Treating intractable lateral epicondylitis by extracurricular arthroscopic operation based on pressure point / 中国骨伤

OBJECTIVE@#To evaluate clinical efficaly of intractable lateral epicondylitis by extracurricular arthroscopic operation based on pressure point.@*METHODS@#From October 2015 to September 2017, 19 patients with intractable lateral epicondylitis were treated with extraarticylar arthroscopic operation based in pressure point. Among patients, including 7 males and 12 females, aged from 33 to 62 years old with an average of(43.16±8.12) years old, The courses of conservative treatment ranged from 7 to 41 months, with an average of(15.47±7.08) months. Postoperative complications were observed, VAS score and Mayo score before and after operation at 3 months were observed and compared.@*RESULTS@#All patients were followed up from 6 to 26 months, with an average (17.16±5.25) months. No infection, skin necrosis and nerve injury occurred. No group weakness occurred within six months after operation. VAS score decreased from 4.42±1.17 before operation to 0.53±0.61 after operation at 3 months. Mago was improved from 62.63±7.88 before operation to 93.42±5.28 after operation at 3 months. According to Mayo score, 17 cases got excellent results, and 2 cases were good.@*CONCLUSIONS@#Intractable lateral epicondylitis by arthroscopic extracurricular operation based on pressure point, which deal with main extracurricular root cause, could anatomical level is understand easily, field of vision is good and diseased tissue is cleaned up thoroughly, and has obvious curative effect.

Finite element analysis of anterior ring injuries in unstable pelvic fractures treated by different methods / 中国骨伤

OBJECTIVE@#To compare the biomechanical stability of different fixation methods for anterior ring injury of unstable pelvic fractures, and to provide reference for clinical treatment.@*METHODS@#An unstable pelvic fracture model (Tile C) with one side of the sacroiliac joint dislocation and the pubic rami fracture was constructed via three-dimensional finite element analysis. Five different fixation methods were used in the front, and the rear was fixed with sacroiliac screws. The von Mises stress and strain distributions of different combinations of fixation methods were analyzed under mimicking standing conditions.@*RESULTS@#After being loaded with 500 N vertically, the maximum stress in the anterior fracture was 3.56 MPa in anterior pelvic external fixation (AEF) group, the total displacement and the vertical displacement of the Y axis at the sacroiliac joint and the fracture were not more than 1.5 mm. The maximum stress at fixation, the front of the fracture and sacroiliac joints in the anterior pelvic subcutaneous approach(APA) group and AEF, was significantly higher than anterior modified Stoppa approach(ASA) group, anterior pelvic Ilioinguinal approach (AIA) group, and canulated screw fixation(CSF) group. The total displacement and the vertical displacement of the Y axis at the sacroiliac joint and the fracture in APA group and AEF group were also greater than the other three groups.@*CONCLUSIONS@#Anterior ring injury of unstable pelvic fractures can be significantly improved after the fixation of the implants in the five combined methods. However, overall biomechanical properties of ASA, AIA and CSF group are superior to APA and AEF group.

Treatment of obstinate tennis elbow by debridement and repair under elbow arthroscopy combined with small incision / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effectivity and the improvement of elbow arthroscopic techniques of treating obstinate tennis elbow using debridement and repair under elbow arthroscopy combined with small incision.</p><p><b>METHODS</b>From March 2014 to February 2017, 36 patients(total 36 elbows) with obstinate tennis elbow were treated consecutively using debridement and repair under elbow arthroscopy combined with small incision open, the two methods alternate. In key process, the first 18 cases [group A including 8 males and 12 females with an average age of (43.89±9.71) years old, the treatment time was(17.39±10.53) months] used direct-looking operation and arthroscopic verification, the latter 18 cases[group B including 7 males and 11 females with an averave age of (44.28±8.04) years old, the treatment time was(15.50±9.18) months] used arthroscopic operation and direct-looking verification. The arthroscopic and gross pathological findings were observed during the operation. After operation serious neurovascular complications were observed. The operation time was compared between two groups. MEPS (Mayo Elbow Performance Score) and VAS scores were recorded preoperatively and postoperatively.</p><p><b>RESULTS</b>All patients were followed up for an average of (17.22±8.47) months in group A and (17.83±8.83) months in group B. There was 1 case of nerve injury without infection. VAS score was improved from preoperative 4.33±1.24 to postoperative 0.61±0.70 in group A, and from 4.50±1.47 to postoperative 0.67±0.69 in group B. MEPS of group A was improved from preoperative 62.22±7.90 to postoperative 93.06±5.18 in group A, and from preoperative 61.94±8.93 to postoperative 92.22±5.21 in group B. There were no statistical differences between two groups in MEPS and VAS score. The operation time in group B(54.06±8.43) min was less than that in group A(73.39±12.78) min. Thirty-two cases were satisfied greatly with treatment results, 3 cases satisfied, 1 case unsatisfied. The main reasons that results in dissatisfaction were nerve injury.</p><p><b>CONCLUSIONS</b>Treating obstinate tennis elbow using debridement and repair under elbow arthroscopy combined with small incision have open and arthroscopic surgery advantages, with thorough therapeutic effect. The procedure is suitable to try to explore and improve the elbow arthroscopic technique.</p>

