Research progress of circadian rhythm and circadian clock gene regulation in the development of myopia / 国际眼科杂志(Guoji Yanke Zazhi)

With the development of society, the incidence of myopia and the population of myopia has increased year by year, which has become a major public health problem. Therefore, the research on the pathogenesis and prevention and control measures of myopia is imminent. In recent years, the role of the biological clock in the development of myopia has gradually attracted scholars interest. Now the author starts from the impact of the biological clock on the axial length, retina and choroid in the development of myopia. In order to provide new ideas for the study of prevention and control measures and the pathogenesis of myopia, a brief review is made from the perspective of contemporary society and disrupted body clock.

Influencing factors of preoperative pulmonary function in elderly patients undergoing rotator cuff surgery / 北京大学学报(医学版)

OBJECTIVE@#To analyze the preoperative pulmonary function in rotator cuff injury patients and the possible influencing factors.@*METHODS@#All the rotator cuff surgery patients who underwent pre-operative pulmonary function examination in Peking University Third Hospital from Jan. 2020 to Jun. 2020 were retrospectively reviewed. Their perioperative medical records and main parameters of pulmonary function were collected from database management system, and their gender, age, body mass index (BMI), smoking history, time from injury, visual analogue scale (VAS) and other factors impacting on preoperative pulmonary function were studied.@*RESULTS@#Twenty-nine patients with rotator cuff injury were included, among whom 1 patient was reported to have restrictive ventilation dysfunction and 2 patients to have obstructive ventilation dysfunction. All the three patients denied the history of respiratory diseases, and had no respiratory symptoms. In all enrolled patients, the mean forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) was 79.2%±5.9%, and the mean VAS pain score was 3.66±1.26. In addition, the dynamic pulmonary functions (FVC, FEV1) were reduced in more than half of the elderly, and the total lung capacity (TLC) was lower than the estimated value in 2/3 of the elderly. There were significant differences in three main indexes of pulmonary functions between genders, and the percentage of the estimated TLC between normal BMI group (18 kg/m2 < BMI < 24 kg/m2) and overweight/obesity group (BMI≥24 kg/m2) was significantly different. Based on the injury time longer than 1 year or not, the results indicated that FVC and TLC were significantly different between the two groups.@*CONCLUSION@#In addition to gender and age, time from injury and severity of pain, as well as overweight/obesity, may influence pulmonary function outcomes in the elderly rotator cuff patients. Targeted intervention can be carried out on these factors before surgery. Preoperative lung function test can be used as one of the basic evaluation indexes for respiratory training and rehabilitation of patients.

Management algorithm for septic arthritis after anterior cruciate ligament reconstruction / 北京大学学报(医学版)

OBJECTIVE@#To summarize the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction.@*METHODS@#A retrospective review was conducted of all the arthroscopic anterior cruciate ligament reconstructions performed at Department of Sports Medicine, Peking University Third Hospital between January 2001 and December 2020. In the study, 65 of 27 867 patients experienced postoperative septic arthritis. The incidence, presentation, laboratory results, treatment, and outcome of all the infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized.@*RESULTS@#A total of 27 867 anterior cruciate ligament reconstructions were performed at our department between January 2001 and December 2020. In the study, 65 (0.23%) patients were identified with postoperative septic arthritis. The most common symptoms of the infected patients were fever (38.7±0.5) ℃, knee swelling, pain, and restricted motion. The mean peripheral white blood cell count (WBC) was (9.2±2.6)×109/L (range 4.2×109/L-19.4×109/L), with (72.5±6.3) % (range 54.9%-85.1%) polymorphonuclear neutrophils (N). The mean erythrocyte sedimentation rate (ESR) was (59.9±24.1) mm/h (range 9-108 mm/h), C-reactive protein (CRP) was (10.9±5.7) mg/dL (range 1.2-30.8 mg/dL), and fibrinogen (FIB) level was (7.0±1.6) g/L (range 3.7-10.8 g/L). All of the laboratory results were statistically higher in the infection group compared with the normal postoperative group (P＜0.001). The synovial white blood cell count (SWBC) of aspirated knee joint fluid was (45.0±29.8)×109/L (range 7.1×109-76.5×109/L). Polymorphonuclear cell percentage (PMNC) was (90.27±7.86) % (range 60%-97%). In the study, 45 patients (69.2%) had positive aspirate cultures. Microbiology showed coagulase-negative Staphylococcus (CNS) and Staphylococcus aureus (SA) were the most common bacterium (34 cases and 7 cases, individually). There were 26 methicillin-resistant Staphylococcus. Both conservative (16 patients) and operative (49 patients) treatments were effective, but conservative group had a longer recovery time (5.6 d vs. 1.6 d, P=0.042).@*CONCLUSION@#Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on synovial fluid analysis and bacterial culture. Our proposed treatment protocol is arthroscopic debridement and antibiotic therapy as quickly as possible.

