Search

BACKGROUND: Among the pathogenic factors of cervical spondylosis, herniation of the intervertebral disc, dislocation of the facet joint and the stenosis of the intervertebral foramen are important factors leading to symptoms in patients. Moreover, inappropriate manipulation may aggravate the possibility of cervical disc rupture, leading to exacerbation of symptoms in patients. OBJECTIVE: To compare the effect between sagittal cervical manipulation and traditional cervical rotation manipulation on the area of the intervertebral disc, facet joint and intervertebral foramen at the operative segment by the finite element analysis. METHODS: The neck CT data of a male volunteer with a normal neck were selected and imported into Mimics 17.0 three-dimensional reconstruction software. Geo-magic Studio 12.0, Solidworks 2017 and Ansys Workbench 17.0 software were used for the construction of the finite element model of cervical vertebrae (C3-6) including intervertebral disc and articular cartilage. The lower end plate of the C5 vertebral body was fixed. A uniformly distributed vertical downward 50 N load was applied on the upper surface of the upper vertebral body (C3). The stress, deformation and deformation direction of the C4-5 intervertebral disc, joint capsule stress, the displacement of facet joints and the area of bilateral intervertebral foramen were compared between sagittal cervical manipulation and traditional rotation reduction. RESULTS AND CONCLUSION: (1) When using the rotation technique, the maximum normal equivalent stress (von Mises stress) of the C4-5 disc was 8.06 MPa; the total deformation was 1.05 mm, and the fiber ring expanded to the left and outside. When using the sagittal tip lifting technique, the maximum normal equivalent stress (von Mises stress) of the C4-5 disc was 2.60 MPa; the total deformation was 0.90 mm, and the fiber ring expanded to the left and back. Compared with the rotation technique, the pressure of the cervical manipulation technique on the disc was less (about 32.3% of the rotation technique), and the deformation degree of the disc was also light (about 85.7% of the rotation technique). (2) When the rotation technique was used, the maximum stresses of the left and right articular capsule ligaments were 0.37 MPa and 1.69 MPa, respectively. The overall displacement of the facet joint was 2.21 mm. The area of the right intervertebral foramen decreased by about 3.8% and the area of the left intervertebral foramen increased by about 0.9%. When the sagittal end lifting manipulation was performed, the maximum stresses of the left and right articular capsule ligaments were 0.27 MPa and 1.70 MPa, respectively; the overall displacement of the facet joint was 1.63 mm; the area of the right intervertebral foramen increased by about 2.6%, and the area of the left intervertebral foramen decreased by about 0.9%. Compared with rotation manipulation, sagittal end lifting manipulation had fewer changes in the displacement of facet joint, joint capsule stress and intervertebral foramen area, so it was safer to operate. (3) In conclusion, compared with cervical rotation manipulation, sagittal end lifting manipulation has fewer changes in facet joint displacement, intervertebral disc stress/deformation degree, joint capsule stress, and foraminal area. In clinical practice, more appropriate manipulation should be selected based on biomechanical results after an accurate assessment of patients’ conditions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Post-traumatic arthritis is one of the most common forms of osteoarthritis. In vivo and in vitro studies have shown that icariin can treat osteoarthritis through multiple targets and multiple pathways with no obvious side effects. However, the analgesic effect and mechanism of icariin on posttraumatic arthritis has not been reported. OBJECTIVE: To investigate the analgesic effect and mechanism of icariin on post-traumatic arthritis in rats. METHODS: Thirty male Sprague-Dawley rats were randomly divided into sham group (n=10), model group (n=10) and icariin group (n=10). The right knee anterior cruciate ligament was cut off in the model group and icariin group, while the right knee joint capsule was cut only in the sham group. The rats in the icariin group were given intragastric administration of icariin (100 mg/kg/d), and the sham and model groups were given the same amount of normal saline at the same time point for 8 weeks. Mechanical withdrawal threshold and thermal withdrawal latency were measured by mechanical stimulation and thermal radiation to evaluate the pain threshold of rats. Open field test was used to evaluate anxiety and depression. General observation and Pelletier scoring of the knee cartilage were performed. Safranin O-Fast green staining and Osteoarthritis Research Society International score were used to evaluate the degree of cartilage degeneration. ELISA was used to detect the contents of inflammatory factors interleukin-1β and tumor necrosis factor-α in synovial fluid and synovial tissue. The protein expression of monocyte chemotactic protein 1/chemokine C-C-motif receptor 2 ligand receptor axis in cartilage tissue was detected by western blot. RESULTS AND CONCLUSION: The mechanical withdrawal threshold and thermal withdrawal latency of the icariin group were significantly higher than those of the model group (P < 0.05). Compared with the sham group, the total exercise distance, the total number of crossing squares and the residence time in the central area of the model group were significantly