Objective To evaluate surgical treatment of chronic tibial osteomyelitis of Cierny-Mader type Ⅳ with Ilizarov technique and lesion osteotomy. Methods From January 2010 to May 2016, 39 patients with chronic tibial osteomyelitis of Cierny-Mader type Ⅳ were treated at our center. They were 33 males and 6 females, 8 to 54 years of age (average, 33.8 years). After debridement and lesion osteotomy, the tibia was fixated with Ilizarov external fixator. Bone was transported to the bone defect after corticotomy was performed on the proximal and/or distal tibial metaphyses simultaneously. Bifocal corticotomy was per-formed in 11 cases, proximal corticotomy in 21 cases, and distal corticotomy in 7 cases. The transport began 3 to 5 days after operation at a speed of 0.5 to 1.0 mm/d initially. The speed was lowered according to the bone healing and pain. Radiographic examination was done every 2 weeks to observe transporting deviation and osteogenesis in the transporting area. The transporting was adjusted whenever any abnormality was observed. The bone transporting lasted for 50 to 130 days (average, 62.4 days). Results The patients were fol-lowed up for 11 to 49 months (average, 21 months). All the soft tissue wounds healed uneventfully and there was no relapse of osteomyelitis. The bone defects in the 32 cases were reconstructed primarily. Nonunion of fracture ends happened in 5 cases and nonunion of the bone lengthening zone in 2 cases. The 7 cases of nonunion were healed after secondary bone grafting. Malalignment happened in 5 cases, 4 of which responded to timely adjustment of the external fixation and one of which had to receive secondary bone grafting after failure in adjustment of the external fixation. Ankle joint dysfunction occurred in 7 cases, 5 of which re-sponded to functional exercise and 2 of which accepted joint dysfunction because they refused surgery after unsatisfactory functional exercise. Pin tract infection of different severities occurred in 9 cases, one of which was treated by replacement of the K-wires under local anesthesia and the other 8 of which responded to rein-forced dressing change. Conclusions Chronic tibial osteomyelitis of Cierny-Mader typeⅣcan be treated by Ilizarov technique and lesion osteotomy. However, the Ilizarov technique should be improved because of the risks of multiple complications which can be reduced significantly by strengthening postoperative instruction, nursing, and regular follow-up.

Objective To explore treatment effect and strategy of postoperative early wound deep infection in spinal surgery with instrumentation.Methods The 9 cases with postoperative early wound deep infection in spinal surgery with instrumentation were treated by debridement,closed suction irrigation and vacuum sealing drainage(VSD).Results Number of surgical debridement was 1 ～ 8 times,all cases were cured,3 cases with complete retention of spinal instrumentation and 3 cases with partial retention,3 cases were replaced pedicle screw-rod system.Duration of hospitalization was 28 ～150 d.The follow-up time was 12 ～24 months.During the follow-up period,no recurrence of infection except 1 case was removed instrumentation after successful intervertebral fusion,because recurrence of infection occurred at 1 year postoperation.Condusions Most cases of postoperative early wound deep infection in spinal surgery with instrumentation can be cured with retention of instrumentation by aggressive debridement,closed suction irrigation and VSD combined with sensitive antibiotics.

Objective To evaluate the clinical outcome of reconstruction of the superior peroneal retinaculum (SPR) by using a portion of Achilles’s tendon and suture anchors in the treatment of chronic peroneal tendon dislocation .Methods Seven patients in our hospital from January 2010 to January 2015 who underwent surgical reconstruction of SPR by using a portion of Achilles ’ s tendon and suture anchors were evaluated .The ankle ’ s range of motion ( ROM) and The American Orthopaedic Foot and Ankle Society ( AOFAS) ankle-hindfoot score were used to evaluate the clinical outcome .Results All 7 cases were followed up for 6 to 24 months,the average time was 14 months,with-out recurrence.The ankle’s ROM improved from (23.6 ±1.9) °preoperative to (30.0 ±1.5) °at the final follow-up,and the AOFAS An-kle Hindfoot Scale improved from (60.6 ±3.6) point preoperative to (93.6 ±3.9) point at the final follow-up.Conclusion Surgical re-construction of SPR by using a portion of Achilles ’ s tendon and suture anchors may be an effective alternative surgical method for chronic peroneal tendon dislocation .

