[Clinical Value of Detecting ABL Kinase Domain Mutations in Patients with Chronic Myeloid Leukemia Based on High-Throughput Sequencing Technology].

OBJECTIVE: To compare the efficacy and clinical value of high-throughput sequencing (HTS) and Sanger sequencing in detecting ABL kinase domain mutations in patients with chronic myeloid leukemia (CML). METHODS: A total of 198 samples of 147 CML patients from July 2017 to March 2021 in Henan Cancer Hospital were collected and underwent high-throughput sequencing and Sanger sequencing to detect the mutations in ABL kinase domain, and the relevant clinical data were collected for comparative analysis. RESULTS: The proportion of total mutations and ≥2 mutations detected by high-throughput sequencing were significantly higher than those detected by Sanger sequencing (P =0.01; P =0.046). ≥2 mutations were detected in 22 cases, of which 5 cases (22.7%) had compound mutations. High-throughput sequencing can detect low level mutations that cannot be detected by Sanger sequencing. In 198 samples, 25 (12.6%) were low level mutations, 33 (16.7%) were high level mutations and 10 (5.1%) were mixed high and low level mutations. In the analysis of related clinical factors, the total mutation rate and the low level mutation rate in the optimal period, failure period and warning period were gradually increased (total mutation rate, P =0.016; low level mutation rate, P =0.005). The mutation rate of the samples with additional chromosomal abnormalities was also significantly increased (P =0.009). The mutation rate of patients who received first- and second-line treatment was significantly lower than that of patients who received third- or higher-line treatment (P =0.006). Analysis based on variant allele frequency (VAF) of the mutation site was helpful to visually evaluate the clonal evolution status of TKI-resistance CML cells. CONCLUSION: High-throughput sequencing is more sensitive and accurate than Sanger sequencing in mutation detection, which is helpful to accurately and visually evaluate TKI treatment response and optimize treatment strategy for CML.

Managing dislocated hard lens nuclei: 23-gauge vitrectomy and lens extraction via a corneoscleral limbal incision versus 23-gauge vitrectomy and phacofragmentation.

PURPOSE: To compare 23-gauge vitrectomy and lens extraction via a corneoscleral limbal incision (CSLI) with 23-gauge vitrectomy and phacofragmentation to treat dislocation of hard lens nuclei. SETTING: Ningbo Eye Hospital, Zhejiang, China. DESIGN: Retrospective case series. METHODS: The study included consecutive patients with complete posterior dislocation of a hard nucleus (grade ≥ IV) into the vitreous cavity. All patients received 23-gauge 3-channel vitrectomy. Some patients also had phacofragmentation and others had lens extraction through a CSLI. RESULTS: The CSLI group comprised 21 eyes of 21 patients and the phacofragmentation group, 22 eyes of 22 patients. The median follow-up was 10.8 months (range 6 to 24 months) and 11.3 months (range 5 to 18 months), respectively. Demographic characteristics, reason for lens dislocation, preoperative corrected distance visual acuity (CDVA), preoperative intraocular pressure (IOP), lens nucleus grade, and comorbidities were similar between groups. The CSLI group had a shorter mean surgical time than the phacofragmentation group (42.5 ± 7.2 minutes versus 68.2 ± 16.5 minutes); less frequent use of perfluorocarbon liquid, octafluoropropane, or air tamponade; lower incidence of retinal tears (9.5% versus 31.8%); and better CDVA but worse astigmatism 1 day and 1 week postoperatively (P < .05). The postoperative IOP did not differ between groups. Corneal edema and recurrent retinal detachment were less common in the CSLI group than in the phacofragmentation group. CONCLUSION: The 23-gauge vitrectomy with lens extraction through a CSLI might have advantages over 23-gauge vitrectomy with phacofragmentation for management of dislocated hard lens nuclei.

Endoscopic release of congenital muscular torticollis with radiofrequency in teenagers.

