Dr. Zhou Lianqi(1915—2012), Professor of Surgery, Former First Chairman of Surgery and Director of Orthopedics, Renji Hospital

Introduction

He was a pioneer who left an indelible mark on orthopedics and one of the founders of the Orthopedics Department at Renji Hospital. In the push to modernize medicine in China, he was an exceptional practitioner and a trailblazing innovator.

Though his career took him across oceans, his allegiance remained with his homeland. Following the founding of the People’s Republic of China in 1949, he made the decisive choice to abandon a comfortable life abroad. He crossed vast seas to return to a nation recovering from decades of conflict, armed with advanced medical knowledge and a profound sense of duty to contribute to its rebuilding.

In the early years of the People’s Republic, he earned widespread respect from his peers in China and internationally for his groundbreaking research on the surgical treatment of poliomyelitis and his innovative approaches to spinal tuberculosis. The surgical methods he pioneered significantly improved his patients’ quality of life.

He served as the inaugural Chairman of the Orthopedics Branch of the Shanghai Medical Association and was a leading figure in Chinese bone oncology. His work filled a critical void in the study of bone tumors in China, providing clinicians with systematic knowledge and precise treatment guidelines. He launched his distinguished medical career at Shanghai Second Medical College, where he was appointed Director of Orthopedics.

With the heart of a dedicated servant and an unwavering passion for his field, he relentlessly explored and innovated. Through his wisdom and dedication, he forged a lasting legacy, nurturing the next generation of medical professionals and advancing the science of medicine in China.

The Path to Medicine

Zhou Lianqi was born on March 10, 1915, into a family of physicians in Hangzhou, Zhejiang Province. Immersed in this environment from a young age, he developed a profound interest in medicine.

The era of his youth was a time of immense upheaval in China. The 1911 Revolution had overthrowned imperial rule and established the Republic of China, but the nation’s path to modernization was fraught with challenges. Political turmoil, warlord fragmentation, and foreign aggression severely hindered national progress.

Against this backdrop, medical education—a vital component of modernization—faced immense obstacles. Healthcare conditions were generally primitive; while many regions relied on traditional Chinese medicine, Western medicine was still emerging in cities and lacked standardized training and widespread adoption.

With outstanding academic results, Zhou Lianqi was admitted to the Medical School of St. John’s University in Shanghai. This institution attracted numerous medical elites from China and abroad. Here, Zhou received systematic medical training, mastering foundational knowledge and essential clinical skills.

In 1941, he graduated with distinction. Over the next seven years, he worked at several prominent local institutions, including Shanghai Tongren Hospital, Soochow Hospital (now the First Affiliated Hospital of Soochow University), and Soochow Railway Hospital. These roles allowed him to hone his surgical expertise and gain extensive clinical experience.

Bringing Global Expertise to Renji Hospital

In 1947, Zhou Lianqi was admitted to the University of Pennsylvania School of Medicine. He first spent a year at the university’s medical research institute in Philadelphia, where he systematically studied the world’s most advanced orthopedic theories and surgical techniques.

Subsequently, he served as an orthopedic resident at Green Lake Sanatorium, St. Monica’s Hospital, and Brandon Orthopedic Hospital in the United States. This period exposed him to a diverse range of complex cases, significantly enhancing his surgical skills and clinical acumen.

When news of the founding of the People’s Republic of China reached America in 1950, Zhou was compelled by an irrepressible desire to return home. He resolutely chose to leave his stable life, bidding farewell to advanced laboratories and esteemed colleagues to contribute to his homeland’s medical cause.

The journey home required overcoming formidable obstacles. After protracted negotiations with U.S. immigration authorities, he finally secured permission to depart. He boarded a ship bound for Hong Kong, navigating vast oceans and circumventing barriers before finally reuniting with his motherland.

Upon his return, Shanghai Second Medical College was being established, becoming the stage for Zhou’s lifelong endeavors. In 1953, as the college was founded, Zhou was appointed Director of Orthopedics—a pivotal milestone in his career. After two years at Ruijin Hospital, he was transferred to Renji Hospital in 1957 during a departmental reorganization, where he continued as Director of Orthopedics.

During the 1950s, Zhou’s work focused on two critical areas: the surgical treatment of poliomyelitis and spinal tuberculosis.

