Clinical results of arthroscopic anterior cruciate ligament reconstruction with short femoral tunnel / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcome of arthroscopic reconstruction of anterior cruciate ligament (ACL) with short femoral tunnel.@*METHODS@#From May 2013 to June 2017, 128 patients with anterior cruciate ligament reconstruction were performed with Transportal technique. Among them, 32 cases had short femoral tunnel were included, including 13 males and 19 females, aged 25.8 (17 to 43) years old, with a mean history of (4.5±1.1) months. The tibial tunnels were drilled in the middle of the footprint of the ACL, and femoral tunnels were drilled by transportal technique. Grafts were fixed with Endobutton at the femoral side and with interference screw at the tibial side. The changes of symptoms and signs were observed and the anterior tibial displacement was measured. The function of knee joint was evaluated by Lysholm score and Tegner score.@*RESULTS@#All patients were followed up for over 2 years. At the latest follow-up, 30 patients were negative and 2 patients were positive in knee shift test; 28 patients were negative in Lachman sign, 4 patients were positive in degree I; 30 patients were negative in anterior drawer test, 1 patient was positive in degree I and 1 patient was positive in degree II. The anterior displacement of the tibia increased by (2.6±1.8) mm compared with the healthy side, which was significantly different from that before operation (=19.77, <0.05). Lysholm score of 82.2±6.1 was significantly higher than that before operation (=17.33, =0.001). According to Lysholm score evaluation, 15 cases got an excellent result, 10 were good, 7 were fair, and no bad results, with a significant difference compared with that before operation (=-7.151, <0.05). Tegner motor function score of (7.4±0.6) was significantly different from that before operation (=9.11, =0.000 5). After operation, the knee joint movement ability of the patients improved significantly. Twelve patients could participate in antagonistic sports and 15 patients could participate in non-antagonistic sports. Fifteen patients were very satisfied with the curative effect, 13 patients were satisfied with the curative effect.@*CONCLUSIONS@#The incidence of short femoral tunnel in anterior cruciate ligament reconstruction with transportal technique is 25%. At present, the clinical effect of patients with short tunnel is acceptable. However, due to the lack of comparative study, the effect of short tunnel on the curative effect is still unclear.

Synthesis and hepatoprotective activity of Mannich base derivatives of silybin / 药学学报

Two novel Mannich base derivatives of silybin, SLB-DEA and DHSLB-PIP, were designed and synthesized. All the structures of new Mannich base derivatives of silybin were characterized by 1H NMR and HR-MS. Their protective action against CCl4-induced liver injury in mice were investigated. The changes of alanine aminotransferase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), total cholesterol (TC) and triglyceride (TG) were determined and the histopathological changes in liver tissues were examined. Pretreatment with a higher dosage of DHSLB-PIP (40 mg·kg-1) prevented CCl4-induced liver injury as indicated by the reduced levels of ALT, AST, LDH and TG. Meanwhile, liver histopathological improvement was observed in the model groups. The pharmacokinetics study in rats showed that the relative bioavailability of SLB-DEA and DHSLB-PIP were 172.5% and 259.8% compared with silybin. All the results suggest that SLB-DEA and DHSLB-PIP may protect liver against injury by CCl4 and the relative bioavailability was significantly increased, which is worth of further investigation for their druggability.

Clinical results of needle Dao for the treatment of subacromial impingement syndrome / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical results of needle Dao for the treatment of subacromial impingement syndrome.</p><p><b>METHODS</b>From September 2013 to August 2014, 90 patients with subacromial impingement syndrome were treated, including 61 females and 29 males, with the average age of (55.21±8.30) years old(ranged, 45 to 65 years old), and mean course of disease (3.49±2.98) months (ranged, 4 weeks to 7 months). Twenty-six patients had pains in left shoulder, and 64 patients had pains in right shoulder. Under local anesthesia, needle Dao was performed to release the pain point at the lower edge of the acromion and the subacromial adhesion. By observing the abduction of shoulder joint, anterior flexion and lifting, internal rotation and external rotation, shoulder pain score, the number of cases cured, markedly effective, effective and ineffective after treatment were counted, and the curative effect of needle Dao for the treatment of subacromial impingement syndrome was evaluated.</p><p><b>RESULTS</b>All the patients completed the treatment successfully without obvious adverse reactions. All the patients were followed up for more than 12 months. The visual analogue scale(VAS) decreased from preoperative 7.72±5.42 to postoperative 1.35±0.78(=15.89, <0.01). The Constant score at the 12th month after operation increased from preoperative 58.89±15.63 to 83.17±19.11(=28.48, <0.01). Overall efficacy evaluation was that, 46 cases were cured, 33 cases were markedly effective, 11 cases were effective, and 0 cases were invalid.</p><p><b>CONCLUSIONS</b>The advantage of needle Dao in the treatment of subacromial impingement syndrome is the minimally invasive treatment of the underlying lesions. The disadvantage is that it can not deal with the impact caused by bone abnormalities.</p>