BACKGROUND: Congenital muscular torticollis (CMT) is due to contracture of the sternocleidomastoid muscle which may cause activity limitations of the neck, tilt of the head, craniofacial asymmetry, and deformity of the skull. The authors present their experience of arthroscopic tight fibrous band release with radiofrequency in teenagers under local anesthesia and evaluate the clinical results. METHODS: A total of 69 patients who underwent arthroscopic release of CMT with radiofrequency under local anesthesia by a single surgeon could participate in this study. Before operation, surface landmarks of sternocleidomastoid muscle, bone, and neurovascular structures were marked. Local infiltrating anesthesia of the surgical region was then performed. Through a working space created by blunt dissection, the arthroscopy and radiofrequency devices were introduced. Then, the clavicular and sternal heads of the sternocleidomastoid muscle were identified and gradually transected. The patients were followed up postoperatively with Cheng's scoring system. RESULTS: There were 31 male patients and 38 female patients. The mean age of the patients was 16.1 years. The mean length of follow-up in this series was 36.7 months (range, 28 to 67 months). During the operation, 62 patients (89.9%) had no pain, 6 patients (8.7%) felt mild pain, and only 1 patient (1.4%) regarded the procedure as very painful. At all follow-up periods, there were no repeat arthroscopies for any of these patients. At the final follow-up, the average rotation deficit improved from 22.5° to 4.1° postoperatively, and the average lateral bending deficit improved from 14.6° to 3.3° (p < 0.05). Overall, the clinical result was good or excellent in 65 patients (94.2%), fair in 4 patients, and poor in 0 patients within the follow-up period according to Cheng's scoring system. To date, no patients had any intraoperative or postoperative complications from this procedure. CONCLUSION: The arthroscopic release with radiofrequency under local anesthesia provides surgeons with an alternative to traditional open techniques for the management of congenital muscular torticollis (CMT). Our date shows that this method is minimally invasive and provides good functional recovery with a lower risk of complications.

[Hamstring tendon transplantation embedding reconstruction of medial patellofemoral ligament for the treatment of recurrent patellar dislocation].

OBJECTIVE: To explore the effectiveness of hamstring tendon graft embedding reconstruction of medial patellofemoral ligament for the treatment of recurrent dislocation of the patella. METHODS: From March 2008 to June 2013,67 patients with recurrent dislocation of patella were treated, including 28 males, 39 females with an average age of 22 years ranging from 10 to 42 years old. The clinical manifestations involved knee joint instability,"giving way", sense of patellar dislocation, anterior knee pain. All 67 patients underwent arthroscopic hamstring tendon graft embedding reconstruction of the medial patellofemoral ligament. The curative effect were evaluated by preoperative and postoperative Lysholm score and Q angle changes. RESULTS: All cases were followed up after operation and the mean follow-up time was(27.5±13.4) months(4 to 69 months). Postoperative incision were healed well and no patellar dislocation or subluxation occurred. Lysholm score improved from preoperative 76.35±2.86 to 82.71±2.29 postoperatively; Q angle decreased from preoperative (18.75±2.33)° to postoperative(13.28±1.75)°. CONCLUSION: The method for the reconstruction of medial patellofemoral ligament can provide enough tension, patellar stability.imoroving the function of knee ioint.

[Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia].

OBJECTIVE: To evaluate the clinical outcome of arthroscopic repair method of meniscus injury with Fast-fix under local anesthesia. METHODS: From October 2005 to September 2012,106 patients with meniscus injuries admitted into our - hospital were studied, including 74 males and 32 females, ranging in age from 13 to 71 years old, averaged 27.6 years old. The duration of the disease ranged from 15 days to 5 years. The main clinical manifestations included knee joint pain after exercise, joint locking, pressing pain of knee joint and positive McMurray signs. The MRI showed meniscus tear or degeneration. Arthroscopic repairing surgeries were performed with Fast-fix under local anesthesia. Each patient was assessed with VAS pain evaluation and Lysholm knee-joint score system before and after operation. All the patients were followed up more than 1 year. RESULTS: One hundred and 2 patients were followed up by recording subjective symptoms, clinical examinations and questions naires for an average of 2.6 years (ranged, 1.1 to 8 years), and 4 patients lost follow-up. All the 102 patients had no anesthetic complications. Ninety-six patients had normal subjective symptom and clinical examinations. Four patients had a mild ache with activities,2 patients had moderate pain after activities with joint space pressing pain. VAS pain evaluation and Lysholm knee-joint score after operation both were much better than that before operation. CONCLUSION: onclusion: Local anesthesia can provide nice circumstances for surgeries. Arthroscopic repair using Fast-fix is an idea method for meniscus injury, especially for the posterior horn tear of medial meniscus, which is simple and convenient with less complications, and satisfactory results.

