AIM: Modern unicompartmental knee arthroplasty (UKA) provides less injury, fewer complications, easier revision, more bone mass reservation and a quicker recovery of joint function, however, its clinical application needs further developments. We conducted a study to summarize the characteristics and therapeutic effect of UKA for the treatment of unicompartmental knee disease, and detect the radiographical results and knee joint function evaluation of all the patients in one-year follow-ups. METHODS: Thirty-six patients with medial compartmental osteoarthritis of knee, who were treated by UKA from March 2001 to March 2006 in the Arthroplasty Center, General Hospital of Chinese PLA. They included 8 males and 28 females, aged 52-71 years and weighed 56-80 kg. The therapeutic effect was assessed by using HSS score. Patient's indication, surgical technique, clinical and radiographical results were followed up and analyzed. RESULTS: ①All 36 patients were followed up for 12-72 months, average 31.5 months.②No complication occurred, such as incisional infection, deep thrombosis and fracture.③The average HSS score was improved from 65 points preoperatively to 94.5 points after the final follow-up. Twenty-nine knees (80%) had excellent results and seven (12%) had good results. The range of motion was average 120° (110°-135°).④No prosthetic displacement, loosening, periprosthetic osteolysis and progressive arthritis was radiographically observed in the opposite compartment and the patellofemoral joint. CONCLUSION: Modern UKA is an effective treatment for unicompartmental osteoarthritis of knee joint by the function evaluation and radiographical results in the follow-ups.

OBJECTIVE:To discuss the value of arthroscopic techniques in determining the indications of unicondylar arthroplasty.METHODS:Twenty-four patients with knee osteoarthritis, 14 males and 19 females, aged 63 (49 - 74), who were scheduled to undergo unicondylar arthroplasty were arthroscopically evaluated at the beginning of surgery. Arthroscopy showed injury of degree IV in the tibial and femoral cartilages in the medial compartment, severe abrasion of meniscus, and exposure of subchondral bone. Unicondylar arthroplasty was given up on 8 cases because of cartilage injuries in the lateral compartment, while the surgery was performed on the other 16 cases. All cases underwent synovium debridement, 5 of which underwent meniscus repair or partial meniscectomy in the lateral compartment, 4 underwent patellar reticulum releasing and peri-patellar denervation, 3 cases underwent synovium plica resection, and 4 cases had their loose bodies removed. Follow-up was conducted on 16 cases for 14 months on average.RESULTS:The average Lysholm score of the patients was 67.5 preoperatively and became 94 postoperatively. After operation, the symptoms of locking and pain were relieved. The functional evaluation result was excellent in 12 cases, good in 2, and fair in 2.CONCLUSION:Arthroscopic evaluation of intra-articular structures is valuable in determination of unicondylar arthroplasty indications. Arthroscopic procedures are valuable in minimizing preoperative symptoms.

AIM: Patients' satisfaction after total knee arthroplastys (TKA) greatly depended on pain remittence of knee joint and the maximal range of motion (ROM). This article is intended to evaluate the clinical outcomes of 87 TKA cases and find out related factors affecting postoperative ROM of the knee. METHODS: ①Materials and subjects: From June 2005 to May 2007, 102 knees of 87 patients were treated with primary TKA in Department of Orthopedics, General Hospital of Chinese PLA. The subjects included 8 males (9 knees) and 79 females (93 knees), with an average age of 67.3 years (ranged from 46 to 78 years). The knee prosthesis included TACK and Gemini II implants of Link Incorporation (n =51), LPS posterior stabilized implants of Zimmer Incorporation (n =17), posterior stabilized and posterior cruciate ligament-retaining implants of Stryker Incorporation (n =23), posterior cruciate ligament-retaining implants of Jinghang Incorporation (n =11). ②Intervention and evaluation: All the patients received TKA. The clinical outcomes were evaluated using HSS (The Hospital for Special Surgery) Knee Rating Score. Factors including age, body mass index, flexion contracture, alignment deformity, preoperative range of motion (ROM), preoperative HSS score, ROM at the time of discharge that may affect postoperative ROM were analyzed by multiple regression analysis. RESULTS: All the patients were followed up for at least one year. ①The average HSS score was 87.5 points and the excellent and good rate was 90.8% which were improved significantly (P < 0.01). ②The multiple regression analysis indicated only ROM at the time of discharge was found to be correlated with postoperative ROM(P < 0.01). ③No deep infection, prosthesis loosening or osteolysis was found in all the patients. CONCLUSION: ROM at the time of discharge is correlated with that at year one after operation. Early functional rehabilitation exercises are helpful to improve the postoperative ROM.