Radiologic observation of the blood supply changes around the knee with osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To compare blood supply changes around the knee joint between normal and osteoarthritis knee.</p><p><b>METHODS</b>From June 2014 to June 2015, 30 patients with knee osteoarthritis and 30 healthy adults were recruited. In osteoarthritis group, there were 9 males and 21 females, with a mean age of (65.967±7.132) years old(ranged, 53 to 82 years old), and the mean arterial pressure was(93.462±7.633) mmHg. In control group, there were 9 males and 21 females, with a mean age of (62.867±6.356) years old(ranged, 50 to 75 years old), and the mean arterial pressure was (92.122±9.675) mmHg. Inspection methods included color ultrasonic and computed tomography angiography of lower limbs. The patients were observed with: (1)collateral circulation; (2)artery circuity; (3)artery malformation; (4)artery stenosis; (5)arterial wall plaque formation. Stenosis was divided into 5 levels: level 1 as no narrow, level 2 as mild stenosis (1% to 49%), level 3 as moderate stenosis (50% to 70%), level 4 as severe stenosis (70% to 99%), level 5 as total obstruction. Diameter and blood flow dynamics of popliteal artery, pretibial artery, and posterior tibia artery in two groups were measured and compared.</p><p><b>RESULTS</b>The study was accomplished with complete data collection, none of the patients was eliminated, and there were no loss of follow up. There were 3 cases in OA group and 4 cases in control group with the formation of collateral circulation, and the difference had no statistically significance. There was none in OA group and 2 in control group with the formation of artery circuity, and the difference had no statistically significance. There were no cases in both groups with artery malformation. In OA group, there was mild in 14 cases, moderate in 7 cases, severe in 9 cases. In control group, there was no arterial stenosis in 9 cases, mild in 10 cases, moderate in 6 cases, severe in 4 cases, total obstruction in 1 case. The difference between two groups was statistically significant; artery stenosis in OA group was more severe than that of the control group. Artery plaque formed in 30 cases in OA group and in 20 cases in control group. The difference between two groups was statistically significant; the rate of artery plaque formation in OA group was obviously higher than that of control group. In OA group, plaque calcification rate was 100% while 63% in control group. Difference of pretibial artery diameter was statistically significant, pretibial artery diameter is larger in OA group. Difference of popliteal artery flow velocity was statistically significant; velocity was faster in OA group. Difference of the posterior tibial artery flow velocity was statistically significant; velocity was faster in OA group. The differences of the three arteries had no statistical significances in related to arterial flow.</p><p><b>CONCLUSIONS</b>Local artery system changes with the onset of knee joint osteoarthritis. Main pathological changesof local blood vessels were stenosis and plaque formation, but the amount of local artery blood flow was roughly the same as the control group. Possible mechanism is that the local artery stenosis speed up the artery blood flow velocity, resulting local perfusion. The local tissue ischemia and hypoxia caused a series of pathological changes. It is better to improve local vascular lesions than to accelerate the blood flow velocity in clinical treatment. Further more, interventional therapy for vascular pathology will be a new trend of osteoarthritis treatment.</p>

