Objective The purpose of this article was to investigate the internal tunnel position during anterior cruciate ligament (ACL) reconstruction with single-bundle ACL. Methods MRI were performed in 10 knees form 10 volunteers at full extension and at 30°, 60°, 90°, and 120° flexion position. All the images obtained were exported into Mimics 10.01. Three-dimensional models were established with Mimics in a computer. All the mark points were confirmed on femur and tibia. The distance between the femoral mark point and tibial mark point was measured. The isometric point was determined as the change in the distance was shorter than 3mm during knee flexion-extension. Results Ten three-dimensional models were established successfully and the isometric points of A0-X, A15-X, A30-X, A45-X, B0-Y, B15-Y, B30-Y, B45-Y, C0-Z, C15-Z, C30-Z, C45-Z, and C60-Z were identified. Conclusion There was no absolute anatomical isometric point, whereas the physiological isometric point did exist. Therefore, determination of tibial point should be considered synthetically. B45-Y was recommended for tunnel position.

BACKGROUND:Interlocking intramedullary nailing exhibits unique superiority in treatment of multi-segment radial fracture,bone nonunion,and osteoporotic fracture. However,distal interlocking screw placement would injury the deep branch of radial nerves. OBJECTIVE:To analyze the anatomical characteristics of the deep branch of radial nerves during radial interlocking intramedullary nailing. DESIGN,TIME AND SETTING:An observational measurement was performed at the laboratory of Department of Orthopedics,Second Affiliated Hospital of Soochow University between November and December 2002. MATERIALS:A total of 44 pieces of fresh adult cadaver forearm specimens were provided by Department of Anatomy,Soochow University,China. A vernier caliper was purchased from Henan Yuanyang Zhenhua Instrument Factory,China. METHODS:The deep branches of radial nerve of 44 fresh forearm specimens were exposed. The lateral epicondyle of humerus was joined to the Lister tubercle of radius. The line passed through 6 horizontal planes,which were as follows in sequence:0,1.0,1.5,and 2.0 cm lower than the articular surface of radial head respectively,the horizontal planes of the deep branch of radial nerve entering the supinator and winding across the radius. The crossed points were named points A,B,C,D,E,and F accordingly. MAIN OUTCOME MEASURES:The distance between the deep branch of radial nerve and fixed points B,C,and D was measured separately when the forearm was kept in pronation,neutral and supination positions. RESULTS:The distance between the deep branch of radial nerve and fixed points B,C,D became nearer and nearer in the sequence of B,C,and D. With the forearm in pronation,neutral and supination positions in sequence,each fixed point became farther and farther from the deep branch of radial nerve. CONCLUSION:When interlocking intremedullary nailing is used to fix radius,it is relatively safe to keep the forearm in neutral and flexion positions,and drilling and insertion of distal interlocking screw at 1.5 cm lower the articular surface of radial head from the posterolateral to anteromedial approach should be selected.

BACKGROUND: With the advancements in helical CT myelography and computer image postprocessing, virtual medical imaging has acquired good outcomes in the diagnosis and treatment of complex cervical spondylosis. OBJECTIVE: To observe the effects and significance of helical CT myelography on multiplanar and three-dimensional reconstruction of virtual anatomical models of cervical spondylosis. DESIGN, TIME AND SETTING: The present computer three-dimensional reconstruction, gold standard control study was performed at the Second Hospital Affiliated to Soochow University between January 2001 and January 2006. PARTICIPANTS: Twenty patients with complex cervical spondylosis, who had received surgery, were employed for this study. METHODS: Virtual anatomical model of cervical spondylosis was established by multiplanar and three-dimensional reconstruction through the use of helical CT myelography in 20 patients. Scanning and reconstruction results were used for pre-surgery disease condition evaluation and virtual surgery. In addition, surgical intuitionistic results were considered gold standard to evaluate the accuracy and efficacy of virtual anatomical models. MAIN OUTCOME MEASURES: The accuracy and efficacy of virtual anatomical models. RESULTS: Virtual anatomical models could concurrently show bony and membranate vertebral canals. These exhibited comprehensive and minute bony anatomic structure of cervical vertebrae and anatomic information regarding dura mater, spinal cord, and nerve sleeve for pre-surgery evaluation and virtual surgery. The imaging virtual anatomic information was in accordance with practical anatomical information in patients. CONCLUSION: Virtual anatomical model can be used to comprehensively evaluate the disease condition of cervical spondylosis and simulate the surgery due to its intuitionistic, vivid, and accurate display of anatomy of cervical vertebrae.