decreased (P < 0.05). Compared with the model group, the above three indexes were significantly increased in the icariin group (P < 0.05). Compared with the model group, the levels of interleukin-1β and tumor necrosis factor-α in knee synovial fluid and synovial tissue were significantly decreased in the icariin group (P < 0.05). Compared with the sham operation group, the articular cartilage surface of the model group was more uneven and deformed, the cartilage tissue was hypertrophy, hardened and dull, and a large amount of cartilage tissue was exfoliated, while the cartilage degeneration in the icariin group was significantly less than that in the model group. The results of Safranin O-Fast green staining and Osteoarthritis Research Society International score showed that the degeneration of knee cartilage in the model group was more severe than that in the sham group, while that in the icariin group was significantly less than that in the model group. Compared with the model group, the protein expression level of monocyte chemotactic protein 1/chemokine C-C-motif receptor 2 ligand receptor axis was significantly lower in the icariin group (P < 0.05). The above findings indicate that icariin can significantly reduce hyperalgesia in the rat model of post-traumatic knee arthritis, and its mechanism may be related to reducing the levels of interleukin-1β and tumor necrosis factor-α in the knee joint and inhibiting the protein expression of monocyte chemotactic protein 1/chemokine C-C-motif receptor 2 ligand receptor axis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Biomechanical studies on the treatment of lumbar intervertebral disc degeneration by oblique-pulling manipulation mainly focus on the stress and displacement analysis of the annulus fibrosus, nucleus pulposus and bony structure, while mechanical studies on the three-articular complex after lumbar intervertebral disc degeneration have not been found. OBJECTIVE: To analyze the biomechanical dynamic changes of the three-joint complex after lumbar intervertebral disc degeneration by oblique-pulling manipulation with finite element method. METHODS: CT images were imported to Mimics, Geomagic Studio, SolidWorks, Hypermesh and other finite element software to construct L4 and L5 vertebral body, intervertebral disc, ligament, joint capsule and other finite element models. According to the different material properties of lumbar disc degeneration, the values were assigned to establish normal, mild and moderate degeneration models. The mechanical distribution differences of the three-joint complex with different degrees of lumbar disc degeneration were analyzed by oblique-pulling manipulation. RESULTS AND CONCLUSION: (1) After oblique-pulling manipulation, the maximum stresses of normal, mild and moderate degenerative intervertebral discs were 0.78, 3.21, and 3.94 MPa, respectively, while the corresponding maximum displacement of the intervertebral disc gradually decreased. (2) After obliquepulling manipulation, the annulus fibrosus stress of normal, mild and moderate degenerative intervertebral discs increased gradually, and the annulus fibrosus stress of moderate degenerative intervertebral discs increased significantly. The maximum stresses in the nucleus pulposus of normal, mild and moderate degenerative intervertebral discs were 0.87, 0.56, and 0.44 MPa, and the maximum stretched heights of the joint capsule were 1.74, 2.48, and 3.10 mm, respectively. (3) The results suggest that the normal intervertebral disc without degeneration can reduce the stress loading of the lumbar triarticular complex and play a protective role. Oblique-pulling manipulation of moderate degenerative intervertebral disc is safe, and its maximum stress will not cause damage to lumbar tissue. [ABSTRACT FROM AUTHOR]

BACKGROUND: Finite element model construction and biomechanical analysis make it possible to explore the formation of hallux valgus and the recovery of related structures and functions. OBJECTIVE: To establish a finite element model of moderate hallux valgus foot in the neutral position with load to analyze the changes of the angle of the first metatarsophalangeal joint and the stress distribution of the corresponding bones under the action of external forces of different parts and sizes. METHODS: One female volunteer with moderate hallux valgus was selected, and CT image data were collected. The computer 3D imaging technology was used to conduct 3D finite element modeling to verify the validity of the model, and standardize the measurement method of the angle of the first metatarsophalangeal joint and the angle between the first and second metatarsal. Variables were controlled and the force was changed in turn to observe the changes of the above two angles, and analyze the stress distribution of the first metatarsal and proximal phalanx. RESULTS AND CONCLUSION: (1) An effective finite element model of moderate hallux valgus foot was established, which showed that a large stress concentration appeared in the first metatarsal. The distribution trend was from the medial middle and lateral middle of the bone body, gradually decreasing towards the dorsal and basal sides of the bone. (2) The feasibility of the method for determining the axis reference point of the first metatarsal, the second metatarsal and the proximal phalanx of the great toe was verified in finite element analysis. (3) The horizontal force acting on the lateral middle area of the distal phalanx of the first great toe has a direct effect on the change of the first metatarsophalangeal angle, but it has no linear effect. The regional force acting on the medial capsule of the metatarsophalangeal joint mainly affects the size of the first-second metatarsophalangeal angle. The horizontal force acting on the medial surface of the proximal metatarsal has little effect on the two angles. [ABSTRACT FROM AUTHOR]