Arthroscopic reduction and utilization of Suture Bridge tech reconstructing footprint area structure for the treatment of anterior cruciate ligament avulsion fracture / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the preliminary curative effect of arthroscopic reduction and utilization of Suture Bridge tech reconstructing footprint area structure for anterior cruciate ligament avulsion fracture.</p><p><b>METHODS</b>From March 2010 to September 2012, 6 patients suffered anterior cruciate ligament avulsion fracture were treated with arthroscopic Suture bridge fixation for anterior cruciate ligament tibial side footprint reconstruction. There were 2 males and 4 females, ranging in age from 14 to 52 years old. There were 2 cases of type III and 4 cases of type IV displaced fractures classified by Meyers-McKeever-Zaricznyj. Preoperative ADT and Lachman tests were positive.</p><p><b>RESULTS</b>All the patients was follow up more than 2 years. Postoperative ADT and Lachman tests were negative without limitation of knee extension. Postoperative X ray and MRI showed that displaced fracture with a good reduction and union, recovered normal shapeness of ACL. The postoperative Lysholm and IKDC scores at different time points(3 months, 1 year, 2 years after operation) improved significantly comparing with preoperative, and the differences were statistically significant (<0.01).</p><p><b>CONCLUSIONS</b>Suture Bridge tech reconstructing footprint area structure for ACL avulsion fracture is an effective and safe method, especially for adolescent patients with unclosed epiphysis and comminuted avulsion fracture.</p>

Total hip arthroplasty for patients with failed internal fixation of acetabular fractures / 中国骨伤

<p><b>OBJECTIVE</b>To observe the clinical result and healing of meniscal suture under arthroscopy for the treatment of the middle aged patients with meniscal injury.</p><p><b>METHODS</b>From March 2014 to January 2015, 40 middle-aged patients included in the standard with injury of meniscus, which were repaired by meniscal suture technique under arthroscopy, involving 24 males and 16 females with an average age of (52.65±3.63) years ranging from 50 to 60 years; 28 cases were on left knee, 12 cases were on right knee. Average flexion angle averaged (117.50±7.16) ° ranging from 110° to 130°. Lysholm knee score averaged 54.30±14.72 ranging from 23 to 71; IKDC score averaged 50.65±15.95 ranging from 18 to 78; the WOMAC score averaged 23.80±19.39 ranging from 2 to 75. All-inside meniscus suture under arthroscopy was performed.</p><p><b>RESULTS</b>All operations were successful without serious complications. Postoperative follow-up was 6 to 12 months, none of the patients lost to follow-up. All patients maintain a category 5 degree muscle strength, normal knee joint mobility, can completely straight and completely buckling. Average flexion angle was (125.00±5.13) ° (110° to 130°) (=3.47,=0.003). Final Lysholm scale, IKDC scores and WOMAC scores averaged 79.50±8.70 (=7.790,=0.000), 79.40±10.40 (=8.431,=0.000), 8.15±6.77 (=3.988,=0.001) separately. Follow-up MRI showed that meniscus healed in 4 cases, partially healed in 22 cases, haven't healed in 14 cases. Failure rate of small lesion was 27.3%(6/22), and failure rate of large lesion was 44.4%(8/18).</p><p><b>CONCLUSIONS</b>Clinical effect of meniscal suture under arthroscopy for the treatment of the middle aged is good. The failing rate was 35% because of healing ability is poor in middle-aged adults. Failure rate of large lesion was higher than that of small lesion.</p>

Arthroscopic rotator cuff repair using a suture-bridge technique in late middle-aged adults / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical results after arthroscopic rotator cuff repair using a suture-bridge technique in late middle-aged adults.</p><p><b>METHODS</b>A retrospective analysis of 30 patients with rotator cuff tears, who were treated consecutively between December 2012 and December 2013 at our clinic, was carried out to evaluate the outcome of arthroscopic suture-bridge technique. The visual analogue scale (VAS), the range of motion (ROM), the rating scale of the University of California at Los Angeles (UCLA), and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) were determined as the evaluation criteria.</p><p><b>RESULTS</b>The mean follow-up period was 13 months. The follow-up rate was 100%. The study included 0 small, 16 medium, 12 large and 2 massive rotator cuff tears. At the latest follow-up, the VAS score decreased significantly from preoperative 6.3±3.2 to 0.8±1.4 at rest,and from preoperative 7.7±2.1 to 1.7±1.6 during motion. The UCLA score improved significantly from 15.1±4.6 preoperatively to 31.2±5.0 at follow-up. The ASES shoulder index improved significantly from 30.2±16.0 preoperatively to 80.4±13.0 at follow-up. The ROM improved significantly. The satisfactory rate was 94%. There were no complications.</p><p><b>CONCLUSION</b>The results of this study indicate that the arthroscopic suture-bridge technique is an effective and reliable treatment for patients with rotator cuff tear in late middle-aged adults.</p>