目的 探讨无近排腕骨骨折的严重腕关节开放性骨折脱位的手术治疗方法.方法 对2008年1月-2014年1月收治的5例无近排腕骨骨折的严重腕关节开放性骨折脱位患者采用彻底清创、腕关节复位固定、血管神经肌腱探查修复进行治疗.术后对患者腕关节屈伸角度、尺桡偏角度、握力以及神经恢复情况进行随访.结果 5例患者均得到随访,时间8～34个月.随访期间腕关节功能良好.腕活动度屈伸75°～115°,平均(95.0±15.0)°.尺桡偏39°～55°,平均(47.4±5.9)o.腕握力为16～21 kg,平均(18.8±1.2) kg.结论 采用彻底清创、腕关节复位固定、神经血管肌腱Ⅰ期修复可有效治疗无腕骨骨折的严重腕关节开放性骨折脱位.

Objective To investigate surgical treatment of chronic osteomyelitis of the lower limb following intramedullary nailing by Ilizarov technique and windowing continuous irrigation of the medullary cavity.Methods From January 2012 to December 2014,we treated 12 patients with chronic osteomyelitis of the lower limb following intramedullary nailing.They were 9 men and 3 women,26 to 47 years of age (average,36 years).The surgical procedures included windowing continuous irrigation of the medullary cavity followed by debridement,external fixation,and bone transport or bone lengthening after metaphysis osteotomy.There were 4 cases of femoral infection and 8 of tibial infection.Irrigation was carried on after operation for an average of 4 weeks (range,3 to 5 weeks).Wound healing,bone union and joint function of lower extremity were followed up postoperatively.Results All patients were followed up for 8 to 20 months (average,10.3 months).All wounds healed without recurrent infection.Five patients had pin tract infection which responded to change of dressing in 4 cases and removal of Kirschner wire.Intramedullary infection did not reoccur.Fine bone union was achieved in all after an average bone lengthening or bone transporting of 5.2 cm (from 4 to 7 cm).The healing indexes ranged from 34 to 69 d/cm (average,52.7 d/cm).The fixation time ranged from 7 to 17 months (average,13 months).Limb isometry was achieved in all but one case whose affected limb was 2 cm shorter because of undue stop of bone lengthening.Joint function of the lower extremity was basically normal in all.Conclusion The chronic osteomyelitis of the lower limb following intramedullary nailing can be cured by Ilizarov technique and windowing continuous irrigation of the medullary cavity.

OBJECTIVE:To investigate the clinical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral ligament (MPFL) for the treatment of patellar dislocations.METHODS:From September 2008 to June 2013, 16 patients with patellar dislocation underwent MPFL reconstructions. There were 2 males and 14 females, aged 11 to 27 years old (16 years old on average). Patellar dislocations occurred in 11 left and 5 right knees. The disease course ranged from 3 to 10 years. The frequency of dislocation ranged from 9 to 33 times (19 times on average). Affected knee joints showed patellar instability; the range of action for patella obviously increased. The X-ray films showed patellar dislocation. The preoperative Q angle was (36 ± 9)°, and the congruence angle was (63 ± 18)°. Reconstruction was performed via allograft tendon. Allograft tendon was fixed through the superomedial pole of the patella, and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All the patients were evaluated postoperatively; Kujala patellofemoral scores, objective knee function, complications, and reoperations were assessed.RESULTS:Primary healing was achieved in all cases. No infection or necrosis and absorption of grafts was observed. All the patients were followed up for an average of 16.4 months (ranged, 10 to 24 months) postoperatively. At the latest follow-up, all the patients had no pain, swelling and patellar instability; neither patella redislocation nor fracture occurred. The X-ray films showed good position of tunnel 6 months after operation, and the congruence angle was (5 ± 9)°, showing statistically significant difference when compared with preoperation (P < 0.05). The postoperative Q angle was (17 ± 8)°, the Kujala knee function score improved significantly from 45.20 ± 9.20 to 89.30 ± 6.40 at the latest follow-up, showing statistically significant difference (P < 0.05).CONCLUSION:MPFL reconstruction improves clinical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation, and it offers good recovery of the premorbid patella mechanics. The interference screw provides firm fixation. Allograft can avoid the graft harvest site morbidity, but it increases the cost of the surgery.

目的 探讨后路经伤椎置钉短节段复位固定治疗单节段胸腰椎骨折的临床疗效、方法 采用后路经伤椎短节段椎弓根螺钉复位固定对30例单节段胸腰椎体爆裂性、压缩性骨折患者进行治疗,对术前评估有神经损伤、椎管占位患者同时行椎管减压,术后复查伤椎前缘压缩率、Cobb角、椎管矢状径占有率以及美国脊柱损伤协会(ASIA)神经功能分级,并定期随访.结果 患者均获得随访8～20个月(平均11.3个月),植骨均获骨性愈合.末次随访时伤椎前缘高度比由术前的(50.3±5.4)％恢复至(93.0±4.7)％,Cobb角由术前(31.1±4.4)°恢复至(4.3±1.1)°.术后神经功能ASIA分级:2例A级无变化外,其余均有1～3级恢复.所有患者均未出现椎弓根钉拔钉、断裂.结论 采用后路经伤椎椎弓根螺钉复位固定是治疗单节段胸腰椎爆裂、压缩性骨折的有效方法,椎体外形矫正率高,术后高度丢失小,疗效满意.