OBJECTIVE:To approach the values of arthroscopic minimally invasive surgery (MIS) in diagnosis and treatment of benign bone and joint tumors.METHOD:20 cases of benign bone and joint tumors were diagnosed and treated by arthroscopic MIS. There were 9 males and 11 females in the group. Their average age was 26 years old (from 19 to 37). There diseased region: 9 in distal femurs, 6 in knee joints, 4 in calcaneus, 1 in distal tibia. Plain radiographies, MRI examinations and CT scans were performed with all patients preoperatively, among them 12 patients were inspected by ECT. In the treatments of distal femoral and calcaneal benign tumors, firstly, Kirschner wires were drilled into the pathological regions under the monitor of C-arm; then 6 mm diameter hollow drills were drilled follow the guide Kirschner wires and run-through the opposite side of cortical bone; then the arthroscope was inserted to check-up the pathological regions, then curettes or bite clamps were inserted from the opposite side to clean up tumor tissues; finally, 8 of the 13 were embedded with allograft gelsiccation bone, other 6 were embedded with carbonate hydroxyapatite cement. One case of distal tibia epidermoid cyst were removed under arthroscope and filled with allograft bone. 6 soft connective tissue tumors in knee articular cavities were removed under the monitor of arthroscope.RESULT:According to pathological reports, 6 were yellow pigments tumors in knee articular cavities, 4 were osteoid osteomas of femoral bones, 3 were osteofibrous dysplasias, 2 were nonossifying fibromas, 4 were bone cysts of calcaneuses, one was distal tibia epidermoid cyst. All patients were followed up with 7 months to 4.6 years (average 25 months). No recurrence occurred, and their joint functions were well.CONCLUSION:It is an accurate, minimally invasive and easy to manipulate technology to treat benign bone and joint tumors with the monitor of arthroscope.

Aim: To sum up therapeutic effects of metal on metal surface total hip arthroplasty in the treatment of adult hip joint disease. Methods: 1 Between March 2004 and January 2006, 23 surface arthroplasties were performed in 17 patients admitted in Chinese PLA General Hospital, including 6 males and 11 females. Their average was 41 years old (arrange 20-55 years old). 2 The Conserve plus metal on metal surface total hip prosthesis, produced by Wright company, was used in this study. Acetabulum (48-52 mm) was cementless while femoral head (decreasing 6 mm) was bone cement, with wall thickness of 3 mm and stem-shaft length of 59-65 mm. 3 The approach adopted the standard operation technique brought forth by Amstutz and Nelson. 4 The clinical and radiographic follow-ups were performed at average 12 months postoperatively. Hip joint function was evaluated according to Harris classification: excellent: 90-100 scores; good: 80-90 scores; fair: 70-79 scores; bad: < 70 scores. The surgery was defined as a success if Harris scores > 80. The anterior and posterior film of pelvis and the lateral film of hip joint were pictured in each patient. Results: The clinical effects of all patients were good. No femoral neck fracture, infection, dislocation, prosthesis loose or nerve and vascular injury occurred. The average Harris hip score was 91.2 (arranged 83-97). According to Harris system, 20 hips were excellent, 3 hips were good. The satisfactory effect rate was 100%. Imaging analysis indicated good location of prosthesis. Conclusion: Metal on metal surface total hip arthroplasty is an efficient method in treatment of adult hip joint disease. The results are satisfactory for short-term follow up.