Stereotactic body radiation therapy for centrally-located lung tumors.

The application of high-dose irradiation to centrally-located lung tumors is generally considered to be of high risk in causing bronchial injury. The aim of the present retrospective study was to investigate the safety and efficacy of stereotactic body radiation therapy (SBRT) for patients with centrally-located lung tumors. In total, 28 patients who underwent SBRT for lung tumors within 2 cm of a major bronchus were retrospectively analyzed. The median total dose prescribed was 45 Gy (range, 36.3-52.5 Gy), the median fraction was 12 (range, 10-15) and the median dose per fraction was 3.6 Gy (range, 3-5 Gy). The median follow-up period for the surviving patients was 14 months (range, 10-41 months). The local control rate of SBRT was 100%, with a complete response (CR) rate of 32.1% (9/28); a partial response (PR) rate of 50% (14/28) and a stable disease (SD) rate of 17.9% (5/28). In total, 15 patients survived and 13 patients succumbed; 11 patients succumbed to tumor progression, one to congestive heart failure and one to a brain hemorrhage. The main side-effects included grade 2 esophagitis (17.9%; 5/28) atelectasis (10.7%; 3/28) and grade 2 late radiation pneumonitis (7.1%; 2/28). Severe late toxicity (≥ grade 3) was not observed in any patient. SBRT is an effective and safe therapy for centrally-located lung tumors.

[Clinical classification of gluteal muscle contracture under arthroscopy].

OBJECTIVE: To explore clinical effects of gluteal muscle contracture and minimum invasive surgery under the arthroscopy. METHODS: Totally 358 patients with gluteus contracture were treated,which included 175 males and 183 females with an average age of (19.7 +/- 6.8) years old (ranged, 14 to 41). All patients have a history of repetitive intramuscular injection of penicillin with benzyl alcohol solvent. According to clinical characteristics and intraoperative situation, patients were classified into four groups:cable strip (118 cases), fanshaped (107 cases), mixed (87 cases), tensor fasciae latae contracture(46 cases). The curative effects were evaluated according to postoperative function evaluation standard of gluteus contracture. RESULTS: All patients were followed up and 37 cases withdrew. The following up time ranged from 1.5 to 8 years with an average of 3.5 years. According to evaluation standard of gluteus contracture, 303 cases got excellent results, 13 cases good,and 5 cases fair at the final follow-up. No recurrence, infection and neurovascular injury occurred. CONCLUSION: The classification of gluteal muscle contracture is beneficial for choose surgical strategy and improve curative effect. The advantage of plasma knife minimally invasive solution in treating gluteal muscle contracture with radiofrequency under arthroscopy is minimally invasive, safe, and benefit for early functional exercises.

[Arthroscopic reconstruction of anterior cruciate ligament with preservation of the remnant bundle].