Objective To evaluate the clinical effect of expandable pedicle screw ( EPS) system and intervertebral fu-sion in osteoporosis lumbar spinal stenosis. Methods 25 gerontal patients with lumbar spinal stenosis and severe os-teoporosis received EPS fixation and intervertebral fusion. The JOA lumbar spine surgery scoring system was used in the post-operative evaluation. The plain films were conducted to evaluate the spinal fusion rate and fixation effective-ness of the EPS according to the methods of Burkus et al and Singh et al. Results All patients were followed up for 6~25 months. At last follow-up, the improvement rate of JOA scores were 19 patients with obvious effect, 4 patients with effect and 2 with no effect. The score of screw stabilization was 2. 9 ± 0. 3. The fusion index was 2. 8 ± 0. 2. There was no loosening,breakage or pullout of the EPS. Conclusions The EPS fixation and intervertebral fusion can achieve excellent clinical effect in osteoporosis lumbar spinal stenosis with high spine fusion rate and low complica-tion.

BACKGROUND:There is little evidence on the use of al ogeneic tendon graft in the reconstruction of ankle joint. <br> OBJECTIVE:To explore the clinical outcome of anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft in patients with chronic ankle instability. <br> METHODS:Twenty-six patients with chronic lateral instability underwent anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon. There were 18 cases of simultaneous injury or chalasia in calcaneofibular ligament and anterior talofibular ligament, and 8 cases of anterior talofibular ligament injury or chalasia. The ankle joint function was evaluated according to AOFAS scale and Good classification. The affect ankle and healthy ankle were compared in the extension, plantar flexion activity, and metaleg activity. <br> RESULTS AND CONCLUSION:Al the 26 patients were fol owed up for 9-24 months with a mean of 15 months. No cases appeared recurrent ankle lateral instability. The mean AOFAS score in the group of calcaneofibular ligament and anterior talofibular ligament was improved from (48.4±3.7) points preoperatively to (88.2±3.8) postoperatively, while that in the group of anterior talofibular ligament was improved from (50.0±6.4) points preoperatively to (89.5±3.4) points postoperatively. According to Good score, there were excellent in 19 feet, good in 6 feet, fair in 1 foot, with an excellent and good rate up to 96%. No serious complication was occurred in this group. Anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft can increase the tendon-bone contact area, improve the rate of tendon healing, and enhance the stability of ankle joint in patients with chronic ankle instability. Further studies are needed to verify its long-term efficacy.

Objective To explore the clinical effect of cryopreserved allograft tendon transplantation in repairing old Achilles tendon rupture. Methods 32 cases with old Achilles tendon rupture caused by acute trauma hospitalized in the period from Jan. ,2010 to Sept. ,2012 were selected;the defects were 3-6 cm long with the average length of(4. 6 ± 1. 0)cm;the tendons used in the operation were cryopreserved allograft tendons of tibialis anterior muscle;Kessler method was applied to end to end anastomosis with 2-0 absorbable Vicryl at the distal and proximal end of the tendon;after surgery,the ankle joint was fixed at routine plantar flexion 20-30°;fixation with coasting or plasterboard lasted from 4 weeks to 6 weeks;sural nerve flap transplantation was made to cover the wound in 3 cases complicated with skin defects;the score of American Orthopedic Foot and Ankle Society(AOFAS)was adopted in the evaluation of curative effect. Results Follow-up lasted for over 1 year with the average of(15.0 ±3.5)months;incision primary healing was found in 29 cases and secondary healing in 2 cases;graft rejection was found in 1 case and the transplanted tendon had to be removed;ankle joint function recovered well after surgery, AOFAS scores went from(50.5 ± 5. 5)before surgery up to(90. 5 ± 6. 5)after surgery. Conclusions Old Achilles tendon rupture can be effectively repaired by cryopreserved allograft tendon,which avoids the second injury caused by autologous tendon and is easy for patients to accept;the graft can be stored for long;while the long-term effect needs follow-up of long period.

目的 探讨青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗方法.方法 采用短缩尺骨、重建下尺桡关节法,对7例桡骨陈旧性骨折、短缩,下尺桡关节重度脱位患者进行治疗.术后对患者腕关节外形、功能进行随访.结果 所有患者外形恢复良好,功能评价优6例,良1例.结论 短缩尺骨、重建下尺桡关节法是治疗桡骨陈旧性骨折、短缩,下尺桡重度脱位的有效方法.