Application of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears / 北京大学学报(医学版)

OBJECTIVE@#To explore the clinical application of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears.@*METHODS@#This research retrospectively analyzed a total of 38 hips from 36 patients (2 of them were bilateral) whose imaging examination showed acetabular labral well healed but the rehabilitating training was limited due to hip pain after arthroscopie repair of acetabular labral tears in our hospital between June 2015 and May 2017. All the patients underwent ultrasound-guided hip joint drug injection treatment. Through comparing the pain and the function of hip before and after drug injection, the clinical application values of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears were explored. The degree of hip pain was assessed by visual analogue score (VAS), which were scored before and after the injection. The hip function was assessed by the hip range of activity. The SPSS 21.0 statistical software was used for the data analysis. The effective rate of hip injection was calculated, which was defined as: ("excellent" + "good")/total number of cases×100%. The degree of hip pain was assessed by VAS, which was divided into 0 to 10 points with 0 for no pain and 10 for unbearable severe pain. The function of hip was assessed by the hip range of activity. The therapeutic effect of "excellent" meant no pain or occasional slight pain in the hip, along with Patrick test was negative and hip joint was not limited; the therapeutic effect of "good" meant that the pain was significantly reduced, and the hip's activity was slightly restricted. "No effect" meant that the pain of hip was not relieved, and the Patrick test was positive.@*RESULTS@#The VAS score of the patient before drug injection was 5.46±1.46, and the VAS score was 2.01±0.53 after drug injection 4 weeks later. The score of the latter was significantly lower than that of the former, and the difference was statistically significant (P<0.05). The hip joint activity after ultrasound-guided hip joint drug injection was significantly improved. The therapeutic effective rate was 84.2%.@*CONCLUSION@#For patients with hip pain and limitations after arthroscopie repair of acetabular labral tears, ultrasound-guided drug injection can effectively reduce hip pain, improve hip activity, and promote hip functional reconstruction.

Heterotopic ossification after arthroscopy for hip impingement syndrome / 中华医学杂志(英文版)

BACKGROUND@#Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome.@*METHODS@#A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11-34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision.@*RESULTS@#A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = -1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = -1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = -1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = -55.23, P < 0.01) and NAHS by 28.75 points (t = -6.03, P < 0.01), and VAS decreased by 4 points (t = 9.80, P < 0.01). HO and non-HO patients were similar for demographic and surgical data, and clinical and functional scores.@*CONCLUSION@#HO incidence after arthroscopic treatment of FAI is similar to that found in previous studies. Most HO have no effect on clinical symptoms. Patients who undergo revision HO resection show improvement in pain and joint function.