OBJECTIVE: To evaluate clinical effects of arthroscopic anterior cruciate ligament (ACL) reconstruction with preservation of the remnant bundle. METHODS: From January 2002 to December 2009, 57 patients with ACL partial rupture were treated with preservation of the remnant bundle. There were 39 males and 18 females, with an average age of 28.5 years old (ranged, 16 to 49 years old). Thirty-three patients had injuries in the left knees,and 24 patients had injuries in the right knees. Forty patients had injuries caused by sports, 7 patients had injuries caused by traffic accidents and 10 patients had injuries caused by daily sprain. The anterior drawer test showed positive results in 23 patients, weakly positive results in 6 cases; Lachman test showed positive results in 19 patients, and weakly positive in 4 patients. Both anterior drawer test and Lachman test showed positive results in 5 patients; and valgus stress test (medial) showed positive results in 24 patients. The mean value of Rolimeter measurement was 8.7 mm, (ranged, 7.5 to 11.5 mm). The mean International Knee Documentation Committee (IKDC) score was 70.0 +/- 7.5 and the Lysholm score was 68.0 +/- 6.3. The duration from injury to surgery was 1 week to 12 months,with an average of 3.1 months. RESULTS: There were 32 patients treated with anteromedial bundle reconstruction and 25 patients treated with poterolateral bundle reconstruction. Fifty-seven patients were followed up, and the mean follow-up time was 22.5 months (ranged, 13 to 37 months). The anterior drawer test and Lachman test were all negative at 1 month post-operation. At the end of the follow-up, the range of motion of all the knees was 120 to 130 degree. There were 54 patients with negative results of anterior drawer test and Lachman test, 1 with weakly positive result of anterior drawer test and 2 with weakly positive results of Lachman test. The measurements of Rolimeter showed excellent stability of the knee. The mean IKDC score was 92.0 +/- 4.9 and the mean Lysholm score was 91.0 +/- 3.7, which all improved compared to preoperative scores. CONCLUSION: Arthroscopic reconstruction of anterior cruciate ligament with preservation of the remnant bundle has satisfactory effects on the knee stability, which could increase the angiogenesis and collagen of the ACL and improve the proprioception of the knee.

[Anterior cruciate ligament reconstruction with tendon graft enveloped by preserved remnants].

OBJECTIVE: To explore the curative effect of anterior cruciate ligament (ACL) reconstruction with tendon graft enveloped by preserved remnants. METHODS: From June 2009 to June 2011,76 patients with ACL injury were treated, and the ACL was reconstructed with tendon graft enveloped by preserved remnants. There were 59 males and 17 females, aged 15 to 46 years with an average of 29 years. The causes of injuries included sports in 32 cases, training in 20 cases, traffic accidents in 16 cases, and other reasons in 8 cases. The average disease duration was 3 weeks (2 to 5 weeks). The results of Lachman test was positive in 72 cases and anterior drawer test were positive in 76 cases. The preoperative IKDC score was 45.9 +/- 3.6. The preoperative Lysholm knee score was 54.3 +/- 4.5. RESULTS: All incisions got an one stage healing, and no early complications occurred. Sixty-nine cases were followed up, and the duration ranged from 17 to 31 months (mean, 23 months). The result of Lachman test was negative at the latest follow-up. At the latest follow-up, the degree of IKDC was A in 36 cases, B in 30 cases, C in 3 cases, no one in degree D. The postoperative IKDC score was 91.5 +/- 3.4, showing significant difference compared with preoperative score. The postoperative Lysholm score was 92.4 +/- 3.8, showing a significant difference compared with preoperative score. CONCLUSION: The clinical effect of anterior cruciate ligament (ACL) reconstruction with tendon graft enveloped by preserved remnants is satisfactory.

[Arthroscopic treatment of painful heel syndrome with radio-frequency].

OBJECTIVE: To evaluate therapy effect of radiofrequency in the treatment of painful heel syndrome under arthroscopy. METHODS: From January 2006 to December 2011, 13 patients with painful heel syndrome being admitted into our hospital were studied. There were 5 males and 8 femals, ranging in age from 35 to 68 years. All these surgeries were performed under local anesthesia. After constructing a man-made lacouna in the subcutaneous tissue above plantar fascia, a medial and a lateral portal were established on both sides of plantar fascia and at the anterior edge of calcaneal tuberosity. Hyperplasia and torn fiber tissue of plantar fascia, and plantar calcaneal bursa were removed with radiofrequency probe under arthroscopy. Then penetration of the plantar fascia was carried out in a reticulation-shaped pattern with a special radiofrequency probe TOPAZ. Each patient was assessed with VAS pain evaluation criteria and AOFAS ankle-hindfoot score system (AOFAS-AH) before and after operation. All the patients were followed up, and the duration ranged from 6 to 12 months. RESULTS: All the 13 patients got excellent recovery with their heel pain relieved significantly. VAS score was 8.71 +/- 1.64 before operation, 6.27 +/- 2.53 at the 1st month after operation, and 2.30 +/- 2.69 at the 6th month after operation. AOFAS-AH score was 56.43 +/- 3.72 preoperation, 68.15 +/- 7.38 at 1st month post operation, and 84.51 +/- 2.93 at 6th month after operation. There were no perioperative and postoperative complications related to the procedure, such as blood vessel and nerve injury, and infection. CONCLUSION: Plantar fasciitis and plantar calcaneal bursitis are main factors of painful heel syndrome. Due to advantages of being easy to operate, having definite effect and no use to do spur removal or plantar fasciotomy. Endoscopy assisted plantar calcaneal bursa removal and plantar fascia penetration by radiofrequency technique can be a satisfactory treatment method for painful heel syndrome.