BACKGROUND: The total knee replacement is considered as one of the most effective and successful operations to cure terminal or severe gonarthritis. How to lower the revision rate as well as increace the effect of prostheses after the knee replacement should be solved urgently.OBJECTIVE: To retrospectively analyse the clinical applications and curative effects of different knee prostheses.DESIGN: Based on patients who accepted knee replacement, preoperative and postoperative condition was observed and compared so as to compare the postoperative effect of different types of knee prostheses replacements.SETTING: Department of Orthopedics, General Hospital of Chinese PLA.PARTICIPANTS: A total of 398 patients (523 knees) were selected from the Department of Orthopedics, General Hospital of Chinese PLA from January 2002 to January 2005, including 276 unilateral knee replacements (276 knees) and 122 bilateral knee replacements (244 knees). Patients were respectively diagnosed as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), pigmented villonodular synovitis (PVNS), etc.METHODS: According to the pathogenetic condition, patients received total knee replacements with different knee prostheses. Types of knee prostheses: ① According to the replacing range, it could be divided into unicondylar prostheses and total condylar prostheses; total condylar prostheses could be subdivided into posterior cruciate ligament (PCL)-retaining and PCL-substituting prostheses. ②According to the degree of mechanical constraint, it could be divided into unconstrained, semiconstrained or fully constrained prostheses. ③ According to whether imitating meniscus-function, it could be divided into tibial plateau rotatable sliding type and fixed type. Follow-up was conducted on patients that mentioned above after half a year. Knee joints were scored by using knee joint scoring system of American special surgical hospital (HSS scoring with the total score of 100 points, those above 85 were considered as excellent; 70-84 as good;60-69 as fair; below 60 as poor). Feller scoring (total score of 30 points; the higher the points were, the better the symptom was) criteria was used in patellar scoring. Investigation and comparison on pain-degree of anterior region of knee,range of motion of knee joint and the stabilization were done during the follow-up, ap and lateral views of patella from 30 degrees and 90 degrees were taken in radiography.MAIN OUTCOME MEASURES: Preoperative and postoperative scores of HSS, patella, anterior pain of knee, function of patella, the maximum flexion and tibiofemoral angle.RESULTS: Follow-up was conducted in 372 patients (490 knees) with the follow-up rate of 93.4%. ①Therapeutic effect:Excellent and good rate of the operation was 89%. Pain and function of patients after operation were obviously ameliorated, effect on pain-amelioration and range of motion of knee joint activation were significant. ② Score of HSS, patellar,anterior pain of knee, function of patellar and the maximum flexion were markedly increased than those before operation (P ＜ 0.01). ③ There were no marked significances in comparison of score of HSS, patellar, anterior pain of knee, function of patellar, the maximum flexion and tibiofemoral angle on different knee prostheses replacements (P ＞ 0.05).CONCLUTION: Prostheses should be chosen carefully and appropriately according to the indications, contraindications,anticipated attainable functions, service life as well as pathogenetic conditions, and then satisfactory curative effect will accordingly be achieved.

AIM To analyze the difference of different treatment methods and stuff for plerosis and curative effect of acetabular defects in revision total hip arthroplasty. METHODS Twenty hips of 18 hip revision cases with acetabular defects who were treated at the Department of Orthopaedics General Hospital of Chinese PLA from March 2002 to April 2003 were analyzed. The patients included 10 males and 8 females with the age of 38 to 72 years with and average of 54.3 years. Sixteen cases 18 hips underwent revision for the first time 2 cases 2 hips for the second time. The severity of acetabular component loosening was classified into five types according to AAOS Type Ⅰin 10 segment bone defect cases 11 hips type Ⅱ in 3 lacuna bone defect cases 3 hips type Ⅲ in 5 mixed defect cases 6 hips. Porous surface acetabular component was use in 9 hips Titanium mesh with allografts was used in 11 hips. Allografts with size 4-6 mm were used in all cases. RESULTS Eighteen patients were followed up for 3 years and 2 months averagely and all involved in the result analysis. ①All of the bone grafts was healed well and the post-operation wounds were all primary healing. ②X-ray test containing of acetabular component was good no translucent line between prothesis and donor bone bed and the bone defect had been repaired. ③The Harris score was 15-43 points before revision and 62-89 points after revision. CONCLUSION Using allografts to repair the contained acetabular defects or using Titanium mesh and compaction allograft to repair the uncontained acetabular defects provide stable condition to the allograft healing. It is verified that the morselised bone healed well the Titanium mesh is labile and the position of prosthesis is good which reaches the aim of repairing bone defect and fixing prosthesis.