Clinical characteristics of 4355 patients with anterior cruciate ligament injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention, diagnosis and treatment. However, few studies have reported such data, especially in China. The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.</p><p><b>METHODS</b>Between 1993 and 2007, a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered. Data were collected using a special database system. And the distributions of characteristics in different groups were compared and analyzed statistically.</p><p><b>RESULTS</b>All subjects were confirmed with ACL tear during surgery. Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05% vs. 24.95%, P < 0.001). This study also found that sports trauma was the main cause of ACL tears. Soccer, basketball, judo, wrestling and track and field were the five most responsible activities for athletes. The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs. 717.5 days, P < 0.001). Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04% single-bundle, 18.30% double-bundle). Three hundred and forty-five patients (7.92%) were combined with other ligaments injuries, 2667 (61.24%) were found with various grades of cartilage lesions, and 3377 (77.54%) were found with meniscal injury.</p><p><b>CONCLUSIONS</b>Sports trauma was the main cause of ACL tears in China, and reconstruction had become the principal surgical choice. In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury, patienttailored ACL reconstruction should be suggested at the right moment.</p>

Comparison of single and double bundle isolate posterior cruciate ligament reconstruction with hamstring autograft / 中华外科杂志

<p><b>OBJECTIVE</b>To determine if double bundle hamstring autograft posterior cruciate ligament (PCL) reconstruction could bring better outcomes than single bundle.</p><p><b>METHODS</b>From June 2007 to June 2009, there were 22 subjects, including 16 male and 6 female patients with an average (37 ± 13) years old (16-54 years old) were reconstructed with single bundle PCL reconstruction (single bundle group), 24 subjects, including 18 male and 6 female patients with an average (37 ± 10) years old (17 - 52 years old) were reconstructed with double bundle PCL reconstruction (double bundle group). There were no differences between the two groups on patients' demographics and the duration from the injury to the operation (P > 0.05). Clinical outcomes, KT2000 and tunnel placements of all the patients were measured and analyzed.</p><p><b>RESULTS</b>The two groups were retrospectively studied and compared with a (29 ± 9) months (24 - 55 months) follow-up. Operation duration of double bundle group was (92 ± 8) minutes which was significantly longer than the single bundle group (78 ± 13) minutes (t = 2.474, P < 0.05). IKDC, Lysholm and Tegner scores were all significantly improved at the last follow-up of both groups (single bundle group: t = 9.578, 13.115 and 8.165, P < 0.01; double bundle group: t = 4.390, 5.522 and 4.313, P < 0.05). Post operative KT2000 side-to-side difference of the double bundle group was significantly smaller than that of the single bundle group under maximum posterior force with the knee in 90° flexion ((1.5 ± 1.5) mm vs. (4.0 ± 2.9) mm, t = 2.538, P = 0.019). There were 66.7% of the patients of double bundle group were normal which was significantly higher than 31.8% of the single bundle group on the IKDC knee examination form (χ² = 5.576, P = 0.018).</p><p><b>CONCLUSIONS</b>Single or double bundle PCL reconstruction could restore the knee's stability and function satisfied. There are no differences between two groups in clinical scores, but double group manifestes a better anterior-posterior stability.</p>