[Efficacies of arthroscopic debridement and olecranon fossa plasty in the treatment of osteoarthritis and posterior elbow impingement].

OBJECTIVE: To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint. METHODS: Between 1999 and 2008, a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement. There were 15 males and 6 females. And there were 16 right and 15 left cases. They included volleyball players (n = 7), tennis players (n = 7), golf enthusiasts (n = 4) and fencers (n = 3). The average duration of onset-operation was 3.5 years (range: 2.5 - 8). Arthroscopic exploration revealed synovial hyperplasia hypertrophy, cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa. Debridement and plasty were performed. Loose bodies were removed from elbow joint in 6 patients. Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area. Dynamic observation showed no posterior elbow impingement. RESULTS: Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up. The average follow-up period was 25.3 months (range: 18 - 42). All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale. The outcomes were excellent (n = 12), good (n = 7) and fair (n = 2). Postoperative patients elbow swelling and pain relieve, sports and life function returns to normal, elbow flexion and rotating mobility obviously improved. With the elbow radiological films to measure the range of motion, the average range of motion was 90.5° preoperatively and improved to 130° postoperatively. There was significant improvement in all cases. CONCLUSION: Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities. Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.

[Diagnostic value of MRI and MR arthrography in the detection of injuries of anterior labrum in shoulder].

OBJECTIVE: To investigate the diagnostic value of MRI and MR arthrography in the detection of injuries of anterior labrum in shoulder and to evaluate the accuracy of MR arthrography in the classification of anterior labrum lesion. METHODS: Seventy-eight patients with arthroscopically proved anterior labrum lesions(study group) and 75 patients with arthroscopically proved intact anterior labrum (control group) from January 2007 to December 2010 were included to the study. All patients underwent MRI and MR arthrography at our institution prior to shoulder arthroscopy. All MRI and MR arthrography were analyzed by one musculoskeletal radiologists and one sports medicine surgeon who had no knowledge of the clinical histories and arthroscopic results. The same classification system of labrum lesions based on arthroscopy was used in image analysis. Imaging findings and arthroscopic findings were compared in all patients. With arthroscopy used as the standard of reference, the sensitivities, specificities and accuracies of MRI and MR arthrography in the detection of anterior labrum lesions were compared, and the sensitivities, specificities and accuracies of MR arthrography in the correct classification of anterior labrum lesions were calculated. RESULTS: In arthroscopy, 78 anterior labrum lesions, 67 rotator cuff lesions and 8 SLAP lesions were diagnosed, for the detection of anterior labrum lesions, the sensitivity of MRI and MR arthrography was 80.8% and 92.3%,the specificity was 89.3% and 97.3%,the accuracy was 85.0% and 94.8% respectively. Seventy-eight patients with arthroscopically proved anterior labrum lesions included 39 Bankart lesions, 32 ALPSA lesions and 7 Perthes lesions, with MR arthrography, Bankart, ALPSA, and Perthes lesions were correctly classified in 84.6%, 84.4%, and 57.1% of cases, respectively. CONCLUSION: MR arthrography has a higher sensitivity, specificity and accuracy than MRI in the detection of anterior labrum injuries. MR arthrography was useful in the classification of different variants of anterior labrum injuries before operations. It may directly influence the surgeon's strategy and is useful in preoperative planning of arthroscopic reconstructions.

Double CT imaging can measure the respiratory movement of small pulmonary tumors during stereotactic ablative radiotherapy.

