[Objective]The purpose of this study was to describe mid report the result of the ulnar nerve transfer to biceps muscle to restore elbow flexion after acute and delayed upper brachial plexus injuries.[Methods]Two patients with acute brachial plexus injury (the time between the injury and the operation were six and eight months) and three patients with delayed brachial plexus injury(the time between the injury and the operation were from twevle to eighteen months) underwent nerve transfer using fascicles of the ulnar nerve to the motor branch of the biceis muscle. The average age of the patients was twenty eight and the mean follow-up periods were nine months after the surgery. Patients were evaluated with regard to reinnervation of the biceps, ulnar nerve function, elbow flexion strength, and grip strength.[Results]For the two acute patients, the first sign of biceps muscle contraction were observed within 1 week, the average time required for reinnervation of the biceps after nerve fascicle transfer was within six months. For the three delayed patients, the first sign of bicep muscle contraction was observed in about three month, and the average time required for reinnervation of the biceps was ten months.Hypoesthesia of the ulnar nerve was clinically abserved in three patients, but this symptom disappeared within month with no treatment.Compared with those delayed cases, the acute patients had faster and better recovery of their olbow flexion function.However, all patients achieved grade-3 or better elbow flexion strength according to the grading system of the Medical Research Council.[Conclusion]The author recommend this safe, simple and effective Oberlin procedure for brachial plexus injuries involving the C5、6 or C5~7 nerve roots.

To investigate the influence of recombinant adenovirus carrying tissue inhibitor of metalloproteinase-3 (RAdTIMP-3) on the main compositions of rabbits intervertebral discs and to assess its potential in treatment for intervertebral disc degeneration.[Method]RadTIMP-3 and empty adenovims vector with Lac-Z gene (Rad66) was propagated in 293 Cells and was purified, identified and tittered. Thirty Japanese white rabbits were randomly divided into 5 groups. And 25 μl of various reagents were injected to the L4、5 and L5、6 intervertebral discs of the rabbits as follows:normal saline in group 1, 1.0×1010 OPU/ml of RAd66 in Group 2, and 1.0×1010 OPU/ml of RAdTIMP-3 in group 3, 4 and 5. The intervertebral discs of each group were collected after 2, 2, 1, 2 and 4 weeks after injection respectively.Then X-gal staining, And Group 1, RT-PCR for TIMP-3 and aggrecan core protein,TUNEL staining, immunohistochemical staining for TIMP-3 and type I! Collagen and Safranin O-Fast green staining was carried out to assess the effects of RadTIMP-3 transfection.[Result](1)concentration of RAdTIMP-3 reached 1.9×1012 OPU/ml after propagation and purification. (2)RT-PCR shows that the expression of TIMP-3 was significantly raised in group 3, 4, 5, as compared with group 1 or 2. And the expression of core protein gene in group 3, 4, 5 increased slightly than in group 1 and 2. (3) TUNEL staining revealed that there was not significant difference between the positive-staining rates of any two of the groups. (4)TIMP-3 staining exhibited an obvious increase of positive-staining rates in group 3, 4 and 5 as compared with groupi or 2. The staining density of Safranin O-Fast Green staining and immunohistochemical staining for type II collagen of group 5 was obviously higher than that of group 1 or 2.[Conclusion]RAdTIMP-3 can express widely and safely in rabbit intervertebral discs, and improve the quantity and quality of matrix. It has the potential to be used in treatment for intervertabral disc degeneration.

[Objective]To investigate the protective effect of Tanshinone IIA (TSⅡA) against interleukin-1β (IL-1β) induced obstruction of energy metabolism of rabbit annulus fibrosus cell in vitro.[Methods]Rabbit annulus fibrosus (AF) cells were cultured in 3-dimension alginate beads and randomly divided into 7 groups. Various concentrations of TSⅡA and IL-1β was added to the medium for intervention: no drug was added in group A as normal control, 4 μg/ml TSⅡA in group B, 10 μg/ml IL-1β in group C, and both 10 μg/ml IL-1β and different concentrations of TSⅡA in groups D-G (0.5 μg/ml, 1 μg/ml, 2 μg/ml and 4 μg/ml respectively). After 3 days of incubation, the cells were collected for measuring the activity of Na+-K+-ATPase and succinate dehydrogenase (SDH), MTT assay for cell proliferation, and AnnexinⅤ-PI staining for cell apoptosis.[Results]The activity of Na+-K+-ATPase of group G (10 μg/ml IL-1β+4μg/ml TS IIA; 3.23±0.28 U/mgprot) was increased significantly as compared with group C (10 μg/ml IL-1β; 1.118±0.15 U/mgprot, P＜0.01). The activity of SDH of group G was 12.48±0.97 U/mgprot, which was obviously higher than that of group C (3.03±0.60 U/mgprot, P＜0.01). The absorbance of MTT assay of group G (0.77±0.06) was significantly increased as compared with group C (0.31±0.07,P＜0.01). The absorbance of groups D-G increased as the concentration of TSⅡA increased. The apoptotic cell rate and dead cell rate of group G was 21.08±1.46% and 8.99±0.33%, which were both lower than that of group C (43.11±2.7,P＜0.01 and 11.71±0.32,P＜0.01).[Conclusion]TSⅡA is able to promote cell proliferation and decrease cell apoptosis of AF by alleviating IL-1β induced inhibition on cell energy metabolism.