Clinical application of all seeing needle system in diagnosis and treatment of patients with hematospermia / 中国内镜杂志

Objective To observe the clinical application of all seeing needle system system in diagnosis and treatment of patients with hematospermia. Methods From May 2015 to September 2016, 22 patients with hemospermia were treated with seminal vesiculoscopy and seminal vesicle lithotripsy by using a all seeing needle system instead of traditional seminal vesicle. Results All the patients were successfully found the seminal vesicle gland and successfully entered the seminal vesicle gland, 16 cases had chronic inflammation of the seminal vesicle, dilute iodine rinse, 6 cases of seminal vesicle, holmium laser lithotripsy, stone basket to remove. The average operation time was (15.7 ± 6.2) min. The catheterization was performed the next day after operation. The average hospital stay was 2 d. After follow-up for 3 to 6 months, 20 patients had disappeared (90.9％). No complication was found Disease and long-term complications. Conclusion The all seeing needle system can replace the traditional seminal vesicle for the operation of seminal vesicle. The puncture system is short, directional and maneuverable. It has advantages of short operation time, simple operation, easy to master and no complications.

Generalized additive model of Plasmodium vivax malaria incidence and meteorological factors / 中国人兽共患病学报

This paper aims to find out the impacts of meteorological factors on malaria transmission by exploring the relationship between monthly local malaria cases and meteorological factors in Tengchong county,so as to develop malaria control strategy.Plasmodium vivax malaria incidence data and meteorological data including monthly mean temperature,maximum temperature,minimum temperature,rainfall,relative humidity,and minimum humidity in Tengchong County,Yunnan from 2005 to 2010 were provided by the Chinese Center for Disease Control and China Meteorological Administration.The correlation between malaria incidence and meteorological factors was analyzed using Pearson correlation analysis.The generalized additive model (GAM) was applied to investigate the relationship between monthly local malaria cases and meteorological factors.Results showed that there was a weak positive correlation between minimum temperature,mean relative humidity as well as minimum relative humidity and local malaria incidences.While a complex nonlinear relationship between the vectorial capacity,relative humidity and the incidence of malaria was detected.Malaria transmission increases when the vectorial capacity was greater than 10 (VCAP＞10) or the average relative humidity was between 55％ and 70％.The malaria transmission declines when relative humidity above 70％.The relationship between meteorological factors and the incidence of local malaria is well explained by GAM,and there is a complex nonlinear relationship between vectorial capacity,relative humidity and malaria incidence.

Anatomical study on the reconstruction of the metacarpal bone with autogenous iliac crest grafting / 中国骨伤