Mid-term results after arthroscopic repair of full-thickness rotator cuff tears / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the mid-term results of arthroscopic repair of full-thickness rotator cuff tears.</p><p><b>METHODS</b>From December 2002 to May 2007, 35 patients(35 shoulders) with full-thickness rotator cuff tears underwent arthroscopic treatment. Five patients were lost in the follow-up period, leaving 30 patients available for evaluation. There were 15 male and 15 female patients, the average age was 55.6 years(31-74 years). Three left shoulder and 27 right ones were involved. All the patients underwent subacromial bursectomy and acromioplasty, 19 cases were repaired by suture anchor. Eleven tears were repaired by suture anchor combined with side-to-side suture. Sixteen patients underwent single-row repair and 14 patients underwent dual-row repair. The follow-up was completed on June 2012. The University of California at Los Angeles (UCLA) scoring system was adopted before operation and at the final evaluation.</p><p><b>RESULTS</b>Thirty patients were followed up for an average of 78.5 months(range 5-10 years). The average score increased from 14.2 ± 3.1 to 33.6 ± 2.1 (t = -37.154, P = 0.000) . The mean pain score was 2.5 ± 0.9 vs.9.5 ± 1.0(t = -24.466, P = 0.000) for preoperative vs. postoperative, the function score was 4.5 ± 1.5 vs. 9.4 ± 1.1 (t = -18.500, P = 0.000), the mean forward flexion score was 3.3 ± 1.6 vs. 4.9 ± 0.2(t = -5.614, P = 0.000), the mean forward flexion strength was 3.9 ± 0.5 vs. 4.7 ± 0.4 (t = -6.591, P = 0.000). The results were 19 excellent, 11 good. The average scores of single-row group and double-row group were 33.6 ± 1.7 and 33.6 ± 2.6 respectively. All patients were satisfied with the operation.</p><p><b>CONCLUSIONS</b>This surgery has many advantages such as mini-invasion and rapid recovery. The clinical results of both single-row repair and dual-row repair are satisfactory. The key to the operation lies in accurate tear pattern recognition, enough tendon release and correct suturing method.</p>

Monitoring and analysis of arsenic pollution in Yangzonghai lake and the influence of arsenic to the surrounding drinking water and local food in Chengjiang of Yunnan province in 2008 and 2009 / 中国地方病学杂志

Objective To find out the arsenic pollution in Yangzonghai lake and its influence to the surrounding drinking water source and the local food and to provide a scientific basis for arsenic pollution control,drinking water and food safety. Methods Arsenic monitoring were carried out in 10 points of Yangzonghai lake,45 water sources within 5 km of Yangzonghai lake, and locally produced food. Results From September 2008 to December 2009, the water arsenic concentrations of Yangzonghai lake ranged 0.06 - 0.18 mg/L, the average arsenic concentrations were 0.12 mg/L and 0.10 mg/L for 2008 and 2009, respectively, the value of 2009 was higher, and the difference was statistically significant(t = 3.284, P ＜ 0.05). There were no significant difference in the average of arsenic concentration of Yangzonghai lake between the dry and rainy season in 2009(t = 0.905, P ＞0.05). The arsenic concentrations from the No. 3 spring water ranged from 0.12 - 30.36 mg/L. After a peak value early in October 2008, the No. 3 spring water showed a downward trend month by month. In 2008 the average arsenic concentration was 23.92 mg/L, 2009 was 2.41 mg/L, down 89.92% over the previous year, the difference was statistically significant(t = 9.582, P ＜ 0.05 ). In January and February 2009, the average arsenic concentration (11.96 mg/L) was significantly higher than those of March-December(0.50 mg/L, t = 57.759, P＜ 0.05). In Yangzong town, the arsenic concentration in the drinking water and river met the national drinking water health standards. Among 78 samples monitored of the locally produced food in Yangzong town, 77 passed, with a pass rate of 98.72%. Conclusions Arsenic contamination has been effectively controlled. The drinking water and local food production has not been contaminated by arsenic except aquatic products in Yangzonghai Lake. It is recommended to take effective measures to prevent water contamination.