Objective: To discuss the clinical manifestations and diagnosis and treatment processes of one patient with subintimal hemangioma of the knee joint, and to improve the clinicians’ understandings of the disease. Methods: The clinical data, imagological data, arthroscopic manifestations, and pathological results of one patient with subsynovial hemangioma of the knee joint were retrospectively analyzed, and the related literatures were reviewed. Results: A 22-year-old female patient presented with intermittent left knee joint pain and swelling for 7 years. The physical examination results showed obvious tenderness in the inner and outer spaces of the left knee joint, and the range of motion of the left knee joint was decreased (0°－90°). The ultrasound results showed that the hypoechoic light clusters were found between the deep layer of the vastus medialis tendon and the synovial tissue; the magnetic resonance imaging (MRI) results showed that the deep medial retinaculum of the left knee joint was swollen near the parapatellar soft tissue, which showed a slightly low signal on T1-weighted sequences and a patch-like signal with slightly higher intensity on T2 fat-suppressed sequences; the high T2 signal was seen in the synovial tissue, and the boundary was not clear. The preliminary consideration was left knee mass. The arthroscopic left knee joint lesion resection was performed； under the arthroscope, the appearance of the medial parapatellar synovium was basically normal, after removing the intimal layer of the superficial synovial tissue, the mass was located between the subintima of the synovium and the joint capsule, the mass was completely removed for submission, and the pathology results showed it was subsynovial hemangioma of the knee joint; the original pain in the left knee joint of the patient disappeared after operation. Conclusion: Lots of patients with subsynovial hemangioma of the knee joint have medical history of trauma, manifesting as unexplained pain, swelling, and limited mobility of the knee joint; the diagnosis of the disease needs to be confirmed through the combination of imagological manifestations, arthroscope, and pathological examination results; the arthroscope surgery can significantly improve the prognosis of the patients, and it has some advantages, such as fewer surgical injuries, fewer postoperative complications, and faster recovery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adult idiopathic scoliosis is a common clinical disease leading to adult spinal deformity. Surgical correction is an effective means to treat the disease, but the choice of surgical timing and surgical correction strategy poses a challenge to clinicians. OBJECTIVE: To follow up the same Lenke 3 adult idiopathic scoliosis volunteer and carry out finite element modeling and simulated posterior orthopedic surgery before and after 5 years, so as to understand the disease progression of this type of adult scoliosis, the biomechanical changes of spinal column and implant, and the changes of orthopedic effects of different orthopedic methods, and to provide data reference for the treatment of this type of disease. METHODS: A typical Lenke 3 adult idiopathic scoliosis volunteer, male, aged 28 years old, was selected as the research object. The volunteer’s spine was scanned by continuous CT. The original image was imported into the finite element software for modeling, and the model was further cleaned. After optimization, a complete Lenke 3 adult idiopathic scoliosis finite element model including thoracic structure was established, and finite element surgical simulation was carried out on this model. Case 1: bilateral screw placement from the upper to lower vertebrae and removal of the corresponding posterior joint capsule to achieve the purpose of joint release; Case 2: posterior key vertebrae were nailed and the corresponding segments of posterior joint capsule were removed for joint release; Case 3: posterior key vertebra nailing, removal of posterior joint capsule of corresponding segments, and release of thoracic vertebrae at anterior scoliosis; Case 4: posterior key vertebra nailing, removal of posterior joint capsule of corresponding segments, and release of lumbar spine at anterior scoliosis; Case 5: posterior key vertebra nailing, removal of posterior joint capsule of corresponding segments, and release of the thoracic and lumbar spine at the anterior scoliosis. Five years later, the volunteer’s scoliosis was modeled again by finite element method and simulated surgery, so as to understand the disease progression, biomechanical changes of spine and implant, and the changes of orthopedic effects of different orthopedic methods. RESULTS AND CONCLUSION: (1) On the scoliosis model established five years later, the surgical correction scheme for Case 1-Case 5 was successfully completed. The correction rates of thoracic scoliosis were 56.8%, 48.9%, 49.8%, 55.9%, and 57.0%, and the correction rates of lumbar scoliosis were 33.0%, 36.9%, 29.4%, 30.0%, and 34.3%. The orthopedic effects of simulated surgery of Cases 3 and 5 were significantly lower than those 5 years ago. At the same time, the maximum screw stress area and the minimum screw stress area were different. (2) The lumbar scoliosis deformity of Lenke 3 adult idiopathic scoliosis volunteers increased with age, but there was no significant progress in thoracic scoliosis. Five years later, the correction rate and effect of each operation scheme on thoracic and lumbar scoliosis decreased significantly, and the area with the largest screw stress under each operation also changed. [ABSTRACT FROM AUTHOR]