Arthroscopic partial meniscectomy for medial meniscal tear in late middle-aged adults / 中国骨伤

<p><b>OBJECTIVE</b>To study the results of arthroscopic partial meniscectomy for medial meniscal tear in late middle-aged adults.</p><p><b>METHODS</b>From October 2010 to October 2012,49 patients meeting inclusion criteria were treated with arthroscopic partial meniscectomy for medial meniscal tear. There were 31 males and 18 females,with an average age of (55.3±2.8) years old. There were 22 left knees and 27 right knees. The average flexion angle was (116.01±12.03)°. The pre-operative HSS Knee Score was 48.73±8.43, and the Lysholm score was 63.95±5.45. The patients were followed up and evaluated. All the patients received a standard surgery, in which the torn tissue was removed, and the anterior part of the meniscus was left in situ.</p><p><b>RESULTS</b>All the surgeries were successful with no serious complications. All the patients were followed up,and the duration ranged from 12 to 36 months. All the patients had 5 degrees of muscle strength. The average flexion angle was (136.77±18.56)°. There was significant difference between the two angles before operation and after operation. The pre-operative HSS Knee Score was 90.17±4.10, and the Lysholm score was 87.84±5.16. Statistically, the difference between preoperative score and the postoperative score was significant.</p><p><b>CONCLUSION</b>Arthroscopic partial meniscectomy is a good option for medial meniscal tear in late middle-aged adults. Operative indication is crucial and the excellent surgical technique is also critical for the good clinical outcome. All the patients could get good clinical results, although there are some patients with motion restrictions in the early stage after operation.</p>

Arthroscopic anterior cruciate ligament reconstruction with remnant preserving technique / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of arthroscopic reconstruction of anterior cruciate ligament (ACL) with remnant preserving technique.</p><p><b>METHODS</b>From May 2008 to October 2010,68 patients with ACL deficiency (33 males and 35 females, with an average age of 25.8 years, ranged from 17 to 43 years) were treated with arthroscopy. The average duration of the disease was (4.5 +/- 1.1) months. The pivot shift test showed positive results in 55 cases, Lachman test showed positive results in 68 cases, and the ADT (anterior drawer test) showed positive results in 68 cases. The anterior transition of the tibia measured by KT2000 instrument was (7.2 +/- 2.3) mm (5 to 9 mm) more than that of the opposite knee. The average Lysholm score was 55.7 +/- 5.4 (45 to 67). The average Tegner activity scores was 3.1 +/- 0.6 (2 to 4). The tibial tunnels and femoral tunnels were drilled in the middle of the footprint of the ACL, and the graft was wrapped by the remnant. Grafts were fixed with cross pin at the femoral side and with biodegradable interference screw at the tibial side. Postoperative symptoms and signs were observed in the follow-up duration. The anterior transition of the tibia was measured by KT2000, the Lysholm and Tegner scores were used to evaluate knee functions.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 24 to 42 months, with a mean of (31.5 +/- 2.4) months. At the latest follow-up, there was no patients had positive result by civot shift test, while the Lachman test showed results of negative or positive of grade I, and the ADT test showed results of negative or positive of grade I or II. The anterior transition of the tibia measured by KT2000 instrument decreased to (1.9 +/- 0.7) mm (0 to 3 mm) more than that of the opposite knee (t = 21.15, P = 0.000 1). The postoperative Lysholm score 86.0 +/- 5.1(81 to 97) and Tegner score 7.8 +/- 0.3 (6 to 9) all increased compared with preoperative 55.7 +/- 5.4 and 3.1 +/- 0.6 (t = 18.55, P = 0.001 0; t = 9.11, P = 0.000 5). According to Lysholm score, excellent results were obtained in 55 cases, good in 10, poor in 3 and no bad results.</p><p><b>CONCLUSION</b>The ACL remnant provide vascular and nerve supply for the graft, promoting union and remodeling of grafts.</p>

Combined closing-wedge high tibial osteotomy with arthroscopy for varus knee and medial compartment osteoarthritis: clinical results at a minimum follow-up for five years / 中国骨伤