PURPOSE: The purpose of this study was to investigate the application of double CT imaging to measuring the respiratory movement of small pulmonary tumors during stereotactic ablative radiotherapy (SABR). METHODS: A total of 122 small pulmonary tumors were measured in 45 patients. CT scans were conducted twice in all 122 tumors, once at the end of quiet inhalation and once at the end of exhalation. CT scans were conducted three times including at the end of quiet inhalation, at the end of exhalation and at free breathing in 36 tumors of 17 patients. The displacement of the tumor center in three directions was measured. RESULTS: The 3D motion of 122 tumors was 10.10±7.16 mm. On average, the tumors moved 1.96±2.03 mm (rang, 0-9 mm) in the X direction, 5.19±4.69 mm (rang, 0-19 mm) in the Y direction, and 7.38±6.48 mm (rang, 0-26 mm) in the Z direction. The 3D motion of tumors in the lower lung (13.00±7.64 mm) was significantly greater than that in the upper lung (7.15±5.14 mm), P<0.01. The 3D motion of the lower left lung was 16.35±7.31 mm, which was significantly greater than that of the lower right lung (11.40±7.04 mm), P<0.05. Movement in the anterior lung in the Y direction was significantly larger than in the posterior lung. The motion was 7.49±5.43 mm and 4.04±3.82 mm respectively, P<0.01. CONCLUSIONS: Double CT imaging provides accurate data for determining the outline of each target area during stereotactic ablative radiotherapy plane. The location of small pulmonary tumor foci was significantly affected by respiratory and cardiac motion.

Effects of radiofrequency energy on porcine articular cartilage: higher-power settings in ablation mode show lower thermal radiation injury.

PURPOSE: The purpose of this study was to compare the radiofrequency (RF) injury effect on cartilage in the different settings that are mostly used in clinical work under rigidly controlled laboratory conditions. METHODS: Twelve fresh porcine knees were used in our study. Five treatment areas were created on the femoral condyles of each knee: the control group, coagulation (setting 2) group, coagulation (setting 7) group, ablation (setting 2) group, and ablation (setting 7) group. Hematoxylin/eosin staining, dual fluorescence staining, and the GAG content were observed to evaluate the histological cartilage changes, vacuolar cell rate of chondrocytes, depth of chondrocyte death, and detection of GAG content. RESULTS: Vacuolar cell rates of chondrocytes in each experimental group were higher than that in the control group (P < 0.05); there was no significant difference in vacuolar cell rate among experimental groups. Dual fluorescent staining showed that the ablation (setting 7) group had a smaller depth of cell death than did the coagulation (setting 2) group (P < 0.05); the other experimental groups showed no statistically significant difference (n.s.). In addition, there was no significant difference in GAG content between the experimental groups and control group (n.s.). CONCLUSIONS: The coagulation mode results in heavier thermal radiation injury to chondrocytes than does the ablation mode. Higher-power settings in the ablation mode result in lower thermal radiation injury and may be most suitable for cartilage debridement.

[Outcome evaluation of arthroscopy-assisted ankle arthrodesis].

OBJECTIVE: To evaluate the methods and results of arthroscopy-assisted ankle arthrodesis. METHODS: From January 2001 to May 2009, 25 patients with end-stage ankle joint pathology were treated with arthroscopy-assisted ankle arthrodesis. There were 18 males and 7 females with an average age of 47.5 years (ranged, 32 to 70 years). The locations were left ankle in 10 cases and right ankle in 15 cases, including 13 cases of post-traumatic osteoarthritis, 10 cases of Kaschin-Beck disease and 2 cases of rheumatoid arthritis. At pre- and post-operation, the 10-point VAS score for ankle pain was obtained; the ankle functional was evaluated by the American Orthopaedic Foot & Ankle Society ankle and hindfoot score, which include pain, activity limitations, maximum walking distance, walking surfaces, gait abnormality, sagittal motion, hindfoot motion, ankle-hind-foot stability, and alignment. RESULTS: All the patients were follow-up,with a mean period of 27.5 months (ranged, 20 to 35 months). All the patients were free of pain and the gait was improved. There were no complications, such as neurovascular injuries, infection or hardware failure. All the patients achieved fusion in a mean of 11.7 weeks (ranged, 8 to 15 weeks). Overall, the mean 10-point visual analog scale (VAS) score decreased from (8.60 +/- 0.96) preoperatively to (1.20 +/- 0.82) postoperatively (t=27.326, P=0.000). After operation, the items of pain, activity limitations, maximum walking distance, walking surfaces, gait abnormality, sagittal motion, hindfoot motion, ankle-hind-foot stability, and alignment improved. AOFAS score was significantly increased from (36.44 +/- 9.90) points preoperatively to (82.44 +/- 4.96) points postoperatively (t=-19.178, P=0.000). CONCLUSION: Arthroscopy-assisted ankle arthrodesis offered minimal trauma, high fusion rates, rapid recovery and low morbidity. This study confirmed the efficacy of the arthroscopy-assisted ankle arthrodesis for ankle joint pathology.