Objective We aimed to investigate the anti-inflammatory mechanism of heat-reinforcing needling on rheumatoid arthritis(RA) with cold syndrome. Methods The RA with cold syndrome model was established by injecting ovalbumin dry powder and Freund's complete adjuvant combined with cold freezing. Fifty rabbits(50% male and 50% female) were randomly divided into the normal group, the model group, the resatorvid(TAK-242) group, the heat-reinforcing needling group, and the lipopolysaccharide( LPS) combined with heat-reinforcing needling group, 10 rabbits in each group. Rabbits in the TAK-242 group were intraperitoneally injected with the TLR4 inhibitor TAK-242(0. 75 mg/ kg); rabbits in the heat-reinforcing needling group were treated with "Zusanli" (ST 36) with heat-reinforcing needling; and rabbits in the LPS combined with heat-reinforcing needling group were injected intraperitoneally with the TLR4 agonist LPS(0. 25 mg/ kg) on the basis of heat-reinforcing needling. Each group received continuous treatment for 14 days. The circumference and skin temperature of the knee joint of the rabbits were recorded; the histomorphology of the synovial membrane of the rabbit knee joints was observed by HE staining; the expression levels of TNF-α, IL-1β, and IL-6 in synovial tissues were detected by immunohistochemistry; the protein expression levels of TLR4, MyD88, and ERK1/2 in synovial tissues were detected by Western blotting; and the mRNA levels of mTOR and p70S6K were detected by real- time PCR. Results The circumference of the knee joint was lower and the skin temperature of the knee joint was higher(P<0. 01) in all intervention groups compared with the model group. The HE staining of the TAK-242 group and the heat-reinforcing needling group showed that the inner mucosa of the joint capsule was basically flat, the proliferation of pannus was reduced, and there was a small amount of inflammatory cell infiltration, while the LPS combined with the heat-reinforcing needling group showed that the inner mucosa of the joint capsule was rough, the pannus proliferated, and the inflammatory cell infiltration and aggregation were obvious. The expression of TNF-α, IL-1β, and IL-6(P <0. 01), the protein levels of TLR4, MyD88, and ERK1/2, and the mRNA levels of mTOR and p70S6K were lower (P<0. 01) in all intervention groups compared with the model group. The circumference of the knee joint was lower and the skin temperature of the knee joint was higher(P<0. 01) in the heat-reinforcing needling group and the TAK-242 group compared with the LPS combined with heat-reinforcing needling group; the levels of TNF-α, IL-1β, and IL-6(P <0. 01), the protein levels of TLR4, MyD88, and ERK1/ 2, and the mRNA levels of mTOR and p70S6K were lower(P<0. 01) in the heat-reinforcing needling group and the TAK-242 group compared with the LPS combined with the heat-reinforcing needling group. Conclusion Heat-reinforcing needling can effectively reduce knee swelling and inflammatory infiltration in RA with cold syndrome model rabbits. The possible mechanism is related to the inhibition of the TLR4-MyD88-ERK1/2 pathway, antagonism of cell proliferation activity, and a decrease of TNF-α, IL-1β, and IL-6 secretion by heat-reinforcing needling. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Lumbar facet joint degeneration has become the focus of scholars’ research in recent years. Understanding the risk factors of lumbar facet joint degeneration plays a key role in preventing and reducing the damage to spine health. Moreover, comprehending its anatomy has important guiding significance for the treatment of spine-related diseases and related operations. OBJECTIVE: To briefly describe the anatomy and histological characteristics of the lumbar facet joints, and summarize therisk factors of lumbar facet joints degeneration. METHODS: A computer-based search of CNKI, Wanfang database, VIP database, PubMed, Elsevier and Web of Science was performed with the search terms “lumbar facet joint, joint capsule, articular direction, eneurosis, osteoarthritis, biomechanics, low back pain, intervertebral disc degeneration, lumbar spondylolisthesis, lumbar degenerative scoliosis” for articlespublished from March 2018 to September 2019. Review, basic research and clinical research were screened by reading title and abstract. The studies with low relevance to the subject were excluded, and 60 studies were included in the final analysis. RESULTS AND CONCLUSION: (1) The main risk factors for lumbar facet joint degeneration include age, gender, abnormal stress, articular surface orientation, joint asymmetry, lumbar segment and disc degeneration. (2) When the joints degenerate, it can cause low back pain, disc degeneration, lumbar spondylolisthesis, degenerative scoliosis and other clinical diseases, which seriously affect people’s daily life and work, and reduce people’s living quality. Therefore, lumbar facet joints should not be ignored in the treatment of spine-related diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the cases of femoral neck fracture, the surgical reduction and fixation of femoral neck fracture have been well achieved, but there are still