CK in minimal invasion group showed less changes compared with conventional group. With statistical difference. But WBC and CRP showed no statisfical difference between both groups. Conclusion Minimally invasive DHS internal fvtation carl reduce operative trauma during treatment of intertrochanterie fractures in the elderly.

OBJECTIVETo compare the effect of using partial median and ulnar nerves for treatment of C(5-6) or C(5-7) avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.

METHODSThe patients were divided into 2 groups randomly according to different surgical procedures. Twelve cases were involved in the first group. The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft, and the spinal accessary nerve was to the suprascapular nerve. Eleven cases were classified into the second group. A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve. The cases were followed up from 1 to 3 years and the clinical outcome was compared between the two groups.

RESULTSThere were 2 cases (16.6%) who got the recovery of M4 strength of biceps muscle in the first group but 7 cases (63.6%) in the second group, and the difference was statistically significant (P<0.025). However, it was not statistically different in the recovery of shoulder function between the two groups.

CONCLUSIONSPartial median and ulnar nerve transfer, phrenic and spinal accessary nerve transfer were all effective for the reconstruction of elbow or shoulder function in brachial plexus injury, but the neurotization using a part of median nerve could obtain more powerful biceps muscle strength than that of phrenic nerve transfer procedure.

Adolescent ; Adult ; Brachial Plexus Neuropathies ; surgery ; Humans ; Male ; Median Nerve ; transplantation ; Middle Aged ; Nerve Transfer ; methods ; Treatment Outcome ; Ulnar Nerve ; transplantation

BACKGROUND:Previous studies have indicated that resistin stimulates a large set of chemokines in chondrocytes that are known to be important in inflammatory joint lesions.
OBJECTIVE:To further investigate the mechanism of co-regulation roles of transcription and post-transcription in the up-regulation of two chemokine genes CCL3 and CCL4 in chondrocytes in response to resistin.
METHODS:Human chondrocytes, T/C-28a2 and ATDC5 cels were cultured. The function of resistin on the chemokine genes, and the expression of C/EBPβ, nuclear factor-κB isoforms and chondrogenic specific miRNAs were tested by qPCR. The co-regulation of C/EBPβ and nuclear factor-κB was investigated by nuclear factor-κB inhibitor (IKK-NBD) and C/EBPβ inhibitor (SB303580) treatments, and subcelular localization was detected with or without resistin stimulation.
RESULTS AND CONCLUSION:Resistin could increase the expression of chemokine genes independently. Chondrocytes reacted in a non-restrictedly cel-specific manner to resistin; C/EBPβ inhibitor, nuclear factor-κB and some chondrogenic specific miRNAs in a combinatorial manner regulated chemokine gene expression. The activity of C/EBPβ was augmented by a transient increase in activity of nuclear factor-κB, and both transcription factors acted independently on the chemokine genes, CCL3 and CCL4.