<p><b>OBJECTIVE</b>To explore the similarity between the iliac crest and the metacarpal bone, so as to provide an anatomical basis for the reconstruction of the metacarpal bone of the hand with the iliac crest grafting.</p><p><b>METHODS</b>There are 16 upper limb specimens and 10 pelvic specimens. The morphological features of the second, third, fourth and 5th metacarpal bones and iliac crest were observed. The following indexes were measured: arc height and length of metacarpal head articular surface, volar-dorsal metacarpal diameter, ulnoradial diamater, arc height and length of iliac crest, and inner and outer diameter. The obtained data were statistically analyzed to compare the morphological, structural features, arc length and diameter length of each metacarpal bone and iliac crest.</p><p><b>RESULTS</b>The arc length of the second metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 22.040(21.425, 23.085) mm, (14.034±0.465) mm, 4.185 (4.113, 4.598) mm, and (12.227±0.414) mm respectively. The arc length of the third metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 23.430(22.743, 24.153)mm, (14.316±0.430) mm, 4.235(4.170, 4.670) mm, and (12.382±0.425) mm respectively. The arc length of the fourth metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 21.960 (21.245, 22.285) mm, (12.382±0.288) mm, 4.125 (4.030, 4.305) mm, and (11.991±0.362) mm respectively. The arc length of the fifth metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 20.030 (19.668, 20.148) mm, (11.807±0.358) mm, 4.015(3.880, 4.205) mm, and (11.659±0.399) mm respectively. The inner and outer diameter of the iliac crest is 14.350 (13.660, 14.739) mm, and the arc length and height are (22.930±0.701) mm and (4.520±0.184) mm respectively. The difference between the volar-dorsal metacarpal diameter of the second metacarpal head and the inner and outer diameter of the iliac crest has no significant; while the volar-dorsal metacarpal diameter of the third, fourth and fifth metacarpal heads are apparently longer and shorter than the inner and outer diameter of the iliac crest, respectively. The differences are statistically significant. The differences between arc length of the iliac crest and arc length of the second, fourth and fifth metacarpl head are statistically significant. However, the difference of arc length between the third metacarpal head and the ilium, as well as the difference of arc height between the second and third metacarpal heads and the iliac crest have no statistical significances, while the arc height of the fourth and fifth metacarpal heads are obviously smaller than that of the iliac crest.</p><p><b>CONCLUSIONS</b>Autologous iliac crest is similar with metacarpal bone in anatomy, which might be a suitable donor for metacarpal bone transplantation.</p>

Case control study on therapeutic effects of dynamic external fixtor combined with limited internal fixation and cross K-wires fixation for the treatment of Pilon fractures of the proximal interphalangeal joint / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects and safety of dynamic external fixtor combined with limited internal fixation and cross K-wires fixation for the treatment of close Pilon fractures of the proximal interphalangeal joint.</p><p><b>METHODS</b>From June 2012 to June 2014, totally 41 patients (45 fingers) with close interphalangeal joint Pilon fracture were treated by dynamic external fixtor combined with limited internal fixation or cross K-wires fixation, and all the patients were followed up. In the dynamic external fixtor combined with limited internal fixation group (group A), there were 21 patients with 22 fingers, including 12 males and 9 females, with an average of (30.6±5.6) years old. In the cross K-wires fixation group (group B), there were 20 patients with 23 fingers, including 11 males and 9 females, with an average of (30.1±5.3) years old. Regular re-examination of X-ray was performed to evaluate the active range of joint motion, fracture healing time, infection rate and postoperative joint motion pain.</p><p><b>RESULTS</b>According to the evaluation criteria of upper extremity function issued by the Hand Surgery Society of Chinese Medical Association, the excellent and good cases of group A was up to 19 and 13 for group B. The evaluation results has significant differences (Z=2.558, P=0.011). The excellent and good rate of group A was obviously higher than that of group B. The average bone union time of group A was (7.9±2.1) weeks, and (8.1±2.3) weeks for group B. There was no significant difference on the mean healing time (t=-0.304, P=0.762). The infection fingers of group A was 5, and 1 for group B. The difference between the results was statistically significant (χ2=3.287, P<0.05). The infection rate of group A was higher than that of group B. The postoperative joint motion pain was evaluated by VAS score, the mean score was 0.18±0.50 in group A, and 0.65±0.88 in group B. The difference between the results was statistically significant (t=-2.207, P<0.05). The postoperative joint motion pain was lower than that of group B.</p><p><b>CONCLUSION</b>Dynamic external fixtor combined with limited internal fixation is a reliable and effective method to treat Pilon fractures of the proximal interphalangeal joint. It allows early postoperative functional rehabilitation and restores the joint function.</p>