many patients with femoral head necrosis, which may be related to the influence of hip bursa pressure on femoral head blood supply. OBJECTIVE: To investigate the effect of different treatment methods on internal pressure of hip joint capsule after femoral neck fracture. METHODS: From January 2013 to December 2017, 120 cases diagnosed as simple femoral neck fracture and Garden type I-IV were collected in the Department of Orthopedics, the First People’s Hospital of Chengdu Shuangliu District. The intrathecal pressure of hip joint was measured in different positions of lower limbs(neutral position, internal rotation 30°, external rotation 30°, external rotation 50°, external extension 30°, andneutral position traction of 3-6 kg). This study was approved by the Medical Ethics Committee, the First People’s Hospital of Chengdu Shuangliu District on January 11, 2013. RESULTS AND CONCLUSION: In different positions of affected limb, the intracapsular pressure of hip joint was the smallest when the external rotation was 30°, and the maximum when the internal rotation was 30°. Among the different types of femoral neck fractures, the internal pressure of hip bursa of Garden type III and IV was significantly higher than that of Garden type I-II. With the increase of traction weight, the pressure in hip capsule increased gradually. It is suggested that placing the affected limb in external rotation of 30° without traction after femoral neck fracture can significantly reduce the internal pressure of hip joint capsule. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effect of the use of non-absorbable suture to strengthen the medial joint capsule on the stability of the patellaafter primary total knee arthroplasty(TKA). Methods: This retrospective study analyzed the data of 22 patients who underwent primary total knee arthroplasty for end-stage knee osteoarthritis from December 2014 to September 2017. The data were analyzed retrospectively according to whether intraoperative use of non-absorbable suture to strengthen the sutured medial joint. The patients were divided into group A and group B. The hipknee ankle angle(HKA), insall-Salviti index(ISR), patella tilt angle(PTA)were measured by the X-ray radiographs before and after operation. All included patients were assessed the function of knee by using the Knee Surgery Society(KSS)scores. Comparingthe data of two groups of patients, including HKA, ISR, PTA and KSS in the X-ray before and after the operation were followed up for 1 month and last follow-up. Results: The KSS, ROM, and HKA were significantly improved in the group A(P <0.05). ROM was improved more significantly at the last follow-up postoperatively. However, ISR had no significant difference between before and after the operation(P>0.05), PTA had significant enhance postoperatively. In group B, the KSS and ROM were not significantly improved at 1 month postoperatively(P>0.05), but were significantly improved at the last follow-up postoperatively(P<0.05). PTA was significantly reduced after the operation(P<0.05). HKA and ISR were no significant difference between before and after the operation(P<0.05). In postoperative stage, the PTA in the group B was smaller than that in the group A(P<0.05). Conclusion: In TKAs using medial patellar approach, the use of non-absorbable sutures to strengthen the the medial joint capsule can reduce postoperative patella tilt and enhance the stability of the patella, which is worthy ofclinical application. [ABSTRACT FROM AUTHOR]

Objective To explore the curative effect of partial closure combined manipulation release and arthroscopic adhesion release in treating primary shoulder periarthritis. Methods A total of 435 cases(490 sides) of primary shoulder periarthritis in the Affiliated Hospital of Chengdu University from January' 2011 to January 2015 were selected,including 55 cases of bilateral shoulder periarthritis. Among them,408 cases(463 sides) as the manipulation release group were treated with partial closure combined with manipulation release and 27 cases(27 sides)as the arthroscopic release group were treated by shoulder arthroscopic adhesions release. The occurrence situation of postoperative complications was compared between the two groups. Hie curative effects were compared between the two groups by using the ASES and JOA scores and shoulder range of motion. Hie patients in the two groups all obtained the outpatient or telephone follow up. the manipulation release group was followed up for 3-16 months, average(7.2±l.1) months;the arthroscopic release group was followed up for 6-24 months,average(11.3±1.6) months. Results Hie two groups all had obvious effect after therapy. The postoperative ASES and JOA scores in the manipulation release group were significantly higher than those in the arthroscopic release group,the difference was statistically significant(P<0.05). Conclusion Partial closure combined with manipulation release has obvious effect in treating primary shoulder periarthritis, which is superior to the arthroscopic adhesion release and is well received by the patients due to small trauma, short treatment time and good effect. [ABSTRACT FROM AUTHOR]

