To investigatethe clinical efficacy of the modified Brostrom methodunder ankle arthroscope to repair the anterior tibiofibular ligament (ATFL) for chronic ankle instability.

From December 2015 to January 2017, 12 patients with chronic ankle instability were treated by modified Brostrom method under ankle arthroscope for repairing anterior talofibular ligament(ATFL). The American Foot and Ankle Surgery Society score (AOFAS), Tegner exercise level score and talus tilt angle change were used to evaluate the curative effect before and after operation, and the patients were followed up to observe the occurrence of complications. Paired t test was used to compare the observation indexes before and after treatment.

All the 12 patients were followed up for (26±8) months on average. During the follow-up period, ankle activity was basically restored to normal in all of them, and ankle instability was not occurred. Ankle swelling and pain disappeared. At the last follow-up, the AOFAS score was (91.0±2.6) and the Tegner score was (6.0±1.2), which were significantly higher than the preoperative ones(t =10.57, 12.38, both P<0.001). The talus inclination angle was (4.5±1.0)° which was lower than the preoperative one(t=7.13, P<0.001).

Anatomical reconstruction ATFL under ankle arthroscope could more accurately detect ligament breaks, locate ligament attachment points, with less trauma, mild pain, and quick recovery in the treatment of chronic ankle instability.

To observe the clinical effect of closed reduction and retrograde elastic stable intramedullary nailing fixation and bone wire internal fixation for displaced surgical neck fracture of humerus in elder children.

Forty-five cases of displaced humeral surgical neck fractures in children and adolescents who met the inclusion criteria from May 2016 to December 2018 in the Renmin Hospital of Hubei Uiversity, were retrospectively analyzed. They were divided into two groups according to different internal fixation methods: the intramedullary nailing group (23 cases) were treated with retrograde elastic stable intramedullary nailing; the Kirschner wire group (22 cases) were treated with closed reduction and Kirschner wire fixation. The t test and chi square test were used to analyze the fracture healing time, shoulder function score, number of complications and excellent and good rate.

The fracture healing time was (8.0±2.1)weeks. There was stattstically significant difference in the functional score of six weeks after operation (t =5.295, P<0.05); there was no stattstically significant difference in the functional score of three months after the operation (P>0.05). The rate of patients who achieved excellent results in shoulder joint function was 88.9%, while the good rates between the two groups showed no significant statistical difference(χ²=0, P>0.05). In the intramedullary nailing group, one case had radial nerve injury, two cases had elastic stable intramedullary nailing penetration, and four cases lost the reduction. In the group of internal fixation of bone wires, there were four cases of bone wires loosening, three cases of reduction loss, no complication of vascular or nerve injury.

It is a minimally invasive and effective treatment method to treat the displaced fracture of surgical neck of humerus in children by using etrograde elastic stable intramedullary nailing and bone wires internal fixation, which is worthy of clinical application. Surgeens should choose the familiar operation method to avoid complications.

To explore the effect of rinsing and disinfecting with iodophor on the thyroid function of patients who recievestotal total hip arthroplasty(THA).

From January 2017 to September 2017, 50 patients (without thyroid disease and infection) who were scheduled to undergo THA in joint surgery department of Shanghai Changhai Hospital were randomly divided into two groups: experimental group (25 patients were treated with iodophor irrigation and immersion disinfection for five minutes after implantation of prosthesis) and control group (25 patients were treated with saline irrigation and immersion for five minutes). The same rehabilitation training program was used in both groups after operation. The results of thgroid stimulating hormone (TSH), tree tri-iodothyronine (FT₃), tetra-iodothyronine (FT₄) and urine iodine were collected before operation, at the postoperative one day, the one week and one month. The changes of TSH, FT₃, FT₄ and urine iodine were evaluated before the operation and postoperative one day, one week and one month. The differences among groups at different time points were tested by paired sample t test.

