Objective:To investigate the indications and effects of arthroscopic all-inside reconstruction in the treatment of isolated posterior cruciate ligament (PCL) injury.Methods:A retrospective analysis was performed on 47 patients with isolated PCL injury, who underwent arthroscopic all-inside reconstruction in the Third Medical Center of the PLA General Hospital from January 2016 to January 2020. There were 39 males and 8 females, aged 27.14±7.70 years old (range 16-40 years old). The preoperative kneeling-position stress X-ray showed that the degree of tibial posterior displacement was 8-10 mm, which was a complete and isolated Grade II PCL injury. The tibial and femoral tunnels were created through posterior-medial, anteromedial, and anterolateral portals, while the lateral portal to the medial femoral condyle was enlarged to position the tibial tunnel and protect the anterior cruciate ligament. The autologous graft tendon was pulled through the femoral and tibial tunnels secured with an adjustable loop plate. The efficacy was evaluated by evaluating and comparing preoperative and postoperative Lachman test, posterior drawer test, knee range of motion and relaxation, pain visual analogue scale (VAS) and Lysholm score.Results:43 patients were followed up for 35.21±3.88 months (range 12-40 months). The symptoms of knee instability all improved after surgery. At the follow-up of 1 year after surgery, 41 (95%) and 40 (93%) patients showed normal or I-degree laxity in Lachman test and posterior drawer test, respectively. The active range of motion and passive flexion of the knee joint were increased to 90°-110° and 110°-130°, respectively. The Lysholm score was 86.44±4.08 at the first year of follow-up and 90.12±3.33 at the last follow-up with significant difference compared with pre-operations ( P<0.05). The VAS score was 2.07±0.94 at the first year of follow-up and 1.28±0.83 at the last follow-up with significant difference compared with pre-operations ( P<0.05). The Lysholm score and VAS were 90.12±3.33 and 1.28±0.83, which were significantly improved compared to 1-year-follow-up ( P<0.05). Conclusion:Routine kneeling stress X-rays can evaluate the degree of tibial posterior displacement in isolated PCL injuries. With tibial posterior displacement equal to or greater than 10 mm, surgical reconstruction was required. All-inside reconstruction of isolated PCL injury was a safe and minimally invasive surgery to improve symptoms and restore knee functions.

Objective To analyze the feasibility and curative effects of one-stage reconstructing the anterior and posterior cruciate ligaments injuries with autologous hamstring tendon using TightRope devices all inside.Methods Thirty-four patients who suffered from the anterior and posterior cruciate ligaments injuries referred to our center from July 2013 to July 2015.Thirty-two of them with the average age 37.4±9.2 years old (range:18-61 years old),including 23 male and 9 female,were followed up over 2 years.According to the anatomy classification for knee dislocation,14 patients were KD Ⅱ type,11 patients KD Ⅲ M type,7 patients KD Ⅲ L type.The interval from injury to surgery was 4-6 weeks.One-stage reconstruction of the anterior and posterior cruciate ligaments was conducted by using autologous hamstring tendon with TightRope device all inside under arthroscopy.Ipsilateral hamstring tendon was taken in the patients of KD Ⅱ type,while opposite hamstring tendon was used in the patients of KD Ⅲ.The semitendinosus graft acted as posterior cruciate ligament,and gracilis graft acted as anterior cruciate ligament.Fold the tendon graft in half into four strands,with the length 6-7 cm,diameter 7-9 mm,and link together with two TightRope devices.The anterior and posterior cruciate ligaments injuries were reconstructed in one-stage with autologous hamstring tendon using TightRope all inside.The medial or lateral collateral ligament in patients of KD Ⅲ type was repaired.The anterior and posterior drawer test,Lachman test,valgus stress test,IKDC classification,Lysholm scores were recorded before and after surgery to evaluate the efficacy of reconstruction.Results Thirty-two patients who were treated with surgery were followed up 2-4 years with average 2.6 years.Preoperative symptoms relieved apparently in the last follow-up in all patients.The anterior and posterior drawer test and Lachman test were negative.The IKDC score of 27 patients at two years after surgery were rated as normal (84％),while that of 4 patients were rated as near normal (13％),1 patients as abnormal (3％).The rates of the normal and near normal were up to 97％.The overall score was improved from preoperation (36.4±4.6) to postoperation (90.1± 10.7,t=27.96,P=0.000).The knee function Lysholm scores was significantly increased from preoperation (52.7±5.3) to postoperation (91.5±9.2,t=23.26,P=0.000).Conclusion The one-stage reconstructing the anterior and posterior cruciate ligaments injuries with autologous hamstring tendon using TightRope devices all inside can recover the stability of knee joint with satisfied joint function postoperatively.