Joint contracture is one of the common musculoskeletal disorders. It has seriously disturbed patients' activities of daily living in various aspects. The pathogenesis of it is eager to explore to distinct degree. Nowadays the thickeness and fibrosis of joint capsular is redarded as the major reason to joint contracture. It is reported that excessive fibroblasts and myofibroblasts activity, collagen hyperplasia, and extracellular matrix (ECM) deposition in these fibrotic condtions lead to the contracture. In addition, upregulators of myofibroblast and collagen synthesis, transforming growth factor-beta 1 (TGF-β1), and connective tissue growth factor (CTGF) were shown to be increased. Altered levels of cytokines were also thought to play a role in this process as elevated levelsof tumor necrosis factor-α(TNF-α), matrix metalloproteinases(MMPs) and abnormal distribution tissue inhibitors of MMPs(TIMPs) were demonstrated in contracted capsules. At present, the methods for clinical treatment of joint contracture mainly include two major categories:stretching therapy, physical factor therapy, exercise therapy, botulinum toxin injection and other non-surgical treatments, arthroscopic lysis, open lysis, and other surgical treatments. Surgical treatment is performed when non-surgical treatment is difficult to achieve further improvement. It has a good effect on mild to moderate joint contracture, but it is difficult to completely restore joint activity for serious joint contracture. Although clinical treatment methods are diverse, the clinical effects are staggered and the effectiveness of their treatment is controversial. Joint contracture is an important challenge faced by orthopedics and rehabilitation physicians, therapists and patients. The review summarized the pathogenesisand treatment of joint contracture and provided a theoretical basis for clinical diagnosis and treatment.

Objective: To investigate the effect and mechanism of static progressive stretching (SPS) in different durations on traumatic knee contracture in rats., Methods: Seventy male Wistar rats were randomly divided into three groups, including surgical modeling group ( n =50), control group (CON, no surgery, no treatment, n =10) and trauma without immobilization group (TRA, no treatment, n =10). The knee contracture model was established, and 50 surgical modeling rats were randomly divided into five groups including static progressive stretching treatment for 20 minutes group (S20 min, n =10), treatment for 30 minutes group (S30 min, n =10), treatment for 40 minutes group (S40 min, n =10), untreatment group (UNT, no SPS, n =10) and modeling group (MOD, n =10, euthanized after immobilization for histological staining and Western blot). Individuals in the S20 min, S30 min, and S40 min groups were anesthetized and submitted to SPS. One treatment session took place every other day. A total of 8 sessions were given till the final treatment session on the day 16. On the day 0, 8, and 16 of intervention, the range of joint motion (ROM) and gait analysis were measured and compared. After the ROM measurements and gait analysis, the rats were euthanized on the day 16 and the samples were stained with HE and Masson methods. The changes of pathological organization were observed. Western blot was used to detect the expressions of transforming growth factor-β1 (TGF-β1) and interleukin-6 (IL-6)., Results: ① ROM：the ROM of S30 min group recovered similar to that of the S20 min and S40 min groups after 8 days of treatment ( P >0.05), and was the best among all the surgical modeling groups after 16 d of treatment ( P <0.05). The ROM of S20 min, S30 min and S40 min groups significantly improved on the day 8 and day 16 comparing with that on day 0 ( P <0.01). ② Gait analysis: the stands in the S30min group improved best on the day 8 and day 16 ( P <0.05) , and better than that on day 0 ( P <0.05). The stride length of the S30 min group progressed similar to that of the S40 min group on the day 8 ( P >0.05), and there was no difference among three groups on the day 16 ( P >0.05). The stride length of the S30 min group appeared to recover more quickly on the day 8 ( P <0.05), and those of S20 min and UNT groups recovered significantly on the day 16 ( P <0.05). In addition, the swings in the S30 min group improved best ( P <0.05), and it appeared to recover better on the day 16 ( P <0.05). There was no statistical difference in terms of the swing speed among the four surgical modeling groups on the day 8 ( P >0.05). The swing speed of the S30min group increased most than those of the other three groups ( P <0.05), and it was much better on the day 8 and day 16 comparing with that on the day 0 ( P <0.05 ). ③ HE and Masson staining: the fibrosis and inflammation of the S30min group were significantly suppressed comparing to the other groups on the day 16. ④ Western blot: The protein expression levels of TGF-β1 and IL-6 were significantly lower than those in the other intervention groups including the S20 min, S40 min and UNT groups on the day 16 ( P <0.05)., Conclusion: Static progressive stretching treatment for 30 min could significantly improve the traumatic knee contracture in rats. The mechanism may be that the SPS decreased the expressions of TGF-β1 and IL-6, reduced the adhesion and inflammation of joint capsule. Therefore it relieved the pain and increased the joint mobility by reconstructing the structure of the capsule and suppressing the fibrotic changes., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

Objective: To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair., Methods: The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups ( P >0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed., Results: The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation ( P <0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group ( P <0.05)., Conclusion: Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.

