Case-control study on Chinese medicine fumigation and massage therapy for the treatment of knee stability and func tional recovery after anterior cruciate ligament reconstruction operation / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical outcomes of Chinese medidine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation,and to explore the effect on tendon-bone healing.</p><p><b>METHODS</b>Total 50 patients were divided into two groups: the control group (normal rehabilitation therapy group),the treatment group (Chinese medicine fumigation and manipulation group). There were 25 patients in the control group, including 16 males and 9 females, who were treated with isometric muscle training, with the gradually enlarging amplitude of flexion and progressive loading of bearing training for knee recovery. There were 25 patients in the treatment group, including 15 males and 10 females,who were treated with the conventional rehabilitation therapy combined with Chinese medicine fumigation and massage therapy. The Chinese herbs named as Haitongpi decoction was steamed by a special equipment to fumigate the knee after operation; Based on the biomechanical parameters of the ligament reconstruction, the massage therapy was designed to control the degree of the knee flexion and release the adhesion for early recovery of knee functions. The Lysholm knee function evaluation system was used, and MRI examination was performed to measure the change in width of ligament tunnel in femur and tibia to evaluate the safety and stability of the treatment.</p><p><b>RESULTS</b>Lysholm system showed that two groups both had improving results from the 1st month after operation to the 3rd month (treatment group, F=36.54, P<0.05; the control group, F=28.12, P<0.05), and the results of the treatment group was better than that of the control group at the observation point (the 1st month, t=0.105, P<0.05; the 3rd month, t=5.361, P<0.01). There was no difference between the two groups when evaluating the bone and tendon healing 3 and 12 months after operation (P>0.05), indicating that Chinese rehabilitation therapy was a safety treatment without the influence on the loosing of tendon.</p><p><b>CONCLUSION</b>Chinese medicine fumigation and massage therapy can early improve the knee function after the anterior cruciate ligament reconstruction operation without the disturbance of the knee stability.</p>

Analysis on morphology and stability of femoral hip prosthesis based on the revision operation / 中国骨伤

<p><b>OBJECTIVE</b>According to the information obtained from the revision of total hip arthroplasty, the situations of the artificial femoral stem under physiological stress were analyzed preliminarily. In order to accumulate clinical experience, the discussions about how to enlongate the life of artifical joints were performed.</p><p><b>METHODS</b>Fifty-three patients required revision operations were selected, including 28 males and 25 females,with an average age of 74.66 years old (61 to 84 years old). The average life of artificial joints was 18.24 years (3 to 27 years). The initial weightbearing was started 11 days (5 to 16 days) after the first operation. The main reasons for the revision were the spontaneous loosening and trauma. Based on imaging and surgical findings, as well as the histological pathology, the situations of the stems in human bodies were determined.</p><p><b>RESULTS</b>Femoral prosthesis would sink under physiological stress. The design of femoral stems, motion of patients', and bone growth determined the secondary stability. Straight stems were helpful for physiological subsidence of prosthesis, achieving the stability with close bone-implant contact by bone growth,which allowed the patient to do early landing exercise. The collared prosthesis and prosthesis combined with internal fixation limited the subsidence of femoral stems. Their stability depends on the time of initial placement and the bone growth for supporting. Delaying the inital weightbearing was suggested for patients with these protheses.</p><p><b>CONCLUSION</b>According to the actual situation of the patients, the appropriate chosen of femoral stems and time to perform the weightbearing can extend the life of the femoral prosthesis.</p>

Biomechanical research on upper femur with vertical and bending stress / 中国骨伤

<p><b>OBJECTIVE</b>To study the bone state with ultimate stress by examining biomechanical distribution of upper femur in Chinese, in order to accumulate more experiences for clinical work.</p><p><b>METHODS</b>Totally 60 Chinese femurs from fresh cadavers were randomly divided into two groups. All the femurs were cleaned, and the body age ranged from 36 to 72 years old, averaged 56.4 years, including 41 from males, and 19 from females. These two groups underwent mechanical stress and bending stress tests. Special mechanical laboratory and machines were used to get the information. Results about the loading value at each testing point under stress were collected.</p><p><b>RESULTS</b>The four faces of the upper femur suffered different stress under external forces. The bone on upper femur can tolerate more mechanical stress than bending stress. Medial and lateral region of the femur neck and the rear side of the small tuberosity section were themain position enduring the vertical stress. The rear position of the base femur neck and the small tuberosity section were the main regions enduring the bending stress. Those main positions had strong cancellous bones. The intertrochanteric fracture fixation and artificial femoral stems were designed depending on this biomechanical basis.</p><p><b>CONCLUSION</b>According to our experiment result, doctors need to chose more effective fixations for upper femur fracture, and femoral stems for the patients. More information should be collected by further researches.</p>

