Serum levels of cartilage oligomeric matrix protein in the diagnosis of knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To select sub-clinical patients with symptoms of knee osteoarthritis (KOA) without X-ray changes by measuring the serum level of cartilage oligomeric matrix protein (COMP) with ELISA, so as to diagnose and treat patients with knee osteoarthritis at early stage.</p><p><b>METHODS</b>The 115 patients with KOA or with symptomatic primary KOA were enrolled from August 2007 to September 2009, which was OA group; and 35 healthy people in the control group. In OA group, there were 55 males and 60 females,ranging in age from 39 to 76 years, with an average of (55 +/- 13.32) years; the body mass index (BMI) ranged from 15.1 to 29.8; the disease course ranged from 6 to 60 months. In the control group, there were 16 males and 19 females, ranging in age from 36 to 77 years, with an average of (53 +/- 12.53) years; the BMI ranged from 14.8 to 29.2. Patients with symptomatic primary knee OA of Kellgren-Lawrence (K-L) grade I-IV were evaluated. Serum level of COMP and its correlation with OA grade were analyzed by ELISA method. The patients were treated with Celecoxib capsules. The patients in OA group were followed up, and the duration ranged from 24 to 38 months (averaged, 33.4 months), and the serum level of COMP were analyzed before and after treatment.</p><p><b>RESULTS</b>The serum level of COMP in the control group varied with age (t= 2.50, P=0.02). The serum level of COMP did not correlate with gender (control group: t=0.98, P=0.34; OA group: t=0.18, P= 0.86), BMI (control group: t=0.56, P=0.92; OA group: t=0.17, P=0.85) and smoking (control group: t=1.89, P=0.08; OA group: t=0.70, P=0.49). The serum level of COMP was higher in the patients with higher K-L grades than in the patients with lower K-L grades (F=15.56, P=0.001) . The sub-clinical KOA patients without X-ray changes can be detected significant higher COMP levels than sub-clinical patients with other diseases (t=2.55, P=0.03). Therefore, according to this method, subclinical OA patients can be detected from people with other sub-clinical diseases successfully.</p><p><b>CONCLUSION</b>The serum level of COMP can be used as a potential prognostic marker to diagnose KOA.</p>

Clinical research of electroacupuncture combined with acupoint-injection of botulinum toxin A in treating the muscle spasticity by spinal cord injury / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical safety and efficiency of electroacupuncture combined with acupoint-injection of botulinum toxin A for the treatment of muscle spasticity by spinal cord injury.</p><p><b>METHODS</b>Thirty-eight patients with muscle spasticity by spinal cord injury were treated from December 2006 to December 2009 including 26 males and 12 females, with an average age of 45.4 years old ranging from 21 to 68 years. The patients were randomly divided into 3 groups according to admission time, 13 patients in group A were treated with electroacupuncture combined with acupoint-injection of botulinum toxin A, and 13 patients in group B were treated with acupoint-injection botulinum toxin A and 12 patients in group C were treated with electroacupuncture. After 6 months these patients were evaluated by improved muscle Ashworth scoring (MAS) and clinical spasticity index (SCI).</p><p><b>RESULTS</b>Thirty-eight patients were followed-up at 6 months after the treatment. The result showed that the MAS scores of group A, B, C before treatment were (3.10 +/- 0.14), (3.20 +/- 0.17), (3.10 +/- 0.16) respectively and the CSI scores were (14.10 +/- 0.14), (14.30 +/- 0.11), (14.20 +/- 0.12) respectively; there were no statistical different among the three groups (P > 0.05). After 6 months of treatment, the MAS scores were (1.10 +/- 0.16), (2.10 +/- 0.13), (2.00 +/- 0.14) respectively and the CSI scores were (9.10 +/- 0.11), (12.10 +/- 0.14), (13.10 +/- 0.12) respectively. The MAS scores and CSI scores of group A were better than the other two groups (P < 0.05).</p><p><b>CONCLUSION</b>The combination of Chinese hydropower needles and acupoints with BTX-A injection can achieve a comprehensive treatment and reduce pain and improve life quality quickly. The electroacupuncture combined with acupoint-inject botulinum toxin A is a noval safe and effective technique for the treatment of muscle spasticity by spinal cord injury.</p>