All the 50 patients completed the operation successfully and were followed up for at least one month after the operation. The preoperative FT₃ of the experimental group was (4.4±0.8) pmol/L, and at postoperative one day, one week, one month were (1.7±0.3), (4.7±0.7)and(4.3±1.0)pmol/L respectively; the preoperative FT₃ of the control group was(4.2±0.7) pmol/L, and were (2.9±0.5), (3.8±0.8), (4.5±0.9) pmol/L respectively at postoperative one day, one week and one month. The experimental group preoperative FT₄ was (15.4±3.6) pmol/L, and were (10.7±2.5), (12.1±2.7), (15.3±3.5) pmol/L respectively at postoperative one day, one weeks and one months; the control group preoperative FT₄ was (15.1±3.8), and were (13.9±2.7), (14.6±2.3), (15.3±3.1)pmol/L respectively at postoperative one day, one week, one month. The experimental group preoperative TSH was (2.6±1.3) mIU/L, and at postoperative one day, one week and one month were (1.3±0.3), (3.1±1.0), (2.4±1.9) mIU/L respectively; the control group preoperative TSH was (2.6±1.0) mIU/L, and at postoperative after one day, one week, one month were (1.3±0.3), (2.0±1.1), (2.5±1.5) mIU/L respectively. The experimental group of preoperative urinary iodine was (251±97) μg/L, and at postoperative one day, one week and one month were (919±224), (453±106), (253±112) μg/L respectively; the control group preoperative one was(254±98) μg/L, and at postoperative one day, one week and one month were (262±215), (255±107), (244±94) μg/L respectively. There were significant differences in TSH, FT₃, FT₄ and urinary iodine between the two groups at one day(TSH: t=0.648, FT₃: t=7.165, FT₄: t=3.296, urinary iodine value: t=8.184; all P<0.05) and one week after operation(TSH: t=2.691, FT₃: t=3.339, FT₄: t=2.754, urinary iodine: t=5.092; all P<0.05). There was no significant difference in TSH, FT₃, FT₄ and urinary iodine values in one month after the operation (all P>0.05).

The use of iodophor irrigation during THA surgery may present a transient effect on thyroid function, which shows the greatest influence on the first day after the operation, but one month later the influence disappear.

To investigategait kinetics and balance after unicompartmental knee arthroplasty(UKA) and total knee arthroplasty(TKA).

A retrospective study of 70 patients with knee replacement in the First Affiliated Hospital of Anhui Medical University and the Fourth Affiliated Hospital of Anhui Medical University from January 2016 to December 2017 was carried out, and they were divided into UKA group and TKA group according to the different operation methods. Thirty five healthy elderly people without history of hip and knee pain or dysfunction were recruited as the control group. Inclusion criteria: medial compartmental knee osteoarthritis with intact cruciate ligament and lateral collateral ligaments, no serious disease of the lower limbs on the non operative side. Exclusion criteria: neurological diseases and other serious lower extremity diseases, bilateral knee replacement at the same time, body mass index (BMI)>30 kg/m².In the UKA group, there were 14 males and 21 females, with an average age of (63.4±7.0)years. The TKA group included 13 males and 22 females with an average age of (65.0±6.1)years old. In the control group, there were 16 males and 19 females with an average age of (64.6±7.1) years. All the cases were completed by the same surgeon. The gait and postural balance parameters were recorded, including gait speed, step length, cadence, single-limb support phase(SLS), center of pressure (COP) path length, 90 %COP postural sway area. One-way ANOVA and Tukey test was applied in age, BMI, gait kinematics parameters and postural balance parameters. Chi-square test were used for gender comparison of three groups. t test was used for HSS score comparison of UKA group and TKA group.

The average follow-up period was (23±15)months. No prosthetic loosening, dislocation, lesions of contralateral compartment joint developed. SLS, COP path length and 90 %COP postural sway area of UKA group were better than those of TKA group (P<0.05). There were significant differences in terms of COP path length and 90 %COP postural sway area between the UKA group and the control group (P<0.05).

This study shows gait kinetics and balance after UKA may be superior to THA, but the balance is still inferior to the normal elderly.

To explore the influence of postoperative pain of discoid meniscus under arthroscopy on knee function and cartilage metabolism in the short term and to analyze its risk factors.