Treatment of chronic mallet finger deformity with minor bone anchors and palmaris longus tendon graft / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of minor bone anchors and palmaris longus tendon graft in treating chronic mallet fingers deformity.</p><p><b>METHODS</b>From January 2008 to June 2013, 26 patients with chronic mallet fingers deformity were treated with minor bone anchors and palmaris longus tendon graft. There were 18 males and 8 females, aged from 18 to 52 years old with an average of (32.0±1.3) years. Among them, 8 cases caused by machine injury, 6 cases by fall injury, 6 cases by sprain from fight, 4 cases by tendon spontaneous rupture, 2 cases by knife trauma. There was no tendon attachment of extensor tendon check in 16 cases, and with 0.3 to 0.5 cm tendon attachment in 10 cases. All patients had the flexion deformity and the disability of dorsiflexion activity. During operation, the distal interphalangeal joint was fixed in 10° to 20° dorsiflexion by a Kirshner wire, the minor bone anchor was used to reconstruct the extensor tendon insertion, the palmaris longus tendon slice was transplanted the decayed area of extensor tendon insertion. Four weeks postoperatively, the Kirshner wire was removed and the plaster external fixation was used, and the patient began function exercises. Postoperative complications were observed and fingers functions were assessed according to Dargan standard.</p><p><b>RESULTS</b>The patients were followed up from 6 to 14 months with an average of (5.0±0.3) months. Wound superficial infection occurred in 2 cases, the skin pressure ulcer in 2 cases, joint activities disability in 1 case; these symptoms got improvement after symptomatic treatment. Traumatic arthritis occurred in 2 cases, 1 case was improved after treatment, and 1 case had chronic pain for a long time. No internal fixation loosening or breakage and tendon rupture were found. According to Dargan standard to evaluate the finger function, 17 cases got excellent results, 8 good, and 1 poor.</p><p><b>CONCLUSION</b>It is an effective way to treat the chronic mallet finger deformity using minor bone anchors and palmaris longus tendon graft, and the method has advantages of reliable fixation, easy operation, satisfactory effect and less complication.</p>

Treatment of patellar fractures with cable through the bone and Kirschner with a hole in the tail / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of a new internal fixation by using a cable through the bone and Kirschner with a hole in the tail, for the treatment of patellar fractures.</p><p><b>METHODS</b>From May 2012 to July 2013, thirty-four patients with patellar fractures were treated with cable through the bone and Kirschner with a hole in the tail. All the patients had close fracture,including 12 transverse fractures and 22 comminuted fractures. There were 18 males and 16 females, ranging in age from 26 to 81 years old, with an average of (46.0 ± 3.0) years old. After open reduction, two appropriate length of Kirschner with a hole in the tail were driven into the patella as perpendicular to the fracture line or the major fragments as possible. A transverse bone tunnel was then drilled with a Kirschner at one side of the patella. Then the cable, which was successively pulled through the bone tunnel and the hole of Kirschner, was crossed in a figure-eight over the anterior of the patella, tightened and fixated by special instruments. The Kirschner was clipped off on the edge of the hole. If it was a comminuted fracture, another cable was used to fasten the patella with cerclage. Postoperative evaluation was based on Bostman.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 26 months, with a mean of (16.0 ± 2.0) months. Fractures healed in all the cases without such complications as infection, loosening of Kirschner and cable loop, and skin irritation. According to the Böstman score system, 33 cases got an excellent result, and 1 good.</p><p><b>CONCLUSION</b>The cable through the bone and Kirschner with a hole in the tail is a simple, stable and effective method for the treatment of patellar fractures, especially the transverse fractures, with earlier knee exercise and fewer complications.</p>

Suture anchor for acute injuries of medial collateral ligament of knee at degree III / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate clinical efficacy of suture anchors in treating acute injuries of medial collateral ligament (MCL) of knee at degree III.</p><p><b>METHODS</b>Twenty-seven patients with degree III acute MCL injuries of knee were treated with suture anchors from January 2007 to June 2011. There were 15 males and 12 females, aged from 19 to 56 (averaged 32.6) years old. The time from injury to operation was 3 to 10 days, averaged 6 days. Symptoms and physical signs before and after treatment were observed, Lysholm scoring were used to evluated clinical efficacy.</p><p><b>RESULTS</b>All patients were followed up from 16 to 30 months with an average of 21.6 months. The stability of knee joints was good in all patients. Abduction stress test was negative when the knee joint was straightened at 0 degrees and flexed at 30 degrees. The average degree of flexed knee (67.00 +/- 5.80) degrees preoperatively was lower than that of postoperatively (136.50 +/- 6.30) degrees at 1 year. According to Lysholm scoring, preoperative scores ranged from 30 to 43 points, averaged 36.46 +/- 1.48; 1 year after operation ranged from 87 to 100 with an average of 91.50 +/- 3.80 and higher than postoperative. Twenty patients got an excellent results, 5 good and 2 fair.</p><p><b>CONCLUSION</b>Suture anchors in treating acute injuries of medial collateral ligament of knee at degree III has following advantages: small range of tissue dissection, easy to operate, reliable fixation and less complications.</p>