[Treatment of adult congenital muscular torticollis with radiofrequency carbonation under arthroscope].

OBJECTIVE: To evaluate the efficacy of sternocleidomastoideus radiofrequency carbonation with local anesthesia under arthroscope for the treatment of congenital muscular torticollis in adults. METHODS: Twenty-six cases of congenital muscular torticollis were treated by radiofrequency carbonation with local anesthesia under arthroscope. The right side was in 14 patients and left in 12. There were 11 males and 15 females with an average age of 22 years old. Sternocleidomastoideus and clavicula were pre-operatively marked. Through an artificial lacuna, arthroscope and radiofrequency probe were inserted. RESULTS: The mean follow-up period was 25 months (range: 15 - 71). According to the motion deficits, craniofacial asymmetry, head tilt and subjective assessment, there were 19 excellent and 7 fair outcomes. Most patients showed a marked improvement in neck motion and head tilt with satisfactory functional and cosmetic outcomes. There was no nerve or vascular injury, no recurrence, infection and scar. The overall efficacy was satisfactory. CONCLUSION: The radiofrequency therapy for torticollis with local anesthesia under arthroscopy has a satisfactory efficacy. The advantages are minimal trauma, simple procedure, less pain and better cosmetics.

Multidrug nanoparticles based on novel random copolymer containing cytarabine and fluorodeoxyuridine.

Novel multidrug nanoparticles were self-assembled from the random copolymer containing cytarabine and fluorodeoxyuridine. The multidrug copolymer carrying 28.7wt.% of cytarabine and 29.1wt.% of fluorodeoxyuridine was prepared by radical polymerization combined with enzymatic selective transesterification. Homopolymers of the two drugs were also synthesized by the same method. And the polymers were characterized by FTIR, (1)H NMR, and gel permeation chromatography (GPC). Self-assembly of the multidrug copolymer was verified by UV-vis and fluorescence spectroscopy. The morphology of nanoparticles formed from the copolymer was investigated by transmission electron microscopy (TEM) and dynamic light scattering (DLS), which indicated that the nanoparticles were regular spheres with a diameter of 133+/-28nm. In vitro drug release studies illustrated that the two synergistic anticancer agents could be simultaneously released from the multidrug nanoparticles.

[RIGIDfix tibial and femur cross pin system used for hamstring grafted anterior cruciate ligament reconstruction].