<p><b>OBJECTIVE</b>To study the results of closing-wedge high tibial osteotomy and arthroscopy for the treatment of medial compartment osteoarthritis of the knee.</p><p><b>METHODS</b>From October 2005 to June 2007, 25 patients met with our inclusion criteria. All the patients with medial compartment knee osteoarthritis were treated with arthroscopy and closing-wedge high tibial osteotomy. There were 11 males and 14 females,with a mean age of 53 years old. The pre-operative HSS knee score was 67.6 +/- 2.8, FTA was (185.54 +/- 1.11) degrees, and aLPTA was (96.54 +/- 0.52) degrees in average. The patients were followed up and evaluated according to HSS knee score. The efficacy of the osteotomy was evaluated by FTA and aLPTA.</p><p><b>RESULTS</b>All surgeries were successful without serious complication. All the patients were followed up, and the duration ranged from 5 to 7 years. The HSS was 85.5 +/- 3.7 at the 1st year and 80.3 +/- 5.4 at the latest follow-up. There was significant difference between every two scores of before operation and the two after operation (t = -33.135, P = 0.000; t = -13.215, P = 0.000). The FTA was (173.65 +/- 0.92) degrees at the 1st year and (174.34 +/- 0.53) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 28.739, P = 0.000; t = 2.331, P = 0.048). The aLPTA was (87.32 +/- 0.33) degrees at the 1st year and (87.67 +/- 2.82) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 37.264, P = 0.000; t = 2.469, P = 0.039).</p><p><b>CONCLUSION</b>Indication is important and good surgical technique is critical for good clinical outcome. A detailed plan before operation is essential for the operation. Arthroscopy is helpful for treating the intra-articular pathology. The osteoarthritis is still in progress but in a slow mode. The combined method of arthroscopy and closing-wedge high tibial osteotomy is a reliable way for medial compartment osteoarthritis of the knee.</p>

Clinical results of anatomical reconstruction of the lateral ligaments for chronic ankle instability / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical and radiological results of lateral stabilization with reconstruction of the lateral ligaments for the treatment of chronic lateral instability of the ankle.</p><p><b>METHODS</b>From September 2005 to March 2010, 29 patients with chronic lateral instability of the ankle were reviewed. There were 24 males and 5 females with an average age of 24 years (15 to 35 years). The duration of the disease ranged from 7 to 10 years, averaged 10 months. The main symptom was repeated ankle sprain. During physical examination, ankle varus and the anterior talar transition were conducted. There was (12.5 +/- 3.2) degrees more inversion activity than the contralateral ankle. Arthroscopy was performed for the chondral injury, and anatomic reconstruction of the lateral ligament with an autologous gracilis tendon graft was performed for lateral instability of the ankle. Clinical and radiological evaluations were performed before surgery and at the most recent follow-up.</p><p><b>RESULTS</b>All the patients with successful surgery, there was no fracture or infection. All the patients were followed up,and the duration ranged from 16 to 60 months, with an average of 28 months. There was no ankle instability or limited mobility of the 29 cases at the latest follow-up. According to the American Orthopedic Foot and Ankle Society ankle-hind foot scale, the mean score was 48.0 +/- 6.7 before surgery and 92.8 +/- 6.2 at the most recent follow-up (P = 0.010). The talar tilt angles on standard stress radiography were (12.5 +/- 3.2) degrees before surgery and (2.5 +/- 0.8) degrees at the most recent follow-up (P = 0.012). The mean distance of anterior talar translation was (16.3 +/- 4.0) mm before surgery and (3.5 +/- 0.8) mm at the most recent follow-up (P = 0.002). There were no severe complications, the results were satisfactory.</p><p><b>CONCLUSION</b>Anatomical reconstruction of the lateral ligament with autologous gracilis tendon graft for the treatment of chronic lateral instability of the ankle can be recommended.</p>