Objective To explore the clinical effect of Ilizarov technique combined with external fixator in treatment ofⅢ degree clubfoot in adolescents.Methods Ilizarov technique and limited external fixator were used for treating 12 adolescent Ⅲ degree clubfoot patients (17 feet).External fixator was weared postoperatively.Results All 12 cases were followed up for 12~49 months.The time of wearing external fixator was 8~12 weeks.The satisfactory correc-tion and foot function were achieved.Osteotomy were bone healing,the function of foot waling was well.According to International Clubfoot Study Group (ICFSG)score,the results were excellent in 10 feet,good in 6,and fair in 1.No serious complications was occurred.Conclusions Combined limited methods with Ilizarov technique for treatment ofⅢdegree clubfoot in adolescents is accord with individualization and minimally invasive surgical principle.A satisfac-tory correction which is unattainable by traditional orthopedic surgery is obtained.

Objective To explore the effect of on-table reconstruction in the treatment of the radial head comminuted fractures. Methods 16 patients with radial head comminuted fractures were treated with open reduction and on-table reconstruction, then fixed with Kirschner wire and plate,finally evaluated the elbow function. Results All patients were followed up from 12 to 18 months, the fractures were healed in 6~12 months. At the last follow-up, elbow aver-age activity:extension 0°~23°,flexion 86°~139°,pronation 56°~72°,supination 36°~83°. According to Broberg-Morrey functional rated average score: excellent in 11cases,good in 2,fair in 3. Conclusions On-table technology can achieve better results by reducing and fixing the radial head comminuted fractures, this method is another choice beside the radial head excision or radial head replacement.

Objective To explore the clinical effects of external fixators on treating patients with open tibial fractures of Gustilo types Ⅱ &Ⅲ.Methods From February 2010 to October 2013,76 patients with open tibial fractures were treated with emergency debridement and bone fixation using composite or circular external fixators.They were 48 males and 28 females,aged from 15 to 66 years(mean,41.6 years).The injury affected the left side in 40 cases and the right side in 36.By the Gustilo classification,there were 37 cases of type Ⅱ,28 cases of type Ⅲ A and 11 cases of type Ⅲ B.Composite external fixators were used in 39 cases while Ilizarov circular external fixators in 37.Results All the patients were followed up for 6 to 30 months (mean,26 months).All fractures united after an average time of 22.6 weeks (from 12 to 54 weeks).Bone lengthening by metaphyseal osteotomy was performed in one case of Gustilo type Ⅲ B for a 4 cm bone defect.Secondary free skin grafting was performed in 15 patients.Transfer of pedicled skin flap was performed in 3 patients,and free skin flap transfer in one.The chief complications were pin tract infection in 9 cases(25 pins),osteomyelitis in 2 cases,knee functional defection in 2 cases,ankle functional defection in 4 cases,and delayed union in 3 cases.By the Johner-Wruhs criteria for functional recovery of the knee and ankle at the last follow-up,52 cases were graded as excellent,21 as good and 3 as poor,giving a good to excellent rate of 96.1％.By the Merchant criteria for fracture healing,42 were graded as excellent,26 as good,6 as fair and 3 as poor,giving a good to excellent rate of 89.5％.Conclusions Application of external fixators to manage open tibial fractures of Gustilo types Ⅱ &Ⅲ can result in good clinical results.Although it is associated with technical difficulty and mild complications,it may be recommended for open tibial fractures,especially types Ⅱ and Ⅲ.

为了避免摩托车和公交车相撞,摩托车紧急制动致搭乘摩托车女士怀中7个月龄婴儿从怀中抛出,被公交车轮子碾压双下肢."120"急送本院.检查双小腿含膝关节毁损伤、失血性休克(图1)、双大腿皮肤脱套伤.经急诊抢救和完善必要术前检查,急诊行双大腿远端1/3截肢术.术后随访10个月,患儿无精神紊乱和语言发育障碍.双大腿残端发育良好(图2).