Aim: To retrospectively analyze the clinical applications and curative effects of different knee prostheses. Methods: A total of 398 patients (523 knees) in General Hospital of PLA from January 2002 to January 2005 were selected, including 276 unilateral knee joint replacements (276 knees) 122 replacements, 122 both knee replacements (244 knees). Patients were respectively diagnozed as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), pigmented villonodular synovitis (PVNS) etc. According to the pathogenetic condition, patients received total knee replacements with different knee prostheses. Types of prosthesis: 1According to the replacing range, it can be divided into single condyle replacement and whole condyle replacement; Whole condyle replacement can be subdivided into replacement with posterior cruciate ligament (PCL) remainned and replacement with PCL substituted. 2 According to the limitation, it can be divided into replacement with limitation, half-limitation and without limitation. 3 According to whether imitate niscus-function, it can be divided into tibial plateau rotatable sliding type and fixing type. Follow-up, was conducted on patients that mentioned above after half a year. Knee joints were scored by using knee joint scoring system of American speical surgical hospital (HSS scoring with the total score of 100 points, those above 85 points were considered as excellent; Between 70-84 as good), Faller scoring standard was used in shirbone scoring, Investigation and comparison on pain-degree of anterior region of knee, range of knee joint activation and the stabilization were done during the follow-up, ap and lateral views of whirbone from 30° and 90° were taken in radiography. Results: Follow-up were conducted in 372 patients (490 knees) with the follow-up rate of 93.4%. 1 Therapeutic effect: Excellent and good rate of the operation was 89%. Pain and function of patients after operation were obviously ameliorated, effect on pain-amelioration and range of knee joint activation were significant. 2 scores of HSS, whirbone, anterior pain of knee, function of whirbone and the maximum genuflex were markedly increased than those before operation (P < 0.01). 3 There were no marked significances in comparison of scores of HSS, whirbone, anterior pain of knee, function of whirbone, the maximum genuflex and femoral tibial angle on different knee prosthesis replacements (P > 0.05). Conclusion: Prostheses should be chosen carefully and appropriately according to the indications, contraindications, anticipated attainable functions, service life as well as pathogenetic conditions, and then satisfactory curative effect will accordingly be achieved.

目的:了解采用自体软骨细胞和异体软骨细胞构建的工程软骨修复软骨缺损后,修复组织中是否存在细胞凋亡,以及凋亡细胞分布的区域.方法:以自体软骨细胞和异体软骨细胞作为"种子细胞"与聚乳酸(PLA)载体构建工程软骨,修复兔膝关节股骨髁关节软骨全层缺损,进行细胞凋亡原位观察(TUNEL法).结果:采用自体软骨细胞和异体软骨细胞构建的工程软骨均可以较好地修复关节软骨的缺损,修复组织为类透明软骨组织,修复组织与受区软骨的交界区以及修复组织的深层均可见细胞凋亡,异体软骨细胞组织工程修复组的修复组织表层也可见细胞凋亡现象.结论:修复组织中的细胞凋亡可能与组织的退行性变及钙化有关.

Aim: To explore the function and the appearance after operation of an improved method of the second toe transfer for thumb reconstruction modified by the great toe fibular skin flap. Methods: The communicating branch formed by wascular anastomosis of toe web was used. After distinguishing the vascular anastomosis of the toe web, the fibular shin flap of great toe was mobilized and transected and wedged into metatarsal side of the second toe. To reduce the narrow appearance of the second toe at the middle part, there were few differences between the toe and thumb in the form. Results: All 14 thumbs of 13 cases were reconstitute successfully, and associated flap survived with satisfactory appearance and function. The flexion range of joint was 60° - 80°, and the function of opposition was recovered. The thermo-taction, algesi-taction and 2-point differential range were recovered 1 - 3 months after operation. The difference in circumference between the reconstructed thumb and the normal thumb was 0.3 cm 6 months after operation without obvious significance (t = 0.02 < 0.05, a = 0.05). Conclusion: It is not difficult to complete the reconstruction by the improved second toe transfer for thumb reconstruction, which is good for the recovery of finger function, as compared to the traditional operation of the second toe transfer for thumb reconstruction.