Double-bundle reconstruction of anterior cruciate ligament using hamstring auto graft under arthroscopy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of double-bundle reconstruction of anterior cruciate ligament (ACL) using hamstring tendon auto graft under arthroscopy.</p><p><b>METHODS</b>From April 2009 to March 2010, 25 patients (13 males and 12 females) with ACL deficiency were treated with arthroscopy, ranging in age from 17 to 43 years, with an average of 25.8 years. There were 17 patients caused by sports injuries, 6 patients caused by accidental falling, and 2 patients caused by traffic injury. The average duration of the disease was 3 months. The main symptom was knee instability in 8 patients, and knee pain and swelling in other patients. Pivot shift test was positive in 15 cases, and Lachman test was positive in 25 cases, the ADT (anterior drawer test) was positive in 25 cases. The anterior transition of the tibia measured by KT2000 instrument was (7.1 +/- 2.4) mm more than the contralateral knee. The average Lysholm score was 40.0 +/- 5.4. The Tegner activity scores averaged 3.2 +/- 0.7. The double tibial tunnels and double femoral tunnels were drilled on the footprint of the ACL to reconstruct the anteromedial and posterolateral bundles under arthroscopy. Tendons were fixed with Endo-buttons at the femoral side and with biodegradable interference screw at the tibial side. Postoperative symptoms and signs were observed during follow-up period. The anterior transition of the tibia was measured by KT2000, and the Lysholm score and Tegner scores were used for evaluating knee function. Statistically analyzed was performed with SPSS 15.0.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 24 to 35 months (averaged, 27 months). At the latest follow-up, there was no positive pivot shift, while the Lachman test and ADT were negative or positive of grade I. The average Lysholm score of the 25 cases was 40.0 +/- 5.4 before operation, and 85.0 +/- 4.5 at the latest follow-up, 3.2 +/- 0.7 before operation and 7.5 +/- 0.2 at the latest follow-up for Tegner activity score. Statistically, the difference between preoperative score and the postoperative score was significant.</p><p><b>CONCLUSION</b>Double-bundle reconstruction of ACL with hamstring tauto graft under arthroscopy is effective and reliable to restore the stability of the knee, and the clinical effect is good to excellent.</p>

Treatment of primary frozen shoulder with manipulation under anesthesia combined with arthroscopy / 中国骨伤

<p><b>OBJECTIVE</b>To study the feasibility and effectiveness of manipulation under anesthsia combined with arthroscopy for the treatment of primary frozen shoulder.</p><p><b>METHODS</b>Thirty-four patients with primary frozen shoulder were treated from January 2006 to March 2009, including 20 males and 14 females with an average age of (56 +/- 3.6) years(ranged from 43 to 62 years). The course of the disease ranged from 9 to 13 months, with a mean time of 11.3 months. All the patient were treated with manipulation under anesthsia combined with arthroscopy. The synovitis of the biceps tendon and the rotator interval was thermo-coagulated, and limited synoviectomy was performed. Subacromial bursoscopy was applied to the patients after glenohumeral arthroscopy. Secondly radiofrequency electrode was used to coagulate bleeding and manipulative relax was performed. All the patients started active and passive postoperative rehabilitation from 1st day after treatment and were followed up for an average of 18.9 months (ranged from 13 to 32 months). The range of motion (ROM) of shoulder joint and feeling of pain calculated by Constant score system were compared before and after the operation.</p><p><b>RESULTS</b>The post-operative feeling of pain according to Constant score system at 12 months after operation(total 15 points) was (13 +/- 1.58), which was different from that of pre-operative score of (5 +/- 2.60) (P < 0.01). As compared with pre-operative conditions, the motion of shoulder revealed significant improvement at different postoperative stages (P < 0.05). The total post-operative score according to Constant score system at 12 months after operation was (86 +/- 11.20), which was higher than that of pre-operative score of (27 +/- 2.40) (P < 0.01).</p><p><b>CONCLUSION</b>Manipulation under anesthsia combined with arthroscopy is an effective, optimal, minimal invasive management with high clinical value for primary frozen shoulder.</p>