Three-dimensional finite element analysis on mechanical behavior of the bone remodeling and bone integration between the bone-implant interface after hip replacement / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the primary stability of the fixed interface between the cementless prosthesis and femur, and its influence on bone ingrowth and secondary stability under the roughened surface and press fit of different prostheses by finite element analysis.</p><p><b>METHODS</b>:A three-dimensional finite element module of total hip arthroplasty (THA) was developed with Mimics software. There was a collection of data when simulating hip arthroplasty. The frictional coefficient between the fixed interface was 0,0.15,0.40 and 1.00 representing the roughness of prosthesis surface. The press fit was 0, 0.01,0.05 and 0.10 mm according to the operation. The Vion Mises stress distribution and the contact pressure,friction stress and relative sliding displacement between the interface were analysed and compared when simulating the maneuver of climbing stairs.</p><p><b>RESULTS</b>At a fixed press fit of 0.05 mm,the contact pressure between the interface was 230 , 231, 222 and 275 MN under four different frictional coefficient (0,0. 15,0.40 and 1.00) with little change; the relative sliding displacement was 0.529, 0.129, 0.107 and 0.087 mm with a consistent and obvious decline. As the fixed frictional coefficient was 0.40,the contact pressure between the interface were 56.0,67.7 ,60.4 and 49.6 MN under four different press fit (0, 0.01, 0.05 and 0.10 mm) with a reduction; the relative sliding displacement was 0.064,0.062,0.043 and 0.042 mm with an obvious decline, and there was a maximal friction stress when press fit of 0.01 mm.</p><p><b>CONCLUSION</b>There is a dynamic process of the bone remodeling and bone integration between the interface after hip replacement, determining the long-term outcome. The interface clearance and the frictional coefficient are the key factors of the bone integration.</p>

Clinical apprehension on application of Tri-lock BPS total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study short-term results and clinical application of Tri-lock BPS in total hip arthoplasty.</p><p><b>METHODS</b>From May 2010 to July 2011, 32 hips in 31 patients (18 males and 13 females, ranging in age from 50 to 77 years old, with an average of 60.5 years old) were treated by total hip arthroplasty with Tri-lock BPS, including 8 patients with osteonecrosis (ON), 13 patients with fresh femoral neck fracture, 10 patients with developmental dysplasia of the hip (DDH). The therapeutic effects were evaluated by self assessment form, preoperative and postoperative Harris hip score, radiographs, Engh score and bone in growth of femoral side described by Gruen. Based on the short-term results,its design characteristic and clinical properties were analyzed.</p><p><b>RESULTS</b>All the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. All the patients were followed up with an average time of 12.2 months (ranged, 10 to 14 months). All the joints had good or excellent clinical results. The Harris score increased from preoperative 38.3 +/- 4.9 to 92.5 +/- 11.2 at the latest follow-up (t = 27.53, P < 0.01). Radiographically, the positions of the prostheses were normal,the average limbs length and femoral eccentricity recovered to normal. X-ray of the hips showed that the femoral stem prosthesis was in line with good initial fixed standard. At 3 months after surgery, X-ray of the hips showed that bone in growth in Gruen II and VI of femoral side.</p><p><b>CONCLUSION</b>Short-term results show that the design of Tri-lock BPS is more in line with human anatomy, and has the advantages in rapid recovery of hip function and retains more bone mass. It offers a newly valuable technology for the treatment of osteonecrosis, femoral neck fracture and DDH and so on.</p>

Anatomical study on the femoral tunnel anatomy reconstruction of anterior cruciate ligament / 中国骨伤