Lumbar fusion is currently the major treatment of lumbar degenerative disease, spinal instability and discogenic disease etc. Transforaminal lumbar interbody fusion (TLIF) is a novel lumbar fusion technique in recent years, and with the progress of minimally invasive spinal surgery, minimally invasive TLIF (mini-TLIF) technique has also got access to rapid development, which has more advantages compared with traditional open TLIF. The authors review the indications and contraindications, surgical method, development and advantages and minimally invasive surgical assistant instruments of mini -TLIF.

[Objective]To explore developmental history of extremity in jury and reconstruction,and to reflect the relationship of modern orthopaedic medical treatment modes to the lire nature and natural law.[Method] The author reviewed the history of organic evolution and 'human evolution,and rank the historical era of life origin,birth of cell and bone architecture,formation and development of bone and joint in living nature and final shape construction of vertebrate and human,and summarized the development of extremity injury and reconstruction after foundation of society via evolutive law.[Result]A scientific and order evolutived series that was not created at natureg please can be seen from origin of life,generation of bone and joint,evolution from high-mammal to human boing.The reason of extremity injury,idea and methods of medical treatment are correlated with the development of seciety civilization,the progress of scientific technique,and change of life style.With the great change of science and technique,life style and idea of human,reasons of extremity injury and orthopaedic diseases have also changed,but the life nature of human being is not changed with them.[Conclusion]Various kinds of techniques and methods that are used to treat trauma and bone disease only accustomize the natural process,rather than excessive intervention.The culture idea of human being,requirement of material and spirit should be developed,and the scientific research of non-protoplasm may break some rules,but the study of life science and medical idea should not disobey natural law and human nature.Suitable techniqus of integrated observation,consolation,nursing and modern techniques are still basic principles of orthopaedic treatment.Nature is forever teacher and origin of medical science.

For the past few years.the number of patients with thoracolumbar fractures increased year after year.With the improvement of surgical instruments and surgical techniques and the health care workers'in-depth study about thoracolumbar fractures,posterior approach treatment of patients with thoracolumbar fractures has achieved an encouraging progress.Now summarization of research progress about operation opportunity,posterior instrumentation and modified posterior surgery is made in this paper.

Many clinical bone nonunion or delayed union often appear in the early stage of bone healing,but they have been always found too lately.Before X-ray films of visual changes indicates salt content inbones reaching 25%,the very early changes ofclinical significance can not be observed.This paper introduces the theory of fracture healing and the definition of bone nonunionand the significance of the basic multicellular unit(BMU)and the OPG-RANKL-RANK system in bone reconstruction.Many technologies such as ultrasonic testing,vibration analysis,mechanical impedance analysis,the bone marrow cavity imaging technologiy,high-resolution CT etc.have been reported in study on the bone,as well as early diagnosis of fracture nonunion.However,the molecular level of early diagnosis is deficiency.

It is generally known that postoperative pain can cause many adverse clinical effects on the patients of orthopaedic surgery such as lack of exercises of the involved limb,atrophy of the related muscles,anchylosis,osteoparosis,et al,which will ultimately affect the patient's final recovery and living quality.This paper introduces some recent advanced theories about the orthopaedic postoperative pain diagnosis,evaluation and various kinds of treatments hoping to achieve more effective perioperative analgesia in orthopaedic surgery.

Fractures of the clavicle are common and have been typically addressed to nonoperative treatment.However,to the comminution or complete displacement,there is a marked risk of nonunion,malunion,and poor outcome.Several treatments have been proposed,but there is no consensus about the treatment of choice.This article investigates the most common treatments and tries to find the indications for the treatments,and the new direction for the treatments of fractures of the clavicle.

[Objective]To investigate the characteristics and treatment strategy for fresh high energy fracture dislocation of tarsometatarsal joints in a retrospective study.[Method]From September 2002 to April 2008,43 patients with fresh high energy fracture dislocation of tarsometatarsal joints were treated with cannulated screw combined with Kirschner wire fixation or Kirschner wire fixation alone.There were 35 males and 8 females,with a mean age of 37.5 years(range,18 to 55 years).The injury was caused by a road accident in 15 patients,by a heavy crash in 21 patients,and by a fall from a height in 7 patients.According to the Myerson damage typing,there were 9 cases of type A,2 cases of type of B1,25 cases of type B2,4 cases of type CI and 3 cases of type C2.Eight were open injuries(6 of Gustilo-Anderson type I and 2 of type Ⅱ)and 35 closed injuries.Internal fixation were undertaken at an average of 4.6 days after injury(range,2.5 hours to 21 days).At 4-6 weeks all the patients began functional exercises after removal of the plaster casts.At 16-18 weeks all the patients began to walk with partial weigh loading after removal of the internal fixators.[Result]All the 43 patients were followed up for 26 months on average(range,13 to 38 months).No infection,breakage,loosening of internal fixator,nonunion or longitudinal arch collapse was found.According to ZHOU'S assay standard.excellent result was achieved in 26 cases,good in 14 cases,and fair in 3 cases,with excellent to good results of 95.3%.Six patients had post-traumatic arthritis,which was complicated with injured articular surface.[Conclusion]Fresh high-energy fracture dislocation of tarsometatarsal joints can be diagnozed correctly.Early diagnosis and correct classification,proper operation timing,anatomical reduction,rational internal and external fixation and timely functional training are essential for patients to achieve good clinical result.