Effect of Panax Notoginseng Saponins on autograft tendon healing in bone tunnel: interface histological characteristics / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of Panax Notoginseng Saponins (PNS) on tendon healing in bone tunnel.</p><p><b>METHODS</b>The experiment was performed in the animal laboratory, Wangjing hospital from April to August, 2010. All the experiment procedures were accorded with the animal ethical requirements. Twenty New Zealand rabbits were randomly divided into blank control group and PNS group with 10 animals in each group. Anterior cruciate ligament reconstruction with toe extensor tendon was done in knee joints of rabbits by suspend fixation model. PNS was injected in bone tunnel of rabbits in PNS group, and nothing was given to blank group. Specimens were collected at 4 and 8 weeks after surgery. Sections were stained with HE stain to observe the changes of interface tissue between bone tunnel and tendon graft. Interface types were classified according to Yamakado method.</p><p><b>RESULTS</b>At 4 weeks after surgery, the interface was filled with connective tissue in both group, while at 8 weeks, there was not obvious gap between bone and tendon graft in both groups under macrography. Under microscope, there were more fibroblast in the PNS group. There was larger new bone formation area in PNS group. The classification on the Yamakado type was significantly different between two group (P < 0.05).</p><p><b>CONCLUSION</b>PNS can enhance tendon-bone healing in bone tunnel, and promote the connection between tendon and bone. The study lacks quantitative analysis of those criteria, and the mechanics of the promotion of tendon-bone healing has not been totally clear.</p>

Research advancement of the tennis elbow / 中国骨伤

Tennis elbow is a common disease. The current research showed that the basic pathology of tennis elbow is not inflammation, but lateral elbow tendinopathy. Ultrasound image has been frequently used for diagnosis of tennis elbow, it can evaluate the condition of disease and show prognosis. Tennis elbow needs a comprehensive treatment. Most patients can obtain satisfactory effects by non-operation, especially the application of the Sodium hyaluronate, autologous blood and botulinum toxin. The principle of operation is to clear the common extensor tendon and repair or rebuild the tendon dead centre if necessarily. The arthroscopic surgery has the advantages of less invasion, rapid recovery,and become the new chioce for the treatment of tennis elbow. Both open operation and arthroscopic surgery can obtain good effects.

Injury and reconstruction of medial patellofemoral ligament / 中国骨伤

Medial patellofemoral ligament (MPFL) is the major static structure to restrain lateral patellar dislocation. There are always MPFL injuries in patellar dislocations. The medial ligamentous deficiency will lead to recurrent patellar dislocation or patellar instability. Surgeon used to suture all those structures in the medial knee compartment before MPFL is recognized. Reconstruction of MPFL becomes an important method to treat patellar dislocation since it is anatomically recognized. Many techniques have invented MPFL reconstruction. The goal of this article is to develop a current understanding of MPFL and its clinical significance, especially MPFL reconstruction. The anatomical double bundle reconstruction of MPFL by bone anchors is a safe, easy and effective way to treat patellar dislocations.

Observation of long-term efficacy of visco-supplementation with sodium hyaluronate in treating knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively analyze the long-term efficacy of intra-articular injection with sodium hyaluronate for the treatment of knee osteoarthritis.</p><p><b>METHODS</b>From January 2006 to August 2007,120 patients (181 knees) with knee osteoarthritis, (mild 61 knees, moderate 72 knees, severe 48 knees), were treated by intra-articular injection with sodium hyaluronate, 2 ml every week for 5 weeks. The clinical effects were analyzed according to VAS, JOA scoring before treatment, at the 1 month, 1, 2 years after treatment.</p><p><b>RESULTS</b>(1) VAS scores were respectively (7.26 +/- 1.83), (1.85 +/- 1.21), (2.54 +/- 1.40), (3.07 +/- 1.51) scores before treatment, at the 1 month, 1 and 2 years after treatment. There was significant difference between every post-treatment and pre-treatment. (2) JOA scoring of knee function was respectively (18.7 +/- 6.6), (84.3 +/- 15.5), (75.4 +/- 22.4), (64.8 +/- 25.6) scores before treatment, at the 1 month, 1 and 2 years after treatment. There was significant difference between every post-treatment and pre-treatment. (3) Assessment of long-term efficacy among 181 knees who were followed up 1 year, 70 cases got excellent results, 54 good, 34 fair and 23 poor. Those who were followed up 2 years,40 cases got excellent results, 54 good, 53 fair and 34 poor. Knee function became poor along with time-lapse. The efficiency was respectively 86.89% (53/61), 79.17% (57/72), 54.17% (26/48) in mild knees, moderate knees, severe knees at the 2 years after treatment.</p><p><b>CONCLUSION</b>The long-term efficacy of intra-articular injection with sodium hyaluronate is satisfactory in treating knee osteoarthritis. The efficacy is better for mild and moderate osteoarthritis than for the severe osteoarthritis. The short-term efficacy is acceptable and the long-term one is worse for the severe knees.</p>