<p><b>OBJECTIVE</b>To measure anatomical data of the femoral tunnel anatomy reconstruction of anterior cruciate ligament (ACL), so provide anatomical basis for clinical anatomy reconstruction of ACL.</p><p><b>METHODS</b>There were 30 adults' cadaveric knee specimens. The ACL femoral tunnel was reconstructed through anterior medial approach (AMP) in genuflex position of 120 degree, and was marked by Kirschner. The soft tissue of the specimen was removed and the femoral condyle was split at the middle side. The index including length of the femoral tunnel, the distance from internal opening of tunnel to cortical edge of femoral condyle and vertical distance to the top of femoral intercondylar notch were measured. Then the time position of internal opening of tunnel in the intercondylar notch was recorded, and the location of outside opening of tunnel to the femoral condyle was detected.</p><p><b>RESULTS</b>The mean length of the femoral tunnel was (36.35 +/- 3.14) mm (ranged, 30.65 to 42.35 mm). The distance from internal opening of tunnel to cortical edge of femoral condyle was (17.84 +/- 3.35) mm (ranged, 14.02 to 23.49 mm), vertical distance to the top of femoral intercondylar notch was (14.05 +/- 2.32) mm (ranged, 9.17 to 20.08 mm). According to the way of circular dial,internal opening of tunnel located at 02:30 +/- 00:10 (ranged, 01:50 to 02:50) in the left knee,and 09:30 +/- 0:15 (ranged, 08:30 to 10:40) in the right knee. The outside opening of femoral tunnel located at (3.16 +/- 2.51) mm (ranged, 1.61 to 6.30 mm) to the proximal end of external epicondyle of femur, and (4.25 +/- 2.16) mm (ranged, 1.73 to 8.52 mm) to the posterior of external epicondyle of femur.</p><p><b>CONCLUSION</b>The anatomical features of femoral tunnel for reconstruction of ACL is revealed,which will provide anatomical basis for clinical practice.</p>

Arthroscopic single bundle anterior cruciate ligament anatomical reconstruction with remnant preservation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the feasibility and clinical effects of single bundle anterior cruciate ligament anatomical reconstruction with remnant preservation.</p><p><b>METHODS</b>From October 2007 to November 2009, 17 patients (10 male and 7 female, ranging in age from 28 to 62 years, with an average of 39.3 years) with posterior cruciate ligament injuries were treated with single bundle anatomical reconstruction with remnant preservation. Nine patients had the injuries caused by traffic accident; 6 patients caused by falling down; and 2 patients caused by sports injuries. The average time from injury to surgery was 8.5 days (ranging from 2 to 14 days). The international knee documentation committee knee evaluation form (IKDC) and Lysholm were used to analysis the effect of surgery.</p><p><b>RESULTS</b>All the patients obtained the follow-up and the average time was 29.5 months (ranging from 24 to 39 months). There were no complications such as injuries of popliteal fossa artery, tibial nerves or peroneal nerve. Twelve patients had knee joint recovering to normal; 1 patient had stiff joints and was treated with arthroscopic surgery to release after 6 months,who had postoperative flexion lack of 20 degree and straight to normal. Three patients had flexion loss of 5 to 10 degree, and 1 patient had hyperextension limitation of 5 degree. Posterior drawer test in 17 patients and the Lachman test were negative. IKDC scores of the 17 patients achieved normal(16 patients) or near normal(1 patient). IKDC overall score normal in 16 patients (94.1%), close to normal in 1 case (5.9%). The IKDC subjective score was 94.3+/-5.1 and Lysholm score was 94.7+/-3.1 at the latest follow-up.</p><p><b>CONCLUSION</b>The single bundle anterior cruciate ligament with remnant preservation anatomical reconstruction can provide good clinical results.</p>

Treatment of type C pelvic fracture with Stoppa approach and posterior percutaneous plate fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of Stoppa approach and posterior percutaneous plate in treating type C pelvic fracture.</p><p><b>METHODS</b>From June 2009 to July 2011,16 patients with type C pelvic fracture were treated with reconstruction plate fixation in Stoppa approach for anterior lesions combined with posterior percutaneous plate fixation for posterior lesions.There were 11 males and 5 females,with an average age of 38.8 years (ranged, 22 to 59 years). According to the Tile classification,10 cases belonged to C1,4 belonged to C2,2 belonged to C3. Tometta and Majeed score standards were used to evaluate clinical results.</p><p><b>RESULTS</b>Sixteen patients were followed up from 4 to 13 months with an average of 7.3 months. Operative time was from 80 to 140 min with an average of 100 min;blood loss volume was from 200 to 500 ml with an average of 280 ml; and the healing time of fracture was from 12 to 16 months with an average of 14 months. According to the Tometta score classification, 9 cases got excellent results, 6 good, 1 fair. According to the Majeed score classification, 9 cases obtained excellent results, 5 good, 2 fair.</p><p><b>CONCLUSION</b>Reconstruction plate fixation in Stoppa approach for anterior lesions combined with posterior percutaneous plate fixation for posterior lesions is an ideal minimally invasive operation in treaing type C pelvic fracture. It can early exercise and has the advandages of small trauma, safe operaton,less complication, stable fixation.</p>