Total hip replacement for the treatment of hip bony fused in non-functional position (17 hips of 12 cases) / 中国骨伤

<p><b>OBJECTIVE</b>To explore the key points in the treatment of hip pathological bony fused in non-functional position with total hip replacement, especially to find out the main reasons for improving the joint function and the patients' life quality before and after the operation. And to accumulate more experience for further clinical treatment.</p><p><b>METHODS</b>From May 2001 to May 2005, 12 patients with hip bony fused in non-functional position were treated with total hip replacement. There were 5 males (ranging in age from 32 to 54 years,averaged 43.25 years) and 7 females (ranging in age from 29 to 64 years, averaged 48.80 years). The patients suffered from ankylosing spondylitis (AS, 5 patients), developmental dysplasia of the hip (DDH, 4 patients), and rheumatoid arthritis (RA, 3 patients). The course of the disease ranged from 5.25 to 20 years. All affected hips were bony fused,lost normal function and had rest pain. The X-ray showed there were no joint space left in the affected hips and trabecular bone crossed the femoral head to the acetabulum. The Harris evaluation system was performed before surgery, at 6, 12 and the 36 months after surgery.</p><p><b>RESULTS</b>The Harris evaluation system showed the joint replacement surgery can significantly improve the patients' life quality. The postoperative scores of pain was (40.00 +/- 0.01), joint function was (31.53 +/- 5.36), range of motion was (1.94 +/- 0.05) and the deformity was (4.00 +/- 0.01), which had significantly difference (P < 0.05) from the scores of preoperative ones as the pain (1.18 +/- 3.32), joint function (0.01 +/- 0.01), range of motion (0.01 +/- 0.01) and the deformity (0.01 +/- 0.01). In the three year follow-up study,total scores had gradual improvement (P < 0.05)in the 6, 12 and the 36 months after the operation, which were (77.47 +/- 5.34), (80.95 +/- 4.01) and (82.90 +/- 3.39) respectively. The scores for limp, support, stairs,activities as wearing shoes or socks,and public transportation were (9.59 +/- 1.54), (8.88 +/- 2.69), (3.29 +/- 0.99), (3.75 +/- 0.66) and (6.01 +/- 0.01) respectively, and the former three, which were (10.47 +/- l.18), (10.06 +/- 1.75) and (3.76 +/- 0.66), had continually improved in 12 months after the operation (P < 0.05). Operation also solved the motion problem and made the joint remain stable. All the patients were recovered without complications of nerve injuries.</p><p><b>CONCLUSION</b>By the three year follow-up study, total hip replacement can significantly improve life quality of patients with hip pathological bony fused in non-functional position.</p>

Effect of treatment based on syndrome differentiation by Chinese medicine on post-traumatic elbow arthritis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To compare the clinical efficacy of treatment based on syndrome differentiation of Chinese medicine and modern conservative therapeutic program on post-traumatic elbow arthritis (PTEA) in order to provide the guidance in clinical practice.</p><p><b>METHODS</b>Seventy-six patients with PTEA requesting the conservative therapy were equally assigned to two groups randomly. The 38 patients in the treated group were administered with Chinese herbal medicines according to their syndrome typing for oral intake and external washing; while the other 38 patients in the control group were treated orally with glucosamine hydrochloride and Celecoxib, combined with intra-articular injection of sodium hyaluronate and peri-articular pain spot blocking with Triamcinolone Acetonaide Acetate injection. All were followed-up for six months with the therapeutic efficacy assessed by Japanese Orthopaedic Association (JOA) and the Hospital for Special Surgery (HSS) Scale scoring.</p><p><b>RESULTS</b>All the 76 patients completed the trial. The JOA and HSS scores in the two groups were not significantly different before treatment (P>0.05), but they did show significant difference after treatment in terms of total score, joint pain, range of motion, and daily activity (P<0.05). However, there was no difference between the two groups in the improvement of joint stability and deformity (P>0.05).</p><p><b>CONCLUSION</b>Both the Chinese drug therapy according to syndrome differentiation and modern conservative therapy are effective in treating PTEA, but the former shows more superiority, and so it is worthy of clinical spreading.</p>