Objective To investigate the efficacy of anatomic plate internal fixation in treatment of complex proximal humeral fractures combined with humeral shaft fractures.Methods This retrospective case series study included 58 patients with complex proximal humeral fractures combined with humeral shaft fractures admitted from July 1998 to July 2015.There were 31 males and 27 females,with a mean age of 63 years (range,18-86 years).According to the Neer classification of proximal humeral fractures,three-part fractures were noted in 42 patients and four-part fractures in 16 patients.Four patients were combined with compressed or splitting fractures of the head of humerus and 38 patients with dislocation of the shoulder.According to the site classification of femoral shaft fractures,proximal 1/3 shaft fractures were noted in 36 patients,middle and distal 1/3 shaft fractures in 19,and multisegmental shaft fractures in three.All patients underwent anatomic reduction and anatomic plate internal fixation.Bone healing,Neer score of function outcome and complications were evaluated after operation.Results Mean duration of follow-up was 8.6 years (range,1-18 years).Bone union was observed in all patients after 10 to 24 weeks (mean,14.5 weeks).According to the Neer score,the outcomes were excellent in 23 patients,good in 25,fair in eight and poor in two,with the excellent rate of 83 ％.Complications such as infection,nerve injury and vascular injury were not observed after operation.Six patients suffered from limitations of shoulder anterior flexion and rise,one patient had humeral head necrosis and treated by shock wave treatment,and one patient had poor incision healing with hemorrhagic effusion and cured after dressing.Conclusion Anatomic plate internal fixation can contribute to fast functional recovery and few complications in treatment of complex proximal humeral fractures combined with humeral shaft fractures.

Objective To investigate the effect of extracorporeal shock wave therapy (ESWT) on early and mid-term knee osteoarthritis (KOA). Methods 70 patients were randomly assigned to ESWT group (n=34) or control group (n=36). The ESWT group was given shock wave on unilateral knee, while the control group accepted shock wave with the energy density of 0. They were evaluated with Visual Analog Scale (VAS) on movement, Lequesne Index and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index before and 12 weeks after the intervention. Results The scores of VAS, Lequesne Index and WOMAC Osteoarthritis Index improved more in the ESWT group than in the control group after intervention (P<0.01). Conclusion ESWT is effective on KOA as a non-surgical treatment.

Objective To observe the effect of extracorporeal shock wave (ESW) on proliferation of chondrocyte in vitro. Methods Chondrocyte from normal rabbit knee using enzymatic digestion was treated with ESW of 0, 1×105, 1.5×105, 2×105, 2.5×105, 3×105, 3.5×105 Pa 0, 300, 600, 900 times in vitro. The pressure and frequency of ESW most promoting chondrocyte proliferation were determined with cartilage cell morphology, HE staining and CCK-8 assay. Results Chondrocyte proliferated most under 1.5×105 Pa and 600 times of ESW, and decreased as the pressure and the frequency increased. Conclusion Chondrocyte is stress-sensitive in vitro. ESW can promote chondrocyte proliferation in certain pressure and frequency