Comparison of the clinical outcome of anterior cruciate ligament reconstruction using allograft anterior tibialis and autologous hamstring tendon / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical outcomes of ACL reconstruction using allograft anterior tibialis and autologous hamstring tendon.</p><p><b>METHODS</b>From September 2005 to May 2007, 100 ACLs were reconstructed, allograft were inplanted in 50 patients and autograft 50 patients. Rigidfix and Intrafix were used for graft fixation. The symptoms and objective signs were compared between two groups. Lysholm score were used for outcome evaluation.</p><p><b>RESULTS</b>There were neither infection nor rupture of the reconstructed ACLs in all patients. All patients were followed and the average follow-up period was 25.6 months (range 12 to 33). There was no positive pivot shift sign in two groups, the anterior drawer test (ADT)and Lachman test were negative or grade I positive. There was no difference in Lysholm scores between two groups(89.3 allograft vs. 90.5 autograft, P>0.05).</p><p><b>CONCLUSION</b>These data suggest that there are no differences in clinical outcomes of ACL reconstruction with allograft anterior tibialis tendon and autologous hamstring tendon.</p>

Arthroscopic posterior cruciate ligament reconstruction with Achilles allograft using transfemoral double-bundle and tibial inlay technique / 中国骨伤

<p><b>OBJECTIVE</b>To investigate and evaluate the results of arthroscopic posterior cruciate ligament (PCL) reconstruction with Achilles allograft using transfemoral double-bundle and tibial inlay technique.</p><p><b>METHODS</b>From September 2005 and August 2007,10 patients underwent arthroscopic PCL reconstruction with double-bundle Achilles allograft, which were deep-frozen and radiated by gamma ray. Two absorbable interference screw in the femur and tibial inlay technique were performed to fix the allograft. Clinical results were evaluated according to the physical examination, Lysholm and IKDC clinical rating scales.</p><p><b>RESULTS</b>The body temperature got to normal level 8 days after surgery. Immunologic rejection was detected but not serious and there were no infection found. All patients were followed up for 6 to 23 months (average 17 months). At the last follow-up, there was no positive Sag sign, Lachman test and PDT were all negative or grade I positive. The average Lysholm score of the 10 cases was 39(25-56) before operation, and 85 (79-92) at the last follow up, 41(28-62) before operation and 86(81-90) at the last follow up for IKDC. Statistical differences existed before and after operation in the two Lysholm and IKDC scores. By Lysholm score, 90% patients got an exellent or a good result; By IKDC score, all patients got an excellent or good result.</p><p><b>CONCLUSION</b>This study has showed that PCL reconstruction with Achilles allograft using transfemoral double-bundle and tibial inlay technique is an effective method.</p>

Uvulopalatopharyngoplasty and maxillomandibular advancement for obese patients with obstructive sleep apnea hypopnea syndrome: a preliminary report / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and the results of the procedure of maxillomandibular advancement combined with uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>Nine cases of obese patients with severe OSAHS [age (47.8 +/- 9.7); body mass index (BMI) (35.3 +/- 2.5) kg/m(2); apnea and hypopnea index (AHI) (88.7 +/- 6.7) per hour] underwent the procedure of maxillomandibular advancement (MMA) combined with uvulopalatopharyngoplasty (UPPP). The patients were monitored by polysomnography (PSG) before operation and 3, 6, 12 months after operation, and cephalometric analysis and velopharyngeal closure function were evaluated at the same time.</p><p><b>RESULTS</b>The maxilla was advanced by (8.3 +/- 1.3) mm and the mandible and chin were advanced by (23.0 +/- 2.2) mm. AHI was (2.1 +/- 1.1) per hour post-operation. All patients had no speaking problem and swallowing difficulty and had a good appearance and occlusions. The OSAHS in this group of patients was cured.</p><p><b>CONCLUSIONS</b>Good short-term effects were observed with UPPP and MMA in the treatment of obese patients with severe OSAHS. It did not cause the velopharyngeal closure insufficiency and maxillary necrosis. A long-term follow-up is needed.</p>