OBJECTIVE: To evaluate the curative effect of RIGIDfix tibial and femur cross pin system used for hamstring grafted reconstruction of anterior cruciate ligament (ACL) in arthroscopy. METHODS: Thirty two cases with ACL ruptures were reconstructed arthroscopically with hamstring grafts and the grafts fixed with RIGIDfix cross-pin on both femoral and tibial sides. They included 18 males and 14 females with a mean age of 28 (20-45) years old; the mean time from injury to operation was 3.6 (2.5-6) months. And each knee was checked by MRI and X-ray preoperatively. Through arthroscopy, we found 19 ACL ruptured from femoral attachment point, 13 from tibial point, 3 cases combined with medial meniscus injury and 4 cases with articular cartilage injury of medial femoral condyle. After semitendinosus or gracilis harvesting, the hamstring grafts were pre-tensioned and woven, the diameter of 4 or 5 strands grafts was 7-8 mm. To position and drill tibial tunnel on ACL stump of tibial crest, and to drill femoral tunnel at 10:00 to 11 o'clock of femoral intercondylar fossa transtibial with knee flexed to 90 degree, the depth of femoral tunnel was 30 mm. The RIGIDfix guide was inserted through tibial tunnel up into the femoral tunnel to drill the sleeve and interlocking Trocar across the lateral femur and keep the two sleeves fixed to the lateral femur. Insert RIGIDfix guide into the tibial tunnel, keeping the top of guide 2-3 mm beneath the endostoma of tibial tunnel, drill the sleeve and interlocking Trocar across the lateral tibia and keep the two sleeve fixed to the lateral tibia. The graft was pulled into the tunnel (the 30 mm mark on the graft should be at the edge of femoral hole) to insert the RIGIDfix cross pins from femoral tunnel to tibial tunnel, while inserting the second, third, fourth cross pin, the graft should be kept under tension. Then a knot was tied through tibial bony bridge using the Enthibond thread switched to the end of tendon grafts. We finally observed the tension of tendon grafts and the impingement of fossa intercondylic under arthroscopy. RESULTS: With a 16-month follow-up evaluation, all of the patients' injured knees were stable and the average Lysholm knee score increased from 62.5 to 94.5. Rulermetr device values were less than 2 mm of sagittal displacement in 28 patients and 4 mm in 4. Postoperative Lachman was negative in 30 patients and weakly positive in 2. According to the IKDC scores, 30 patients reported normal function, 2 reported nearly normal function and none reported abnormal or severely abnormal function. CONCLUSION: The grafting method of fixing both femur and tibia sides with absorbable cross pins is feasible. In this way, the graft is stabilized to allow for reconstruction. A surgeon should refrain from dissecting the tendon and enlarging the tunnel so as to promote the healing of tendon and bone.

[Biomechanical evaluation of tendon graft fixation at the tibial site in anterior cruciate ligament reconstruction with Intrafix and bioabsorbable interference screw].

OBJECTIVE: The fixation strength of the hamstring tendon graft on the tibial side is considered the weak point in anterior cruciate ligament (ACL) reconstruction. This work tested the hypotheses that some of these devices will resist graft slippage under loads better than others, and that some will have higher ultimate strength than others. METHODS: Fourteen fresh frozen human cadaver knees underwent fixation of the hamstring tendon harvested from the knee to be used as graft material to reconstruct the ACL and were divided into two equal groups based on the fixation methods: bioabsorbable interference screw group and Intrafix group. A MTS 858 MiniBionix II testing machine was used to carry out tensile testing under an axial load parallel to the tibial tunnel with a velocity of 10 mm/min. Ultimate failure load, displacement of 100N, displacement of 400N, stiffness and mode of failure were recorded respectively. RESULTS: The maximum load for the Intrafix fixation group was (719.094+/-160.478) kgxmxs(-2), significantly higher than that of the bioabsorbable interference screw fixation group [(476.640+/-64.226) kgxmxs(-2), P<0.05]. The displacement levels of 100 kgxmxs(-2) and 400 kgxmxs(-2) for the Intrafix fixation group was (1.025+/-0.326) mm and (4.728+/-1.992) mm respectively, not significantly different from those of the bioabsorbable interference screw fixation [(1.335+/-0.539) mm and (7.564+/-4.307) mm respectively, t=0.2173, 0.0944, both P>0.05], and the stiffness of the Intrafix fixation group was (96.770+/-36.848) kgxm(-1)xs(-2) not significantly different from that of the bioabsorbable interference screw fixation group [(63.976+/-31.003 kgxm(-1)xs(-2)), t=0.0967, P>0.05]. After randomized t-test of significance, the displacement levels of 100N and 400N of these 2 groups were not significantly different. CONCLUSION: Both tibial site fixation with bioabsorbable interference screw and that with Intrafix in ACL reconstruction with 4-stranded hamstring tendon grafts can meet daily physiological demand. Tibial site fixation with Intrafix shows a higher failure load.