Arthroscopic debridement of osteoarthritic elbow in professional athletes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Arthroscopic debridement is an appropriate procedure for osteoarthritic elbow in general populations. However, the results of arthroscopic debridement in the professional athletes, a younger and highly active patient cohort is unclear. The purposes of this study were to assess the clinical outcomes of arthroscopic debridement of osteoarthritic elbow in professional athletes and to evaluate the effect of prognostic factors on the clinical outcomes.</p><p><b>METHODS</b>From January 1999 to January 2006, 35 professional athletes with osteoarthritc elbow (36 elbows) were treated with arthroscopic debridement, consisted of osteophytes removal, loose bodies removal and fenestration of the olecranon fossa as necessary. Average patient age was (23 ± 5) years (range 7 - 34 years). Average follow-up was (43 ± 23) months (range 16 - 98 months). Athletic activities consisted mainly of wrestling, judo and weightlifting. Patients were evaluated preoperatively and postoperatively with the modified Hospital for Special Surgery (HSS) elbow scoring system.</p><p><b>RESULTS</b>According to the modified HSS elbow scoring system, the result was excellent for 16 elbows, good for 14 and poor for 6. No case had got worse after surgery. All athletes reported an improvement in pain. After athletic training, 15 elbows were not painful, 16 mildly painful, 3 moderately painful and 2 severely painful. The arc of flexion-extension improved from 111° preoperatively to 127° postoperatively. All of the athletes were able to return to their previous level of training. Five athletes won national-level championships. At follow-up, 17 athletes (18 elbows) were greatly satisfied with the results, 12 satisfied and 6 unsatisfied. Postoperatively, one athlete reported ulnar nerve symptoms and two others had residual loose bodies. The fenestration of the olecranon fossa was associated with a significantly increased chance of a poor outcome. The nature of the osteoarthritis, duration of symptoms, osteophytes removal and loose bodies removal did not predict the outcomes.</p><p><b>CONCLUSIONS</b>Arthroscopic debridement of osteoarthritic elbow in professional athletes can yield significant short-term pain relief, as well as restoration of elbow range of motion and resuming their athletic training. The long-term durability of this procedure with regard to preservation of range of motion and radiographic progression of arthritis remains unknown.</p>

Arthroscopic Bankart repair with suture anchors: results and risk factors of recurrence of instability / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence.</p><p><b>METHODS</b>From March 2002 to March 2010, 259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors. And 188 patients (50 athletes, 138 nonathletes) were available for follow-up. The mean age at the time of surgery was 25.3 years (range, 13 - 58 years). The mean follow-up was 38.6 months (range, 12 - 110 months). All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES) shoulder score and Rowe score system. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. The ASES score was 72.6 preoperatively, and Rowe score was 33.4.</p><p><b>RESULTS</b>The ASES scores improved significantly to 91.9 postoperatively (P < 0.001). The Rowe scores improved to 81.9 postoperatively (P < 0.001). And 152 patients were greatly satisfied with the results, 16 satisfied and 20 unsatisfied. The satisfactory rate was 89.4%. 24 patients (12.8%) suffered a recurrence after surgery, 14 athletes and 10 nonathletes. The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group. On average there was no significant loss of external rotation postoperatively (average, 75.2° preoperatively and 67.2° postoperatively). Patients under age 20, and athlete patients were associated with recurrence (P < 0.05). Other factors including length of time until surgery, type of anchors, number of anchors, presence of bony Bankart lesion, presence of a superior labrum, anterior and posterior tear, presence of posterior or inferior labrum lesion, presence of rotator cuff tear, ligamentous laxity and rotator interval closure did not influence the recurrence rate (P > 0.05).</p><p><b>CONCLUSIONS</b>Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. Identification of risk factors for recurrence allows for consideration of open stabilization. In the series, patients under age 20 and athlete patients are the most important risk factors for recurrence.</p>