Aim: To study the functional recovery of knee joint after patellar habitual dislocation treated with modified Madigan procedure. Methods: From August 1999 to April 2003, 12 knees of 7 patellar habitual dislocation patients(male 3 and female 4) with the mean age of 31.7 years(ranging from 19 to 55) from General Hospital of Chinese PLA were treated with modified Madigan procedure. Follow-up of 12-44 months(mean of 30.3 months) and satisfactory rate by questionnaire were performed in the treated patients. Physical and X-ray examination were performed and the complications were observed. Results: In all the cases after operation, no dislocation reoccurred, fear was tested disappearing and Thumb sign was negative. The subjective satisfactory rate was 11 out of 12 knees. One patient was still in pain on one side of the operated knees. Complications: extension lag was found in the knees of three patients at the starting stage of extension, 2 of whom recovered during 1 month after rehabilitation exercise. Meanwhile, the rest one patient was found with extension lag in low patella, and recovered to normal function half a year later. Conclusion: It is satisfactory to the objective and subjective results of functional restoration of knee joints after patellar habitual dislocation treated with the modified Madigan procedure. Incision of lateral brisement of knee joint was found small arthroscopically, and could recover fast. But it is suggested to the patients with severe genu valgum that they should be treated with transposition of patellar tendon insertion or osteotomy of upper femoral condyle.

Aim: To evaluate the mechanism and effects of mark ⊢ ⊣ -like parallel capsule release on the treatment of post-traumatic knee ankylosis. Methods: Twenty knee ankylosis patients were treated with mark ⊢ ⊣ -like parallel capsule release, which was focus on the horizontal retinacula and capsule release beside both sides of the suprapatellar bursa reconstruction. The horizon limitation of soft tissues to the patella was relived to ensure the flexion of knee joint. Results: During a mean follow-up of 41.43 months (3-68 months), the range of knee flexion increased by 85.9° averagely (20.6° pre-operation, 106.5° post-operation). No pain, instability or extension lag happened except one case had patella fracture during manipulation. Conclusion: The mark ⊢ ⊣ -like parallel capsule release can relieve horizon limitation of the retinacula of two sides of patella and articular capsule. it is helpful to the flexion of knee joints and can avoid the complication of extension lag caused by puadriceps tendon and patellar tendon lengthening.

Aim: To investigate the biochemical and biomechanical changes of the tibial condylar subchondral bone of instable knee joint at its early stage. Methods: The instable knee joint models were made with rabbits. The subchondral bone of main loading area of the tibial condylar was harvested and then tested under compressive stress with Instron mechanical material machine to detect its ultimate strength and compressive modulus, meanwhile the content of the uronic acid, the pyridine(Pyr), and the hydroxyproline (Hyp) in the subcondral bone were measured respectively as well. Results: The ultimate strength and compressive modulus of subchondral bone were averagely decreased by 40% and 33.7% respectively at 1 week after operation, which were significantly different from those of the control(P < 0.01). But as time passed, the ultimate strength and compressive modulus of subchondral bone were decreased gradually. The proteoglycan content and collagen content of subchondral bone increased rapidly at 1 week after knee operation, but the Hyp content decreased by 69.4%, and then the proteoglycan content declined while the collagen content and Hyp content went higher accompanied with the increases of ultimate strength and compressive modulus. Conclusion: In the early stage of the instable knee, the biochemical and biomechanical changes of the tibial condylar subchondral bone occur, which may be connected with the changing metabolism of subchondral bone under the abnormal stress.

Objective To prove the possibility and reality of the treatment of the gluteal contr acture and snapping hip with arthroscopic soft tissue release.Methods 10patients(20hips)in this group,2snapping hip,8glute al contracture after repeated intra musclar injections.8of them can' t squat down while keep their two knee s contacting,2cases even can' t squat in any position.Results All of the patients can fully finish this posture immediate ly postoperatively.The days stay in hospital after operation is much shorter,and no complications such as sciatic nerve injure nor hematoma in the arthroscopic release group.Conclusion Arthroscpic release of contracture d tissue is a safe,effective and cosmetic way to treat the snappin g hip and gluteal contracture.A new a rthroscpic surgical technique,ie,operating within man-made soft tissue caves,was developed.