Developmental dislocation of the hip(DDH) is one of the most serious hip diseases. Patients with unilateral DDH are prone to secondary osteoarthritis, low back pain, gait disturbance and compensatory scoliosis because of the leg length discrepancy. Total hip arthroplasty(THA) is the highly effective treatment for patients with hip pain or dysfunction caused by unilateral DDH, thus decrease the demand for hip-preserving surgeries such as capsular arthroplasty which may postpone or avoid hip replacement. However, the failure rate of THA for young patients is high and the majority of young patients may require one or more revision arthroplasties throughout their lifetime. The basic principle of capsular arthroplasty is that the femoral head wrapped by capsule is placed into a newly reamed socket on the location of true acetabulum. Therefore, hip replacement for patients with previous capsular arthroplasty becomes easier and safer than primary THA. However, the early capsular arthroplasty have been abandoned due to the relatively high rates of femoral head necrosis and hip stiffness. Ganz modified the early procedure with the technique of surgical hip dislocation in 2012, and emphasized the importance of postoperative rehabilitation. The incidence of complication, therefore, decreased greatly due to the preservation of main blood supply of femoral head as well as the proper postoperative management. In order to improve the clinical outcomes of this modified procedure, the selection of indications and surgeons' experience should also be taken into consideration.

Objective: To study the effect of reserving articular capsule and traditional total hip replacement for old patients with unstable femoral neck fractures., Methods: From January 2010 to January 2015, one hundred and twenty patients with femoral neck fracture were retrospective review. Among them, sixty patients were treated with total hip arthroplasty reserving articular capsule, the others were treated with traditional total hip arthroplasty without reserving articular capsule. The gender of reserving articular capsule group and traditional group were (male/female) 34/26, 31/29 respectively; the age were (73.4±4.4), (72.3±4.1) years old, respectively. All patients were followed up for six months, the operation time, blood loss, length of stay, incidence of postoperative complications, incidence of postoperative hip dislocation and hip Harris score of the two groups were observed., Results: The operative time of the reserving articular capsule group and traditional group were (95.68±6.90), (93.39±7.90) min ( P >0.05), and the blood loss were (998.78±15.20), (1 000.25±16.80) ml ( P >0.05). The time for hospital stay were (10.74±2.90), (13.25±2.20) days( P <0.05). The Harris scores were 58.53±5.10, 49.38±4.90( P <0.05) at 1 month after operation;91.08±7.50, 90.74±7.10( P >0.05) at 6 months after operation., Conclusions: The method of reserving auricular capsule can not increase the operative time and the blood loss. But it has a favorable effect on decreasing the hospital stay, complication, the rate of early dislocation of the hip joint, improving the function of hip joint., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To investigate the methods and the effectiveness of arthroscopic treatment combined with repair of the cyst wall using the tendon flap of medial head of gastrocnemius muscle after resection of popliteal cyst., Methods: A retrospective analysis was made on the clinical data of 140 patients with popliteal cyst between August 2009 and June 2014, including 44 males and 96 females with a mean age of 54.68 years (range, 14-80 years). The median course of symptoms was 31 months (range, 20 days to 30 years). According to Rauschning and Lindgren criteria for popliteal cyst grade, 4 cases were rated as grade I, 44 cases as grade II, and 92 cases as grade III. The preoperative Lysholm knee score was 68.99 ± 8.23. Firstly, cyst was resected, then the hernia sac of joint capsule was repaired with the tendon flap of medial head of gastrocnemius muscle, and finally a knee arthroscopy was used for the diagnosis and treatment of intra-articular lesions., Results: No complication of nerve or blood vessel injury, infection, or necrosis occurred. The mean follow-up was 26 months (range, 6-64 months). During follow-up, 1 case (0.71%) had cyst recurrence. According to Rauschning and Lindgren criteria for popliteal cyst grade, 37 cases were rated as grade 0, 92 cases as grade I, 10 cases as grade II, and 1 case as grade III at 6 months after operation, showing significant difference when compared with preoperative one (Z = -14.303, P = 0.000); the Lysholm knee score (85.51 ± 9.23) was significantly higher than preoperative score (t= -15.798, P = 0.000)., Conclusion: Arthroscopic treatment combined with repair of the cyst wall with the tendon flap of medial head of gastrocnemius muscle after resection of popliteal cyst is a better way to avoid recurrence.