BACKGROUND: A large number of allogeneic bones have been applied in the clinical treatment due to the development of low temperature, cells, immune, and sterilization technology which brings hope to patients with all kinds of large bone defects. OBJECTIVE: To investigate the effect of allogeneic frozen bone graft with external fixator on repair of massive bone defect. METHODS: Large bone defects in 36 patients were repaired by allogeneic frozen bone graft and external fixator. The mechanical support and fixation were provided and the regular return visits were preformed. RESULTS AND CONCLUSION: The patients were followed-up for 1-24 months. Among these 36 cases, one case was lost and all the other 35 cases showed primary bone healing. The mean healing time was 9-20 months. No obvious immune rejection to the grafts was observed in most of the patients in early operation. The joint activity and body weight was good. Some patients showed mild limb swelling, three cases of slight swelling and pain were appeared around the incision, four cases of patients with more wound exudates and the bacterial culture was negative. Smear staining showed that there were plasma cells, lymphocytes and few neutrophils which may due to the chronic immune rejection. After dressing and application of prednisone for 3 days, the secretions were reduced and all the incisions were healed. Allogeneic frozen bone graft with external fixator is a useful and reliable reconstructive method for the treatment of large bone defect.

Objective To study the clinical efficacy of the inflatable self-locking intramedullary nailing in treatment of the middle 1/3 of humeral shaft fracture.Methods Expandable self-locking intramedullary nail was used for the treatment of middle 1/3 humeral fracture in 18 cases.Results 10 cases underwent closed reduction,and the operation time was 40~60 min,intraoperative blood loss was 40~150 ml;8 cases underwent open reduction surgery for 60~100 min,and intraoperative blood loss was 50~150 ml.18 patients were followed up for 3~5 years.18 patients got clinical bone healing in 12~18 weeks.Shoulder function according to the Neer score were excellent in 13 cases,good in 4,and fair in 1 case.There were no neurovascular injury,infection,fat embolism,no case of nonunion,fixation loose in 18 cases postoperatively.2 cases were found the needle point tenderness,and pain disappeared after removing the fixation.Conclusions Placement and removal of expandable self-locking intramedullary nail fixation in the treatment of middle 1/3 humeral shaft fracture are simple,and the fixation is stable with minimal trauma in surgery,and early upper limb rehabilitation training makes good limb function recovery with fewer complications.

OBJECTIVE:To compare the effect of different defect diameters on healing in the middle 1/3 tibia monolayer cortical bone defect mouse model so as to establish an animal model for bone tissue engineering study, mechanism study on bone defect repair, and gene therapy research. METHODS:Ten 8-week-old C57BL/6J mice, weighing (20 +/- 2) g, were randomly divided into 2 groups, 5 mice in each group. The middle 1/3 tibiae monolayer cortical bone defect model of 0.8 mm (group A) or 1.0 mm (group B) in diameter was established with burr drill. At 7, 21, and 28 days after modeling, the molybdenum target X-ray radiography was used to observe the defect repair; at 28 days, Micro CT and three-dimensional imaging were used to evaluate bone defect repair, and tibia specimens were harvested for HE staining. RESULTS:At 7 days after modeling, tibia fracture occurred in 5 mice in group B, no fracture in group A. X-ray films, Micro CT scan, and HE staining showed bony union in group A at 28 days. The quantitative analysis of trabecular bone by Micro CT showed that trabecular number, connectivity density, and bone volume in group A were significantly greater than those in group B (P < 0.05), mean of segmented region--mean 2 was significantly less than that in group B (P < 0.05), but no significant difference was found in trabecular separation and trabecular thickness between 2 groups (P > 0.05). CONCLUSION:The middle 1/3 tibia monolayer cortical bone defect mouse model of 0.8 mm in diameter is the ideal animal model for study repair mechanism of tibia defect or bone tissue engineering.

新时期,我军担负着国防、反恐和执行联合国维和任务等诸多军事使命.这些军事使命中,必不少的作业之一就是扫雷、排爆作业.众所周知,扫雷、排爆作业是随时都充满着危险的高风险作业,可以说是与死神共舞.

Objective To evaluate the role of different imaging examinations in diagnosis and minimally invasive surgery of intercondylar eminence fracture of the tibia. Methods Different imaging examinations and minimally invasive surgery were done on 43 patients with intercondylar eminence frac-ture of the tibia admitted from July 2004 to December 2007. Preoperative and postoperative imaging data were collected for comparative analysis of functional score. Results Fracture detection rate of X-ray was 95%, that of CT three-dimensional reconstruction 100% and that of MRI 90%. All fractures were healed at one stage, with sound knee function. Conclusions The traditional X-ray examination is the first choice for diagnosis of the intercondylar eminence fracture of the tibia. In the meantime, three-di-mensional reconstruction of CT can help enhance accuracy of diagnosis and MRI can help diagnose cruci-ate ligament injury. Arthroscopic and minimally invasive surgery is rather complex but good to recovery of knee joint function. Compared with other methods, tension band is simple but reliable, for it can avoid breakage of the fractured bone and is suitable for all types of fractures.