From January 2017 to December 2018, 152 patients with lateral discoid meniscus of knee joint admitted to the Department of Sports Medicine, Qilu Hospital, Shandong University were all treated with arthroscopic meniscus suture. Those with VAS pain score ≥1 three months after operation were included in pain group (n=43), and the rest were included in painless group (n=109). The Lysholm knee score scale (LKSS) and Hospital of Special Surgery (HSS) knee score were used to evaluate the knee function of the two groups before and after treatment. Enzyme-linked immunosorbent assay (ELISA) was used to detect and compare cartilage metabolism indexes in joint fluid of the two groups, and multivariate logistic regression analysis was conducted to analyze the risk factors of postoperative pain.

LKSS and HSS scores of both groups were significantly higher in three months after the surgery than those before the surgery(all P<0.01), and the pain group were significantly lower than the painless group (t=12.217, 5.928, both P<0.01). Serum metalloproteinase (MMP) -1, MMP-3 and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in the two groups of joint fluid were significantly lower than those before surgery (all P<0.01), and the levels of the painless group were significantly lower than those of the pain group (t=7.230, 12.411, 11.504, all P<0.01). Multivariate logistic regression analysis showed that age, articular cartilage injury and loading time ≥one week were independent risk factors for postoperative pain (OR=5.068, 7.893, 8.142, P<0.05), postoperative cold compress as a protective factor (OR=0.150, P<0.05).

The treatment of discoid meniscus by arthroscopic meniscus suture and plasty can achieve better knee function and improve the intra-articular environment in the short term. Postoperative pain will have a negative impact and there are many risk factors, which should be paid attention to and prevented in clinical practice.

To investigate the short and medium term curative effect, patella bounce and causes of knee valvular osteoarthritis treated by monocondylar replacement.

Eighty-four patients (84 knees) with medial compartment osteoarthritis of the knee underwent unicondylar replacement in the First Affiliated Hospital of Zhejiang University from July 2017 to May 2019. The clinical treatment was retrospectively analyzed.Independent sample t test was used to compare the knee function of the patients before surgery and at the last follow-up (one year after surgery). Hospital for Special Surgery knee score (HSS), knee range of motion (ROM), visual analogue scale (VAS), and lower limb strength line including tibial angle (FTA) and hip-knee-ankle angle (HKA) were measured, and complications were recorded.

All the surgical incisions were healed at grade A and all the patients were followed up. Twenty-four hours after the operation, the drainage volume was (121±81) ml on average. Four patients received allogeneic transfusion, and the transfusion rate was 4.76%.VAS score of the patients in the last follow-up was lower than that before surgery (t=70.721, P<0.05), and HSS score and ROM of the patients in the last follow-up were higher than that before surgery (t=-37.6, -6.800; both P<0.05). The HKA angle in the last follow-up was higher than that before the surgery (t=-10.965, P<0.05), and the FTA angle in the last follow-up was lower than that before the surgery (t=14.022, P<0.05). Two patients had patella flapping when bending the knee, and four patients had knee valgus after the surgery. All the complications healed by themselves at the last follow-up.

The short-term efficacy of monocondylar replacement for medial compartment osteoarthritis is satisfactory, but it requires surgeons to pay attention to avoid complications during the operation.

To retrospectively evaluate the effect of two-stage revision on periprosthetic knee infections with negative cultured result.

Twenty-seven cases of microorganism culture negative periprosthetic joint infections(PJI) after total knee arthroplasty from January 2010 to December 2017 were collected for this study. The treatment included using antibiotic-loaded bone cement spacer, post-operative parenteral antibiotic for three weeks, following by oral levofloxacin and rifampicin for three weeks. The successful rate of treatment for periprosthetic knee infections were evaluated. Logistic regression was used to analyze the correlation between sinus tract formation and duration of infection, antibiotic usage, etc.

A total of 27 cases of culture-negative PJI, of which 26 cases were cured, success rate of infection treatment was 96.3%, 24 cases(88.9%) preserved functional knees, two cases were cured by arthrodesis. Only one case failed to be eradicated infection, the failure rate was 3.7%. Gender, age, time of preoperative antibiotic infection control, C-reactive protein, erythrocyte sedimentation rate, white blood cell count, neutrophil percentage, D-dimer and other factors had no significant correlation with sinus tract formation(all P>0.05).