Objective To evaluate the clinical therapeutic effects of Vbeam 595 nm pulsed dye laser in114 cases of port wine stains.Methods 114 patients with port wine stains were treated with Vbeam 595 nm pulsed dye laser with 3～10 ms pulse width and 7mm spot size.The energy fluence used varied from 10 to 15 J/cm2.Dynamic cooling device(DCD)was used to protect epiderm,with DCD spray 30～40 ms and DCD delay 10～30 ms.The interval of therapy was 4～8 weeks.The results were graded on basis of cleaning and fading as follows:grade Ⅰ(＞75%),gradeⅡ(50%to 74%),grade Ⅲ(25%to 49%),and grade Ⅳ(＜25%).Results 114 patients completed the therapy.The number of treatments ranged from 1 to 10(mean 5.9).The results evaluated as grades Ⅰ,Ⅱ,Ⅲ and Ⅳ were 74 patients(64.9%),29 patients(25.4%),9 patients(7.9%)and 2 patients(1.8%),respectively.The therapeutic effect was analysed according to number of treatments.the ages of patients,site and color of the lesions.It was found that the therapeutic effect was prominent in patients of younger age,with pink lesions located on the neck and face.No recurrence and scar happened after 6 months to 2 years follow-up.Conclnsions Vbeam 595nm pulsed dye laser is a safe and effective method for the treatent of port wine stains,with less complications.

BACKGROUND:Insulin-like growth factor-1(IGF-1) is an important regulator in osteoblasts proliferation,differentiation and matrix synthesis,which participates in the process of fracture healing and repairing. OBJECTIVE:To investigate the potential bone regeneration effect of human bone marrow mesenchymal stem cells(MSCs) transfected into IGF-1 retroviruses vector on bone defects repairing. DESIGN,TIME AND SETTING:A controlled observation experiment was performed between March 2004 and May 2005 at the Laboratory Animal Center of Soochow University. MATERIALS:MSCs were transfected into IGF-1 retroviruses vector in vitro and combined with demineralized bone matrix(DBM) . METHODS:Fifteen BalB/C nude mice were prepared for 8 mm calvarial defects models and divided into 3 groups by number table method,with 5 animals in each group. DBM transfected with IGF-1 and DBM transfected with vector were implanted into the defect in MSCs cells transduced with IGF-1 and vector groups,respectively. There was no other intervention in the blank control group. The implants were harvested and evaluated by histological examination at 4 weeks after model preparation. MAIN OUTCOME MEASURES:①The mRNA expression of IGF-1 was analyzed by RT-PCR and Western Blot. ②The complexes of cells and DBM were analyzed by scanning electron microscope(SEM) at days 3 and 6 after co-culture. ③Gross observation of the calvarial defects models. ④Osteogenic activity of the implants was evaluated by hematoxylin-eosin staining at weeks 4 after model preparation. RESULTS:①There were mRNA and protein expression of IGF-1 in MSCs cells transduced with IGF-1 vector. ②SEM showed that there were plenty of cells adhered to surface of DBM,and grew into inner part at the 3 days after co-culture with IGF-1,which secreted much collagen fibers at days 6. The count of adherent cells and collagen fiber was smaller in the vector group at each time points. ③No obvious inflammatory reaction could be seen in each group at 4 weeks after model preparation. Compared with vector control,abundant new bone and blood vessel formation occurred in the calvarial defects treated with DBM/IGF-1,and no new bone formation in the blank control groups. ④Results of hematoxylin-eosin staining showed that grafts in the MSCs cells transduced with IGF-1 group was combined closely with calvarial defects,new bone and vessel could be found. There were few bone-like materials formation in vector group,and no defects in control group were repaired. CONCLUSION:The composites of IGF-1 transfected MSCs and DBM has good effect in repairing calvarial defects.

[Objective]Ulnar fractures fixed by interlocking intramedullary nails or dynamic compression plates were tested to compare their biomechanical function,in order to provide the theoretical basis for clinical practice.[Method]In the experiment,12 pieces of fresh ulnars were used to produce middle-part transverse fracture models;which were fixed by interlocking intramedullary nails or six-hole 3.5 mm dynamic compression plates seperately.The diameter of intramedullary nail was 4mm,and the length was 200-230mm.The specimen was set on the MTS test machine.The rigidity and strength of ulnar fractures fixed by interlocking intramedullary nails were compared with those of ulnar fractures fixed by six-hole 3.5 mm dynamic compression plates in the anti-axial test,anti-bending test,anti-torsional test.[Result]In the anti-axial test,anti-bending test and anti-torsional test,the rigidity of ulnar fractures fixed by interlocking intramedullary nails was 450.00?38.42 N/mm,45.64?5.24 N?cm/Deg,11.42?1.21N?cm/Deg in sequence;while the rigidity fixed by dynamic compression plates was 405.40?29.26 N/mm,41.00?4.78 N.cm/Deg,10.05?1.32 N?cm/Deg accordingly.Burdened 1000N axial pressure,the displacement of interlocking intramedullay nail fixing specimen was 2.20?0.11 mm,and the compression plate fixing specimen was 2.48?0.15 mm.Given a 5 N?M bending burden,the maximum radial bending degree of interlocking intramedullay nailfixing specimen was 3.25?0.15 mm,which was 3.60?0.21 mm of compression plate fixing specimen.In the anti-torsional test,the interlocking intramedullay nail and compression plate fixing specimen could burden 2.40?0.13 N?M and 1.90?0.10 N?M respectively.The experimental data were analyzed by software SPSS.10,which came to a distinguished difference by t-test(P