BACKGROUND:No method is ideal for treating traumatic avascular necrosis of talus up to now.Extracorporeal shock wave therapy(ESWT)is a micro-traumatic,simple,and effective method to treat musculoskeletal diseases;however,the therapeutic effect on necrosis of talus needs to be further studied.OBJECTIVE:To evaluate the therapeutic effect of liquid-electric extracorporeal shock wave on traumatic avascular necrosis of talus,and to explore new treatments of traumatic avascular necrosis of talus METHODS:A total of 34 patients with traumatic avascular necrosis of talus were selected from the Affiliated Hospital of Medical College of Chinese Armed Police Force from September 2004 to June 2009.The patients were randomly divided into ESWT and control groups,with 17 patients per group All patients were treated with pain point positioning combined with surface X-ray localization,theworking voltage of 8-10 kV,energyflowdensity of 0.12-0.16mJ/mm2,impact frequency of 40-50 times/min,and impact of 800-1000 times,once a week,for 3-5 cycles.Pain was evaluated with VAS before and after treatment,function of ankle was evaluated with AOFAS standards,and MRI of ankle was re-checked at 18 months after treatment to compare necrotic area before and after treatment.RESULTS AND CONCLUSION:VAS pain,function of ankle,and necrotic area of ankle in the ESWT group were significantly improved compared to those in the control group at 18 months after treatment(P<0.01).Activity of one case in the control group was limited by severe pain due to traumatic arthritis in the first 15 weeks after ankle arthrodesis surgery.This suggested that significant effect and fewer complications,for treating traumatic avascular necrosis of talus.

ObjectiveTo study the rehabilitation for the forearm rotation function handicap after the fracture of radius. Methods53 patients with the forearm rotation function handicap after operation for the fracture of radius were reviewed. ResultsThe patients were followed up for 2～7 years. The angles of pronation and supination in forearm were 23.47° and 34.42° before treatment, and were 66.59° and 78.56° after treatment （P<0.01）. The patients with the course of disease less than 2 months procured better forearm rotation function the those more than 2 months （P<0.01）. ConclusionThe forearm rotation function need to be prevented and rehabilitated early after the fracture of radius.

To explore the effect of allogenic achilles tendon on one-stage reconstruction of antedor/postedor cruciate ligaments,3 cases with ruptured anterior/posterior cruciate ligaments and received allogenic achilles tendon reconstruction,at Department of Orthopaedics,General Hospital of Chinese People's Armed Police Forces,from June 207 to April 2008,were collected.A more than 6-month follow-up showed that all cases could walk at 12 weeks postoperatively.Anterior andposterior drawing tests,as well as inversion and extroversion stress test were negative,with 100° movement ranges.In addition,no serious complication occurred.The Lysholm knee fuction scores were 87,83 and 85,respectively.The results suggest that the allogenic achilles tendon seems to be a satisfactory treatment option for one-stage anterior/posterior cruciate ligaments reconstruction,which has merits of easy operation,small trauma and good short-term results.However,further research is needed to determine the role of allogenic achilles tendon in knees with multi-ligament injury.

ObjectiveTo investigate atlantoepistrophic imaging features of patients with vertigo of cervical syndrome.Methods74 patients with vertigo of cervical syndrome were checked by photographs of cervical vertebrae of A-P position, lateral position and mouth open position, some patients were checked by CT three-dimensional reconstruction and/or MRI vertebral arteriography.ResultsImaging examination of these patients showed that physiolgical curvature of cervical vertebrae became straightened, width of both lateral masses of atlas was inequality, space of both lateral masses of atlas to odontoid process of vertebra dentata was also inequality, and inferior articular surface of lateral mass was not parallel with superior articular surface of axis. The CT could display the side displacement and anterior or posterior rotation of lateral masses of atlas. The cervical MRI vertebral arteriography could display the effect of side displacement and rotation of lateral masses of atlas on vertebral artery. If side displacement or rotation of vertebral artery occurred, the diameter of artery decreased.ConclusionThe diseased region of vertigo of the cervical syndrome is the atlas and axis, especially the side displacement and anterior or posterior rotation of the atlas.

[Objective]To demonstrate mechanism of ESW in curing osteogetic disorders,we studied expression of some osteogenetic factors in human mesenchymal stem cells(hMSCs)when exposed to ESW.[Method]After success in marrow aspiration,isolation and obtainment optimal experimental energy,a dose of 5kV and 100 times of ESW was applied to hMSCs of passage 1.The expression of IGF-Ⅰ and TGF-?1 were examined by immunocytochemical staining.[Result]The cytochemical staining results showed that expression of IGF-Ⅰ and TGF-?1 appeared at different passage of hMSCs after ESW intervention.Appearance of IGF-Ⅰ was earlier than TGF-?1 which didnt express until passage 7.At the same interval,the expression of IGF-Ⅰ and TGF-?1 in control group difference is lower than ESW group,respectively(P