The culture-negative periprosthetic knee infections can be treated successfully by second-stage revision using antibiotic-loaded bone cement (vancomycin, tobramycin) implantation combined with intravenous cephalosporin infusions, the strategy may obtain a reasonable cure rate and preserve joint function. However, the effectiveness of this treatment strategy needs to be further demonstrated due to the lack of control group and short of cases.

To observe the knee joint kinematics after internal tension reducing technique assisted anterior cruciate ligament(ACL) single-bundle reconstruction under arthroscopy.

A study was performed on 80 patients with ACL injury from January 2017 to December 2018. Forty cases underwent ACL reconstruction assisted by intra articular graft tension reducing technique(experimental group) and 40 cases underwent the conventional ACL reconstruction(control group). The maximum step length, minimum step length, period of the limb walking and six freedom degrees of knee(flexion and extension angle, varus and valgus angle, internal and external rotation angle, antero-posterior displacement, proximal-distal displacement, internal and external displacement) at three, six, 12 months after operation were recorded by Opti_Knee(3D motion analysis system for the knee). The values of two groups were compared with 40 healthy adults. The count data were compared using the chi-square test, the paired t test was used for the pairwise comparison, the comparison among multiple groups was performed by Student-Newman-Keuls (SNK) analysis.

There was no significant difference in maximum step length, minimum step length, period of the limb walking between experimental group andcontrol group at three months, six months, and 12 months after the operation and healthy adults(P>0.05). The internal and external rotation angle(F=51.141, 13.204) and the antero-posterior displacement(F=51.246, 12.207) at three, six months after the operation of the experimental group were smaller than the control group(P<0.05), and were similar to the healthy adults(P>0.05). There was no significant difference in flexion and extension angle, varus or valgus angle, proximal-distal displacement, nor the internal or external displacement between the two groups(P>0.05). There was no significant difference in six freedom degrees of knee between the two groups at 12 months after the operation(P>0.05), which was similar to healthy adults(P>0.05).

Compared with conventional surgery, internal tension reducing technique assisted anterior cruciate ligament reconstruction could get more satisfactory early knee joint kinematics recovery, and the knee joint kinematics could more objectively evaluate knee function and stability.

To evaluate operative technique and clinical results of arthroscopic biceps tendon reconstruction for the middle-aged patients with superior labrum anterior posterior(SLAP) tear.

From September 2012 to February 2015, 75 patients with shoulder pain were retrospective analyzed in Beijing Chaoyang hospital. Inclusion criteria: age over 40 years, conservative treatment for three months but invalid, the physical and imaging tests met the clinical diagnosis of typeⅡSLAP injury combined with rotator cuff injury. Exclusion criteria: patients with unstable shoulder or had performed the shoulder surgery before, and the patients who were unable to cooperate due to mental problems. The shoulder function was evaluated according to America Shoulder and Elbow Surgeons (ASES) score and University of California at Los Angeles (UCLA) score, the preoperative and postoperative scores were analyzed by the paired t test using SPSS 19.0 software.

Eventually 66 patients were included with an average age of (56±11) years and with an average follow-up time of (17±8) months. The preoperative ASES score was(62.3±6.6), UCLA score was (12.1±2.3). After the operation, the ASES score was (93.7±4.6)(t=15.46, P<0.05), the UCLA score was (31.3±2.8)(t=22.19, P<0.05). This meant that the arthroscopic biceps tenodesis could improve pain relief.

The method using the suture anchor combine with Bio-Cork screw to construct biceps tendon is safe, reliable, and can reduce the failure rates, and obtain good clinical effect.

Pathological ossification is one of the most important features of ankylosing spondylitis. There are many studies on the ossification of ankylosing spondylitis, including the relationship between inflammation and ossification, ossification signal pathway and Wnt signaling pathway. To study the ossification process of ankylosing spondylitis from different aspects and thoroughly understand the mechanism of ossification, it is of great significance for the treatment of ankylosing spondylitis.