Twelve cases of the pectoralis major muscle tendon rupture with surgical treatment-an average of 6.7-year follow-up / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pectoralis major tendon rupture is a relatively rare injury leading to both functional and cosmetic deficiency. The peak torque of the pectoralis major is significantly decreased after conservational treatment of a total rupture. We suppose that surgical intervention is better choice.</p><p><b>METHODS</b>We retrospectively evaluated 12 patients who were diagnosed with distal pectoralis major muscle rupture and underwent operation in our institute from 1993 to 2007. All patients were male with a mean age of 32 (19 - 54) years. In 4 patients, tendon reconstruction was accomplished by fixing the tendon to the humerus using sutures passed through predrilled humeral bone tunnels. In 8 patients, tendon reconstruction was accomplished by directly suturing the muscle to the tendon. All patients followed an accelerated rehabilitation protocol. Treatment results were evaluated according to the following criteria: (1) visual analogue pain scale, (2) isokinetic strength measurements, (3) range of motion of shoulder joint, (4) cosmetic result, and (5) postoperative sports activity performance. In this study, we aimed to describe our surgical technique of reconstruction of the rupture of pectoralis major muscle and to summarize the clinical results of the operative treatment.</p><p><b>RESULTS</b>At the final follow-up examination (6.5 years postoperatively), only nine patients were available for evaluation. Three of them had excellent results, and five had good results, while one had poor results. Eight of the patients were able to return to their preinjury level of sporting activity. In summary, 89% of the patients achieved excellent or good results.</p><p><b>CONCLUSION</b>Surgical treatment by anatomic tendon repair and accelerated rehabilitation can make recovery of strength and function of the pectoralis major muscle.</p>

Arthroscopic treatment of bursal-side partial-thickness rotator cuff tears / 中华外科杂志

<p><b>OBJECTIVE</b>To study the surgical techniques and results of arthroscopic treatment of bursal-side partial-thickness rotator cuff tears.</p><p><b>METHODS</b>From June 2002 to December 2007, 57 patients with bursal-side partial-thickness rotator cuff tears underwent arthroscopic treatment. There were 34 male and 15 female patients, the average age was 49.7 years (25 - 71 years). Fifteen left shoulder and 34 right ones were involved. Seven cases were classified as degree I, 6 as II and 36 as III according to Ellman classification. The anterior-posterior and the supraspinatus outlet projection of the X-rays were obtained before surgery. Twenty-nine patients had been received by sonography and 36 patients had undergone MRI examinations. All the patients underwent subacromial bursectomy and acromioplasty, 13 cases underwent cuff debridement, 36 cases underwent cuff repair. Among them, 3 cases were treated by side to side suture of rotator cuff, 26 cases were treated by suture anchor, 7 cases were treated by side to side suture combined with suture anchor. UCLA scoring system was adopted before operation and at the final evaluation.</p><p><b>RESULTS</b>Forty-nine patients had been reviewed at least 2 years after the operation with an average of 48 months (2 to 7 years). The average score was 32.1 ± 3.8 postoperatively, and the mean pain score was 2.9 ± 1.0 vs 8.4 ± 1.7 (P = 0.000) for pre- vs. post-operation, the function score was 5.4 ± 1.2 vs. 9.1 ± 1.4 (P = 0.000), the mean forward flexion score was 4.3 ± 1.1 vs. 4.9 ± 0.2 (P = 0.000), the mean forward flexion strength was 4.0 ± 0.4 vs. 4.8 ± 0.4 (P = 0.000), the results were 16 excellent, 31 good and 2 bad. Forty-seven patients were satisfied with the operation.</p><p><b>CONCLUSIONS</b>Arthroscopy is an effective method for the treatment of bursal-side partial-thickness rotator cuff tears. The key to the operation lies in bleeding control, proper acromioplasty and correct suturing method. This surgery has many advantages such as mini-invasion and rapid recovery.</p>