Study on short-term effects of ankle replacement for the treatment of hemophilic arthritis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the short-term effects of ankle joint replacement for the patients with hemophilic arthritis. To find out the main points for improving the joint function and the patients' life quality. To accumulate more experience for clinical treatment.</p><p><b>METHODS</b>The Kofoed evaluation system and the AOFAS evaluation system were used to follow-up 6 hemophilic patients with ankle arthritis (6 males, ranging in age from 23 to 57 years, with an average of 41.2 years), who were treated with ankle joint replacement from 2004.7 to 2007.7. The scores before operation, and the 6th,12th months after operation were compared.</p><p><b>RESULTS</b>The Kofoed evaluation system showed the joint replacement significantly improved the scores for relieving pain, joint function, range of motion and the total score (P<0.05). Except the score for relieving pain, the other three also had significant differences between the 6th month and the 12th month after the operation (P<0.05). Compared with each details of the joint function, there was significant improvement before and after the operation (P<0.05). The ankle got more extended range of motion in the 12th month after operation than the 6th month (P<0.05). The AOFAS evaluation system showed the joint replacement significantly improved the scores for relieving pain, joint function, X-ray measurement and the total score (P<0.05). There was no differences between the 6th month after operation and the 12th month in the results for relieving pain and the X-ray measurement (P>0.05). However, the joint function and the total score had significant differences (P<0.05). Compared with each details of the joint function, there was also significant improvement before and after the operation (P< 0.05), and the walk distance, as well as the joint flexion and extension activities, had differences between the 6th month and the 12th month after the operation. Both of the two evaluation system showed the operation could get good curative effects (P< 0.05), and the artificial joint could constantly be in good condition from the 6th month to the 12th month after operation (P> 0.05).</p><p><b>CONCLUSION</b>In this short-term observation, the joint replacement can significantly improve the life quality for the hemophilic patients with ankle arthritis.</p>

Controlled clinical trials on the effects of Chinese traditional medicine for the treatment of osteoarthritis of knee joint at early stage and its MRI changes / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of Chinese traditional medicine for the treatment of osteoarthritis of knee joint at early stage, as well as to observe the changes of articular cartilage in MRI before and after the treatment.</p><p><b>METHODS</b>Sixty patients were divided into two groups according to Doll's law, 32 patients in the treatment group (6 male and 26 female, with an average age of 52.2 years, ranging from 43 to 65 years, 40 joints), 28 patients in the control group (5 male and 23 female, with an average age of 54.4 years, ranging from 42 to 65 years, 33 joints). The patients in the test group were given Chinese traditional medicine orally, and patients in the control group were given celecoxib and the glucosamine hydrochloride orally for three months. MR scan and ISOA score were given respectively before and after treatment. After the treatment, the articular cartilage changes of the weight bearing area were observed to evaluate the therapeutic effects.</p><p><b>RESULTS</b>All the patients were followed up ranging from 13 to 17 months, with an average of 15.3 months. According to MRI evaluation, 15 joints got an excellent result, and 17 joints got a good result in the treatment group, the total excellent and good rate was 80.0%; and in the control group, above data were 8, 11 and 57.6% respectively. The average ISOA score of the treatment group after treatment was 0.35 +/- 0.16, and in the control group was 3.68 +/- 0.18. There was significant differences between the two groups of ISOA score (t = 6.94, P<0.05).</p><p><b>CONCLUSION</b>Chinese traditional medicine can significantly alleviate or inhibit the cartilage degeneration of knee osteoarthritis at early stage and improve joint function. It had significant clinical effects.</p>