[Objective]To study the clinical results of methods of improvement of pedicle screw stability in patients of osteoporosis. [Method]Thirty-four cases of patients with osteoporosis were operated using pedicle screw and methods of improvement of pedicle screw stability were used during the operations.Of which,male 20,female 14;the mean age of 57(range 40～71).According to Jikei grading scale for osteoporosis,8 were of early stage,11 of stageⅠ,8 of stageⅡ and 7 of stageⅢ.There were 14 cases of fractures and 20 cases of osteopathy.For patients of early stage and stageⅠ(19 cases),long and large size of pedicle screws were used,meanwhile stiff connection rod system,two cross-link devices,placement of pedicle screw with large angles in horizontal and sagital planes were applied.For patients of stageⅡ and stageⅢ(15 cases) bone cement was used to fill the pedicle hole to ensure the screw stabily.[Result]There were no neurologic and vessel injuries or aggravated as well as no breakage of screw except two cases with loosening of screw during the follow-up with the mean period of 14 months(range 9～26).The loss of correction of reduction in fractures was 5%,the rate of fusion was 100% in grafting.[Conclusion]Different methods of improvement of pedicle screw stability used in osteoporosis may avoid loosening of screw and loss of correction.

BACKGROUND: Fracture of humeral ectocondyle is a kind of articular epiphyseal fracture. It is one of the most prevalent disorder of cubital articulation. The occurrence of fracture and the mechanical mechanism of treatment is not very well cognized in clinic.OBJECTIVE: To analyze the stress distribution of the humeral ectocondyle in different postures so as to investigate the treatment mechanism of the humeral ectocondyle fracture.DESIGN: Computer simulation study on stress.SETTING: Department of Experimental Mechanics, Fuzhou University, and Department of Orthopedics, Third Affiliated Hospital of Peking University.MATERIALS: This experiment was conducted in the Fujian Experimental Mechanic Committee of Fuzhou University between January 2000 and December 2002. Humerus from a 6-year-old. corpse (Provided by the Department of Anatomy of Fujian College of Traditional Chinese Medicine). Instruments were computer, SUPER-SAP93 software, material sickle and measuring instrument and so on.METHODS: 9 kinds of loading conditions were simulated and added on three dimensional finite elemental model of humerus in SUPER-SAP93software, and then the stress distribution was filed out and analyzed.MAIN OUTCOME MEASURES: The average Mises stress of lateral condylar area and humeral trochlea area.RESULTS: At flection posture of elbow, the average Mises stress of lateral condylar area was the largest while at extension posture the stresses of nodes affected by extensor tendon were larger than those of lateral condyle.CONCLUSION: At the flection posture of elbow, the fracture of lateral condyle of humerus was resulted from c9llision occurring when radius and ulna struck humerus while at extension posture, it was chiefly due to extensor tractive force. We can use extensor tractive force to reduce the fracture of lateral condyle and avoid extensor tractive force to fix it.

Objective To observe whether the full-thickness defects of articular cartilage at the knee joint of rabbits could be repaired by implantation of polyglycolic-acid(PGA) composites adhered with bone marrow stromal cells (BMSCs). Methods Culture-expanded rabbits’BMSCs were seeded onto porous PGA scaffolds. After a 72-hour co-culturing, the cell-adhered PGA was implanted into the articular cartilage defect at the intercondylar fossa of the femur. The rabbits were sacrificed 12 weeks later after the operation and the specimens were examined histologically for morphologic features, and stained immunohistochemically for type Ⅱcollagen. Results The specimens harvested from BMSCs-PGA composite demonstrated a hyaline cartilage formation. No obvious progressive degeneration sign was found in the newly formed tissue. The control groups showed no hyaline-like cartilage formation. Conclusion PGA composites adhered with in vitro culture-expanded autologous BMSCs can facilitate formation of hyaline-like cartilage in rabbits.

Objective To discuss the repair methods for the cartilage defects of the knee joint. Methods The cylindrical osteochondral grafts were harvested from the non-weight-bearing area of the knee joint and then transplanted to the cartilage defects in 6 patients with cartilage defects of the knee joint. Results The clinical symptoms of all the patients followed up for 2-24 months disappeared and the joint mobility recovered to normal. A follow-up MRI showed consistent cartilage coverage and the excellent position of the cylindrical osteochondral grafts. Conclusions The osteochondral autograft is a practical surgical method because it is characterized by less trauma, simple performance and good maintenance of the curvature of the articular surface.