Poliomyelitis (infantile paralysis) was then rampant in China, posing a major public health crisis. Limited medical resources and the absence of a vaccine meant many children were infected, often resulting in permanent limb paralysis. It was one of the leading causes of disability in the country. Zhou performed numerous surgeries for the sequelae of poliomyelitis, developing innovative methods such as triple arthrodesis and tendon transfers to restore function and improve quality of life. These procedures—which encompassed muscle transfers, joint fusions, and corrective surgeries—enhanced muscle strength, joint stability, and alignment, enabling some patients to regain near-normal mobility.

Spinal tuberculosis was also prevalent. In China’s early post-recovery phase, underdeveloped healthcare systems limited prevention and treatment options. Patients often suffered from spinal deformities, spinal cord compression, and disability due to delayed care. Zhou led his department in extensive research on the subject, publishing influential papers like “Complications of Spinal Fusion in Treating Spinal Tuberculosis: A Clinical Report of 120 Cases” and “A Study on Complications of Spinal Tuberculosis Fusion Surgery.”

Additionally, Zhou explored the field of surgical pharmacology. His team summarized the efficacy of hyaluronidase in treating hematomas and soft-tissue edema. Hyaluronidase works by breaking down hyaluronic acid, which reduces tissue viscosity and promotes the diffusion of fluids. This property accelerates the resolution of hematomas, reduces swelling, improves circulation, minimizes fibrosis, and aids recovery.

The year 1964 marked a milestone in Chinese bone oncology. Zhou spearheaded the publication of Bone Tumors, a landmark reference that filled a critical void in domestic literature. Aimed at clinicians, the book synthesized global knowledge and was based on foundational Western texts such as H. Jaffe’s Tumors and Tumorous Conditions of the Bones and Joints (1958) and L. Lichtenstein’s Bone Tumors (1958). It also incorporated recent international research and the team’s own clinical experience. The book’s 30 chapters covered fundamental topics—from history and classification to diagnosis and treatment—and detailed benign and malignant tumors, metastases, and tumor-like lesions. Illustrated with case studies, diagrams, and photographs, it was widely acclaimed.

The following year, Zhou’s team published the first domestic report on Tarsal Tunnel Syndrome—a condition caused by compression of the tibial nerve within the tarsal tunnel, a narrow space between the medial malleolus and the flexor retinaculum. Inflammation, injury, or tumors in this area can compress the nerve, causing plantar pain, numbness, burning, or weakness. Diagnosis relies on clinical exams and imaging, while treatment ranges from physical therapy to surgical decompression. Early intervention typically yields a good prognosis, whereas delays risk permanent nerve damage. First described by Keck and Lam in 1962, Zhou’s 1965 report bridged a crucial knowledge gap in China and cemented the academic reputation of the Renji Orthopedics department.

Striving to Recover Lost Ground
Following the tumultuous decade of the Cultural Revolution, Zhou swiftly resumed his work in orthopedics. As China entered an era of reform, its medical education and research sectors began to flourish once more.

Seizing this opportunity, Zhou deepened his academic pursuits. In 1979, he published his findings on ischemic contracture-induced clawfoot deformity, based on a series of 12 cases, as well as his work on the application of lumbar transverse process fusion for spondylolisthesis. He pioneered lumbar spinous process fusion in China and led the nation’s research into the diagnosis and treatment of lumbar spinal stenosis and nerve entrapment.

In 1981, the Orthopedics Branch of the Shanghai Medical Association was formally established. Zhou was elected by its 19 founding members to serve as its inaugural Chairman, a position he would hold for nine years.

As rapid urbanization led to a surge in industrial accidents and resulting limb amputations, the field of orthopedics was challenged to develop new techniques and innovations. That year, Zhou’s team published their method for thumb reconstruction using the residual little finger. This technique effectively restored both function and appearance while minimizing surgical complexity and the risk of rejection. The approach marked a significant advance in hand surgery, profoundly improving the lives of patients.

In September 1982, at the invitation of the President of the Canadian Spine Society, Zhou traveled to North America to attend spine surgery conferences in Ottawa and Denver, where he presented two papers.