Arthroscopic reconstruction of the posterior cruciate ligament using single-bundle bone-patella tendon-bone graft with moderate to long term follow-up / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the 4- to 10-year results of arthroscopic reconstruction of the posterior cruciate ligament (PCL) using single-bundle bone-patella tendon-bone graft, and to find out the principle and influential factor of the isolated PCL reconstruction.</p><p><b>METHODS</b>From May 1998 to July 2004 the data of 29 patients with isolated PCL reconstruction retrospectively investigated, using single-bundle bone-patella tendon-bone graft. Twenty-two cases were followed up with average 7.1 years (5 - 10 years). Follow-up included the subjective knee function evaluation, KT2000, Biodex and the radiographic assessment.</p><p><b>RESULTS</b>The mean final follow-up IKDC score, Lysholm score, and Tegner score of the 22 cases were 89.4 +/- 8.1, 94.5 +/- 9.2, and 6.9 +/- 2.6 respectively. There were statistically significant improvements in them when compared with preoperative data respectively (P < 0.01). The average posterior displacement measured with KT2000 was (4.9 +/- 1.1) mm (90 degrees flexion) and (4.3 +/- 1.2) mm (30 degrees flexion) respectively. At the final follow-up, KT2000 examination revealed >or= 6 mm of posterior laxity in 6 patients (group A), and <or= 5 mm posterior laxity in 16 patients (group A). A statistically significant improvement was noted in comparing the mean final follow-up IKDC score, Lysholm score, and Tegner score between the group A and B (P < 0.01). The average time from injury to surgery of group A and B was (17.6 +/- 3.9) months and (2.9 +/- 2.1) months respectively, the difference was statistically significant (P < 0.01). The data was received from the Biodex dynamometer for the 22 patients who were followed up in clinic service. Patients achieved (90 +/- 22)% (60 degrees /s) and (87 +/- 19)% (120 degrees /s) recovery of the extensor peak torque respectively, for the flexor peak torque patients achieved (93 +/- 16)% (60 degrees /s) and (92 +/- 20)% (120 degrees /s) respectively, the difference between the peak torque of extensor and flexor in the same condition was statistically significant (P < 0.01). X-ray findings: 8 of the 22 patients (36.4%) were assessed as mild grade change (3 case in medial compartment isolated, 1 case in patellofemoral joint isolated, and 4 case in both compartments) and 2 patients (9.1%) as moderate grading in final follow-up radiographs (in both anterior and medial compartments), and 12 of the 22 patients (54.5%) revealed normal X-ray findings. The average time from injury to surgery of patients who revealed joint degeneration and patients who revealed normal X-ray findings was (16.6 +/- 2.7) months and (3.3 +/- 1.7) months respectively, the difference was statistically significant (P < 0.01).</p><p><b>CONCLUSIONS</b>Arthroscopic reconstruction of the posterior cruciate ligament using single-bundle bone-patella tendon-bone graft produces well results with moderate to long term follow-up. For the patients with III or IV PCL injury, PCL reconstruction should be done as soon as possible.</p>

Clinical evaluation of double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: a prospective, randomized and controlled study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In clinical studies there is still a lot of controversy about the increased anterior and rotational stability between double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the clinical results of four-tunnel DB ACL reconstruction.</p><p><b>METHODS</b>Sixty-four consecutive patients with ACL ruptures from May 2005 to May 2006 were randomly assigned into two groups: 32 cases for SB ACL reconstruction and 32 cases for DB ACL reconstruction. Clinical data, including KT 2000, Biodex test, Lysholm score, Tegner score and IKDC score, were prospectively collected until at least 10 months post-operative.</p><p><b>RESULTS</b>The average values of KT 2000 were (1.47 +/- 1.17) mm and (1.68 +/- 1.14) mm for the SB and DB ACL reconstruction groups at 30 degrees of knee flexion (P > 0.05), and were (1.04 +/- 0.98) mm and (1.13 +/- 0.98) mm at 90 degrees of knee flexion (P > 0.05). There were also no significant differences in Lysholm score, Tegner score, IKDC score and Biodex test scores between the two groups (P > 0.05). The operation time of DB ACL reconstruction was 20 minutes longer than the SB ACL reconstruction (P < 0.05).</p><p><b>CONCLUSION</b>Double bundle ACL reconstructions have no obvious clinical advantages over single bundle ACL reconstructions.</p>