Pith decompression of the femoral head and allograft fibula grafting for treatment of avascular necrosis of femoral head / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of the pith decompression of the femoral head and fibular allograft transplantation in the treatment of early stage avascular necrosis.</p><p><b>METHODS</b>From January 2004 to November 2008, 32 hips of 25 patients with avascular necrosis of femoral head of Ia-IIIb period were treated by the pith decompression of the femoral head and fibular allograft transplantation, hollow lag screw fixation, included 17 males and 8 females, aged from 20 to 55 years old (39.1 years on average). Preoperative pain was from 2 to 14 months (means 5.5 months). All patients were applied on conventional X-ray films, MRI examination, Harris score.</p><p><b>RESULTS</b>The patients were followed up for 12 to 48 months (means 36.4 months). X-ray film showed 21 hips of 18 cases improved,6 hips of 4 cases unchanged, no collapse of articular surface, 3 hips of 2 cases deterioration, 2 hips of 1 case failed. Preoperative Harris score was (77.0 +/- 8.0) and postoperative (90.6 +/- 2.5), there was a significant difference (t = 1.67, P < 0.05).</p><p><b>CONCLUSION</b>Pith decompression of the femoral head and fibular allograft transplantation in the treatment of early stage avascular necrosis of femoral head has advantage of joint function in bed-ridden after a short time, quick recovery,clinical symptoms improved. Its short-term efficacy is certain but long-term efficacy is still need further observation.</p>

Micro-modified Fulkerson osteotomy for the treatment of habituation patellar dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate clinical effect of micro-modified Fulkerson osteotomy under arthroscope in treating habituation patellar dislocation.</p><p><b>METHODS</b>Twenty patients of habituation patellar dislocation (25 knees) were treated by the medial retinaculum plication, lateral retinaculum releasing and modified Fulkerson osteotomy (tibial tubercle anteromedial transfer) under arthroscope. There were 5 males and 15 females with the age from 16- to 28-years-old (average of 21 years). The subjective symptoms and the joint function were evaluated according to Lysholm and Tegner scoring system.</p><p><b>RESULTS</b>All the patients were followed up from 12 to 36 months with an average of 24 months. No found redislocation in the patients. The Lysholm score was 54.4 +/- 12.1 and 87.7 +/- 9.6 (t=2.33, P<0.05) before and after surgery respectively. The Tegner score was 2.8 +/- 0.8 and 5.1 +/- 1.3 (t=4.36, P<0.01) before and after surgery respectively.</p><p><b>CONCLUSION</b>Micro-modified Fulkerson osteotomy under arthroscope for the treatment of habituation patellar dislocation is a rescheduled in extend knee equipment, its advantages including affirmative effect, minor damage, quick rehabilitation, fewer complications and lower rate of recurrence after operation.</p>

A biomechanical research into different internal fixations for ACL avulsion fractures of tibial eminence / 中华创伤骨科杂志

Objective To conduct a hiomechanical comparison of the four common internal fixation methods for the anterior eruciate ligament(ACL)avulsion fractures of displaced tibial eminence.Methods Sixteen fresh cadaver knee joints were used and randomized into four equal groups of four fixation methods:antegrade wiring group, retrograde wiring group,suturation group,and intramedullary screw group.The knee joint specimens were fixed at flexion of 30?and subject to continuous stretch stresses of 30 N,60 N and 90 N respectively on a material testing machine(MTS 858 Bionix test system,USA)which conducted a simulated Lachman test.The specimens were scanned at different angles by a three dimensional laser scanner.Data were recorded and processed by image software to es- tablish three-dimensional structure models of femur,tibia and knee joint.The test results were analyzed statistically on a computer.Results There were no obvious differences between each fixation group in the length change of ACL when the stresses were 30 N and 60 N(P＞0.05).Under 90 N stress,however,the mean length change between the femoral and tibial attachments of ACL was the smallest(4.8?1.7)mm(2.5 to 6.2 mm)in the suturation group(P＜0.05). There were no distinct differences between the intramedullary screw group and the retrograde wiring group in the changes of A CL shift(P=0.214).The average front shift in the retrograde wiring group was(6.2?1.2)mm(4.8 to 8.2 mm) and significantly smaller than that in the antegrade wiring group(P＜0.05).The antegrade wiring group made the largest average front shift under different stresses and its average front shift was(7.2?1.3)mm(5.6 to 8.7 mm). Conclusions The knee joint stability provided by the suturation fixation is distinctly better than that by the other three fixation methods.The antegrade wire fixation provides the poorest knee joint stability.There is hardly any difference between intramedullary screw fixation and retrograde wiring fixation.