That same year, he published research on the treatment of tibial shaft nonunion. In a study of 28 cases at Renji Hospital from 1973 to 1980, follow-up on 23 patients showed that 22 had achieved bony union within three to five months, a success rate of 92%. For 11 cases with a history of infection, posterior bone grafting successfully prevented recurrence. The study concluded that the Phemister grafting technique—being simple, low in complications, and highly effective—remained the first choice for uncomplicated cases, while posterior grafting was optimal for infected cases by avoiding the affected area.

Zhou also advanced the integration of neurosurgery and hand surgery. His team conducted a review of tendon transfers for paralytic claw fingers and nerve anastomosis for traumatic paraplegia. Under his leadership, they also carried out in-depth research on the repair of the flexor tendon sheath, refining treatments for hand injuries.

The 1980s saw rapid leaps in electronic technology, and Zhou closely monitored these innovations for medical applications. Mid-decade, Doppler ultrasonic stethoscopes were gaining traction in clinical use. Zhou’s team demonstrated the effectiveness of a custom-developed device in localizing vascular occlusions in limbs. It proved invaluable for assessing post-traumatic blood supply, checking anastomosis patency, and mapping vasculature, as it was non-invasive, reliable, and user-friendly.

Drawing on international reports that electromagnetic fields could promote bone healing, Zhou conducted both animal experiments and clinical trials mid-decade. His animal studies showed that a 2-gauss magnetic field accelerated the healing process by one-third. Clinical observations of 58 patients supported these findings. His work provided a systematic discussion of the underlying mechanisms and reviewed global methods in the field.

As CT technology emerged, Zhou’s team turned their attention to lumbar spinal stenosis. This condition, caused by the compression of nerves due to bony or soft-tissue hypertrophy, leads to back pain, leg numbness, weakness, and intermittent claudication, and is prevalent in aging populations. Using myelography and CT scans, they analyzed 54 cases, excluding those with spondylolisthesis. The use of CT, which provided crucial three-dimensional imaging for surgical planning, was a key component of their work. Beyond the 15 cases of spondylolisthesis treated with laminectomy and fusion, other patients underwent laminectomy and medial facetectomy, achieving a success rate of nearly 90%.

The team concluded that myelography and CT were vital for diagnosing complex cases of stenosis, emphasizing that normal canal size varies by individual and that bony metrics alone are insufficient for diagnosis. For spondylolisthesis, they noted that laminectomy alone might not relieve symptoms, necessitating personalized surgical strategies. This research provided a critical theoretical foundation for treatment.

By the late 1980s, rising living standards and more sedentary lifestyles led to an increased incidence of lumbar disc herniation. Zhou’s team analyzed surgical outcomes in hundreds of cases. A long-term follow-up of 45 patients, ranging from one to 33 years, revealed age-specific patterns of degeneration. They discussed the indications for conservative versus surgical treatment, emphasizing that not all back and leg pain originates from a herniated disc. They found that clinical signs alone were inadequate for an accurate diagnosis; the use of CT, especially when combined with myelography, significantly improved diagnostic precision. Intraoperatively, they recommended that if no clear lesion was found, a partial facetectomy should be performed to expose the lateral recess and avoid missing a pathology.

This comprehensive study offered vital clinical insights, underscoring the need for integrated diagnostics and surgical precision to guide optimized treatment and improve prognoses.

Epilogue

The life of Zhou Lianqi both witnessed and shaped the development of modern orthopedics in China. His exceptional surgical skills healed countless patients across the nation, while his forward-thinking vision nurtured generations of orthopedic talent. Among his protégés were distinguished figures like Academician Chen Zhongwei and Academician Dai Kerong, who inherited his commitment to medical ethics, scholarly rigor, and clinical excellence. He personally mentored four master’s students and twenty young orthopedists who have since become pillars in their own fields, perpetuating his legacy.

Zhou Lianqi passed away in 2012, but he left behind a rich legacy in the orthopedic world he so deeply cherished. His academic achievements, his noble medical ethics, and his boundless love for the field of medicine endure, continuing to inspire future generations to advance the healing arts.

Editor: Chen Qing @ ShanghaiDoctor.cn, 

Note: Chinese Sources from “The Path of Benevolent Medicine” which was published in 2024. It records 90 important medical figures in the history of Renji Hospital. Yewen Renyi (ShanghaiDoctor.cn) team was one of the major writers of the book and is authorized by Renji hospital to create English version on the website of ShanghaiDoctor.cn