Surgical selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture.</p><p><b>METHODS</b>From June 2000 to August 2010, 72 patients with membranous urethral trauma caused by pelvic fracture were selected. There were 46 males and 26 females,ranging age from 26 to 62 years (averaged 35.2 years). The time from injury to hospitalization time was 1 to 3 hours. According to Tile pelvic fracture classification, there were 8 patients with type A, 45 patients with type B, 19 patients with type C. Thirty of the 35 patients with partial rupture of posterior urethral were treated by catheterization,5 patients treated by rupture anastomosis on the stage I combined with cystostomy; 25 of the 37 patients with complete rupture of posterior urethra were treated by early realignment, and 12 patients were treated by cystostomy. Urinary incontinence, impotence and urethrostenosis were evaluated.</p><p><b>RESULTS</b>All patients were followed up for 5 to 10 years (mean 7.7 years). Incidence of urethrostenosis, impotence and urinary incontinence in patients treated by cystostomy were significantly higher than rupture anastomosis on the stage I and early realignment (P < 0.05); while incidence in patients treated by catheterization was significantly lower than other groups (P < 0.05).</p><p><b>CONCLUSION</b>For patients with partial rupture of posterior urethral, catheterization and rupture anastomosis on the stage I are preferred methods; while patients with complete rupture of posterior urethra, early realignment is a preferred method with advantages of simple operation and less complications.</p>

Treatment of Hoffa fracture using hollow lag screw / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the operation techniques and clinical effects of hollow lag screws for the treatment of Hoffa fractures.</p><p><b>METHODS</b>From February 2001 to May 2009, 13 patients with Hoffa fractures were treated with hollow lag screws, including 8 males and 5 females, ranging in age from 23 to 45 years, with a mean age of 34.2 years. Six patients had the fractures on the left, 7 patients on the right. According to the Letenneuer type, femur lateral condyle: type I in 3 cases, type III in 2 cases; femur medial condyle: type I in 3 cases, type II in 2 cases, type III in 3 cases. According to the type of fracture, hollow lag screws were used to treat the fracture with different approach.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 23 months,with a mean of 16.5 months. All the patients had no complications such as popliteal artery, tibial nerve or peroneal nerve injuries. According to Letenneur knee function score: 10 patients got an excellent result, 3 good. At the half year after operation, the X-ray showed all the fractures had bone union. There were no hollow lag screw loosening, broken or nonunion.</p><p><b>CONCLUSION</b>The clinical effect of hollow lag screw for the treatment of Hoffa fractures is satisfactory. The surgical approach and fixation should be determined by the type of fracture, the location of the fracture line and the size of fracture fragments.</p>

Surgical treatment of thoracolumbar fractures using reduction and short-segment pedicle screw at the fracture level with the approach through para-vertebral muscles / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the efficacy and clinical outcome of reduction and pedicle screws fixation at the fracture level with the approach through para-vertebral muscles in treating thoraeolumbar fractures.</p><p><b>METHODS</b>From January 2007 to March 2010,27 patients with thoracolumbar fractures were treated with posterior open reduction and internal fixation with the approach through para-vertebral muscles. There were 19 males and 8 females with the mean age of 36.3 years old (ranged,21 to 57). According to Magerl type, type A2 was in 5 cases, A3 in 14, B1 in 3, B2 in 5. According to Frankel classification of spinal cord injury: grade D was in 6 cases and grade E in 21 cases. X-rays and CT scans were performed after operation. Cobb angle of the injured vertebral segment,the percentage of vertebral compression,and sagittal diameter stenosis rate of the injured spinal canal were observed by radiographic data. Neurological function was evaluated by the Frankel grade.</p><p><b>RESULTS</b>All patients were followed up from 12 to 28 months with an average of 19.6 months. The percentage of vertebral compression, Cobb angle of the injured vertebral segment, spinal canal sagittal diameter stenosis rate were respectively corrected from (46.6 +/- 10.5)%, (18.3 +/- 7.2) degrees, (30.2 +/- 7.2)% to postoperative (5.2 +/- 3.7)%, (5.3 +/- 5.1) degrees, (6.3 +/- 4.2)% and (6.7 +/- 4.6)%, (7.1 +/- 3.1), (7.2 +/- 4.5)% at last follow-up. There were significant difference in above items between preoperation and postoperation (P < 0.05); and there was no significant difference in above items between postoperation and last follow-up (P > 0.05). In aspect of nerve function, 3 cases with Frankel grade D recovered to grade E.</p><p><b>CONCLUSION</b>Using reduction and short-segment pedicle screws fixation at the fracture level through para-vertebral muscles approach is an effective method in treating thoracolumbar fractures. The method has advantages of simple operation,easy establishing screw, short operative time, less blood loss, which can obtain good reduction and stable, reliable fixation after operation.</p>