Medial plica after reconstruction of anterior cruciate ligament / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The medial plica may be caused by direct trauma or joint degeneration, which also could be iatrogenic. There have been few reports in the literature discussing incidence of the medial plica caused by an operation on the knee joint, specifically after the reconstruction of anterior cruciate ligament (ACL). In this study, we aimed to evaluate and analyze the relationship between the incidence of the medial plica and reconstruction of the ACL.</p><p><b>METHODS</b>A retrospective case series study was conducted to review the findings of 1085 patients between 2003 and 2007, who underwent second-look arthroscopy after reconstruction of the ACL (between 2002 and 2006). The correlation of the incidence of medial plica with the stability of the knee joint, the time from onset of injury to reconstruction surgery, the associated injuries, and the rate of progress during postoperative rehabilitation were analyzed.</p><p><b>RESULTS</b>We found that 722 patients had the structure of a medial plica. The incidence after reconstruction of the anterior cruciate ligament (66.5%) was significantly higher than usually reported. All these medial plica had avascular fibrotic and thickened edges. An excision of pathologic medial plica and fat pad synovial fringes were done. The incidences were significantly different between the two groups with their reconstruction operation time, from onset of injury to surgery (less than one month or over 2 years), and the progress rate of postoperative rehabilitation (knee flexion could not be over 90 degrees in four weeks). The incidence was not different between the groups with knee stable conditions.</p><p><b>CONCLUSIONS</b>Medial plica is more common in patients after reconstruction of ACL. More associated injuries and more rehabilitation difficulties can increase the medial plica incidence.</p>

Arthroscopic treatment of recurrent anterior shoulder dislocation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of the arthroscopic procedure on the patients with recurrent anterior shoulder dislocation.</p><p><b>METHODS</b>From January 2001 to March 2006,52 patients with recurrent anterior shoulder dislocation were treated by arthroscopy. Among them 44 patients were followed up for 12 to 54 months(on average of 26 months). The data of the 44 patients was reviewed. Three evaluation systems, University of California at Los Angeles Shoulder Scores (UCLA), Simple Shoulder Test (SST) and Dawson, were used. The study evaluated the effect based on the Dawson system by the factors as: age, course of the disease, frequency of dislocation and relocation methods and the range of shoulder movement.</p><p><b>RESULTS</b>The ratio of recurrent dislocation after operation was 4.5%. Assessing through 3 evaluation systems, UCLA, SST and Dawson, results were similar: the follow-up evaluation were extraordinarily different from preoperative assessment, and the rating of good or excellent at the time of the final follow-up reached 91% higher. Based on the Dawson system, the evaluation results had no statistic diversity according to such factors as: age, course of the disease, frequency of dislocation and relocation methods.</p><p><b>CONCLUSIONS</b>The effects of arthroscopic surgery to the recurrent anterior shoulder dislocation are satisfied and evidence-proved. It is a good option for both common patients and athletes.</p>

Diagnosis and management of septic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction / 中华外科杂志

<p><b>OBJECTIVE</b>To summary the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament (ACL) reconstruction.</p><p><b>METHODS</b>The knee joint infections after arthroscopic anterior cruciate ligament reconstruction were retrospectively studied. From January 1997 to July 2007, 16 of 3638 patients undergoing anterior cruciate ligament reconstructions experienced postoperative septic arthritis. The incidence, cause, presentation, laboratory results, treatment, and outcome of all infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized.</p><p><b>RESULTS</b>The incidence of septic arthritis after ACL reconstruction was 0.44%. The most common symptoms of the infected patients were fever, swelling, severe pain, tenderness, restricted motion. Eleven (68.8%) patients were positive for bacteria cultures, and Staphylococcus epidermidis was the most common bacteria. Nine of the 16 patients were performed arthroscopic debridement, and the other 7 patients were conservatively treated. All patients regained full range of motion and normal stability at the 19.7 months follow-up.</p><p><b>CONCLUSIONS</b>Septic arthritis, which could bring the dysfunction of the joint, is subsequent with cartilage injury and the failure of the ACL grafts. Early diagnosis and treatment of arthroscopic debridement in time are essential to the ultimate clinical outcome.</p>