Objective: To introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method., Methods: Between July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P > 0.05). The operation time, intraoperative blood loss, incision length, incision healing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale., Results: The intraoperative blood loss in trial group was significantly less than that in control group (P < 0.05). The incision length in trial group was significantly shorter than that in control group (P < 0.05). Difference was not significant in operation time and the rate of incision healing between 2 groups (P > 0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture healing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P > 0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003)., Conclusion: It can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.

Objective: To retrospectively analyze the advantages and disadvantages of radiographic methods commonly used for diagnostic of condylar fractures., Methods: From Jan 2002 to Nov 2013, 290 patients (405 condylars) in the temporomandibular joint (TMJ) division of Ninth People's Hospital Shanghai Jiao Tong University School of Medicine were diagnosed as condylar fractures. Panoramic films and CT were taken in all patients to check and count the amount of condylar fractures, including intracapsular condyle fracture (type A, B, C and M), condylar neck fracture and subcondylar fracture. MRI was also taken in 119 patients with 174 condylar fractures to check the position of TMJ disc. The data were analyzed and compared among the three examinations in the diagnosis of the condylar fractures., Results: Panoramic films showed 79.8% (323/405) condylar fractures. Among condylar fractures, intracapsular condylar fractures, condylar neck fractures and subcondylar fractures accounted for 48.9% (198/405), 20.3% (82/405) and 10.6% (43/405) respectively. CT showed 64.0% (259/405) intracapsular condylar fractures, 24.0% (97/405) condylar neck fractures and 12.1% (49/405) subcondylar fractures. Among intracapsular condylar fractures, Type A fracture was the most common type of ICF, which accounted for 48.7% (126/259), followed by Type B fracture, which accounted for 30.9% (80/259) and Type M fracture, 12.4% (32/259). Type C fracture was the least type which accounted for 8.1% (21/259). According to the diagnostic criteria of CT, there were 10 condylar neck fractures misdiagnosed with intracapsular condylar fractures. MRI showed 94.9% (129/136) TMJ disc displacement in intracapsular condylar fractures, 53.6% (15/28) in condylar neck fractures and 60.0% (6/10) in subcondylar fractures. Among intracapsular condylar fractures, there were 95.3% (61/64) TMJ disc displacement in type A, 95.2% (40/42) in type B, 89.0% (8/9) in type C, and 95.2% (20/21) in type M. There was significant difference of TMJ disc displacement between intracapsular condylar fractures and condylar neck fractures or subcondylar fractures (P < 0.05), and no significant difference between condylar neck fractures and subcondylar fractures (P < 0.05). There was also no significant difference among various type of intracapsular condylar fractures., Conclusions: Panoramic films can initially diagnose condylar fractures but with the high misdiagnosis rate for intracapsular fractures, minor fractures and fractures without fragment displacement. CT, especially coronal CT, should be considered for positioning fracture lines and confirming the displacement angle of fragment. MRI should also be used to determine the position of TMJ disc in intracapsular condylar fractures.

Objective: To study the effect of the double-digest and magnetic beads method for DNA extraction from 3 types of decomposed tissues., Methods: DNA of cartilages, nails and joint capsule in 91 highly decomposed corpses which had not been extracted by common magnetic beads method, were prepared with the double-digest and magnetic beads methods, and quantified with Quantifiler kit, followed by amplification with Sinofiler kit or Minifiler kit., Results: DNA concentration extracted from the 91 highly decomposed cartilages, nails and joint capsule samples was 0-0.225 ng/microL. Sixty-two samples whose DNA concentration were more than 0.020 ng/microL had obtained 9 or more STR loci successfully. The detection rate was 68.13%., Conclusion: The successful rate of STR genotyping for the 3 types of decomposed tissues can be significantly improved by the double-digest and magnetic beads methods.