Clinical study on the effects of the femoral attachment site of grafts and the tunnel angle on the function of knee joint after anterior cruciate ligament reconstruction / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of the attachment site of grafts and the tunnel angle on the function of knee joint after anterior cruciate ligament reconstruction.</p><p><b>METHODS</b>From January 2006 to May 2009, 47 patients(32 males and 15 females, ranging in age from 19 to 51 years old, with an average of 35.3 years old) were treated with single-bundle reconstruction of anterior cruciate ligament. Several indexes were measured at the latest follow-up as follow: attachment sites of graft on the femoral condyle were recorded, the femoral tunnel angles on coronal and sagittal planes were measured on postoperative X-ray films. According to the IKDC score, these patients were divided into two groups. In the first group, 38 patients were found the IKDC score more than 90 at the latest follow-up, and in the second group 9 patients were found IKDC score less than 90. By comparing the two groups, the relation of the indexes and postoperative function of knee was analyzed.</p><p><b>RESULTS</b>The IKDC which was more than 90 at the latest follow-up was found in 38 patients, whose femoral attachments site of ACL was positioned at (29.73 +/- 4.31)% (ranged from 16.21% to 53.82%) from the posterior end of Blumensaat's line. IKDC which was less than 90 was found in 9 patients, whose femoral attachments site of ACL was positioned at (46.61 +/- 3.43)% (ranged from 27.18% to 72.34%). There was significant difference between the two groups (P = -0.000 7). The IKDC more than 90 at the latest follow-up was found in 38 patients,whose femoral tunnel angle on coronal plane was (49.5 +/- 4.72) degrees (ranged from 33 degrees to 67 degrees) and on sagittal plane was (31.3 +/- 5.12) degrees (ranged from 11 degrees to 45 degrees) were significantly less than those whose IKDC less than 90 at the latest follow-up on coronal plane was (67.6 +/- 3.09) degrees (ranged from 41 degrees to 81 degrees) and on sagittal plane was (41.2 +/- 5.69) degrees (ranged from 23 degrees to 56 degrees) (P = 0.000 7, P = -0.000 8).</p><p><b>CONCLUSION</b>There is close relation between the attachment site of grafts and the tunnel angle with the function of knee, so in anterior cruciate ligament should be anatomic reconstructed with the anterior medial approach.</p>

Treatment of adolescent clavicular fracture with titanium elastic nails / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the feasibility and clinical effects of titanium elastic nails (TEN) for adolescent clavicular fracture.</p><p><b>METHODS</b>From October 2008 to November 2009, 17 adolescent patients with clavicular fracture were treated with internal fixation, including 11 males and 5 females who ranged in age from 12 to 18 years (mean 15.3 years). The mean time from injury to surgery was 3.5 days (2-7 days). Constant function score before surgery and that 3 months after surgery and shoulder ROM before surgery and that 2 months after surgery were compared. Fracture reduction and healing were followed up by X-rays to analyze internal fixation with the TEN technique.</p><p><b>RESULTS</b>All patients were followed up for a mean of 6.5 months (range 3-8 months), during which no infection, TEN fracture or skin bursting was observed. The Constant score rose from preoperative (45.3 +/- 6.1) to (85.6 +/- 4.3) at 3-month follow up (t = 22.164, P < 0.01),and the shoulder activity degree at 2-week follow up was improved obviosly from preoperative (P < 0.01). X-ray at 12-16 weeks after surgery showed good bone healing and recovery of shoulder function.</p><p><b>CONCLUSION</b>Internal fixation with TEN in the treatment of adolescent clavicular fracture is safe, minimally invasive,reliable and cosmetic. This technique provides a liable ption for the treatment of adolescent clavicular fractire</p>