[Objective]To investigate the treatment method and clinical outcome of posterior midline approach and internal fixation with Y-shaped plate for complex distal 2/3 humeral fracture.[Method]From November 2001 to February 2006,33 patients with complex distal 2/3 humeral fracture were treated with posterior midline approach and Y-shaped plate internal fixation.There were 5 females and 28 males,with a mean age of 37.6 years(ranging from 19 to 57 years).According to AO/ASIF classification,type C1 fracture was found in 21 cases,type C2 in 3 cases and type C3 in 9 cases.Seven of these were open fractures(4 cases of Gustilo-Anderson type Ⅰ and 3 cases of type Ⅱ).Measures of auto-ilium transplant(21 cases)and homolegous allograft bone transplant(12 cases)were also taken.The operation was performed at 2.5 hours～7 days after injury with mean 3 days.[Result]Thirty-three patients were followed up for a mean period of 15.6 months(6～28 months).Fractures of 31 patients healed at 19 weeks after the treatment.Delayed union occurred in two patients.The function of the elbow was evaluated according to Morrey's scale,the results showed excellent in 24 cases,good in 7 cases,and poor in 2 cases.At the last follow-up,the muscle strength of elbow extension was about 4～5 grade.[Conclusion]Posterior midline approach and Y-shaped plate internal fixation of complex distal 2/3 of humeral fracture is a safe and effective technique.Protecting the radial nerve and ulnar nerve,prophylactic bone grafting and reasonable postoperative rehabilitation are very important to obtain satisfactory clinical outcome.

Helical tomotherapy is the radiation treatment device that combined CT imaging with a linear accelerator, and capable of implementing 360-degree intensity modulated radiation therapy (IMRT), MVCT image guidance, adaptive therapy, stereotactic radio-surgery (SRS) and stereotactic body radiation treatment (SBRT) etc. A very broad spectrum of tumor can be treated by helical tomotherapy.

The rapid cooling contracture in myocardial protection is getting more and more attention. Rapid cooling contracture is referred to as the undepolarized myocardial contracture induced by rapid cooling, which is related with the sudden increase of Ca2+. The Ca2+ released from sarcoplasmic reticulum subsequently causes myocardial contracture through the myofilaments sliding. Its deleterious effects include: more energy consumption, impaired cardiac function, Ca2+ overload, et al. And some investigators have put forward some principals to prevent the bad influences of rapid cooling contracture.

[Objective]To observe clinical value of multi-slice spiral X-ray computed tomography(MSCT)volume rendering technique(VRT)and multi-planar reconstruction(MPR)in classification and treatment of tibial plateau fracture(TPF).[Method]From August 2005 to February 2009,49 fratures in 45 patients with TPF were treated.Their clinical data were studied retrospectively.There were 32 males and 13 females.The patients were aged from 20-65 years(mean 46 years).Four patients suffered bilateral TPF.All patients were examined with standard X-rays and 64-slice spiral CT scanner.Axial CT scans were processed with VRT and MPR.Their X-ray plain films and 64-slice spiral CT seans(including VRT and MPR)were performed to determine their fracture types and protocol.[Result]According to the VRT and MPR findings,13 fractures(13/49)classified by X-ray plain film were corrected,protocols were changed for 9 fractures(9/49),and 15 fractures(46.9%)of intereondylar eminence of the tibia and 6 fractures(28.6%)of proximal fibula were underdiagnozed.[Conclusion]MSCT(VRT+MPR)can clearly show the area and degree of tibial plateau collapse,the details of TPF and the delitescence fracture,help to determine TPF types,decrease the underdiagnosis rate and choose a rational protocol.The use of combined VRT and MPR is a supplementary means for X-ray plain film and axial CT scanning.which has great clinical value.

Objective To observe influence of auxiliary treatment of bronchoscopy alveolar lavage on respira-tory mechanics index and infection control effect in patients with severe ventilator associated pneumonia(VAP). Methods 84 cases of severe VAP patients were randomly divided into the observation group (n =42 cases)and con-trol group (n =42 cases),control group was given antibiotics and conventional sputum suction lavage treatment,the observation group was given bronchoscopy alveolar lavage and antibiotics.Clinical pulmonary infection score (CPIS) and serum calcitonin level (PTC)were recorded in the two groups before and after treatment.Respiratory mechanics indexes such as the dynamic compliance (Cdyn),the airway peak pressure (PIP),work of breathing (WOB)and airway resistance (Raw)were measured in the two groups before and after bronchoscopy alveolar lavage,and the clin-ical efficacy of two groups were compared.Results CPIS of the observation group (6.37 ±1.31),(5.42 ±1.13), (3.52 ±0.53)was significantly lower than that of the control group (7.72 ±1.56),(7.14 ±1.33),(5.13 ± 0.94)(t =4.295,6.387,5.821,all P <0.05 )after 3,5,7d treatment.PTC of the observation group ((4.71 ± 0.85)μg/L,(2.65 ±0.61 )μg/L,(0.62 ±0.23)μg/L)were significantly lower than those of the control group (5.10 ±0.92)μg/L,(3.96 ±0.72)μg/L,(1.31 ±0.43)μg/L(t =4.295,6.387,5.821,all P <0.05)after 3,5, 7d treatment.Cdyn of the observation group after 1 and 4h bronchoscopy alveolar lavage (35.39 ±6.39),(35.59 ±5.83)were high those of the control group (26.82 ±4.63),(25.64 ±4.28)(t =7.038,-10.462,all P <0.05);WOB (10.08 ±0.45),(8.10 ±0.38),PIP(21.28 ±2.76),(15.29 ±1.67)and Raw (10.08 ±0.45),(8.10 ± 0.38)in the observation group after 1and 4h bronchoscopy alveolar lavage were lower those in the control group WOB (0.63 ±0.17),(0.49 ±0.12),Raw(13.49 ±0.50),(11.42 ±0.42),PIP(27.38 ±3.10),(23.44 ±2.60)(1h:t =9.681,3.937,32.853,all P <0.05;4h:t =12.231,6.064,6.313,all P <0.05).Total effective rate of the obser-vation group was obviously higher than that of the control group after treatment (93.3% vs.77.8%,chi -square =5.486,P <0.05).Conclusion Auxiliary treatment of bronchoscopy alveolar lavage has clinical curative effect in patients with severe VAP,the method can effectively decreased PTC level of VAP patients,to acquire lung infection control,and improve the respiratory mechanics parameters.

Objective To evaluate the clinical efficacy of absolute ethanol combined with histoacryl sclerotherapy in treating high-reflux venous malformation in children.Methods The clinical data of a total of 339 sick children with venous malformation,who were admitted to authors' hospital during the period from April 2009 to April 2014 to receive interventional sclerotherapy under general anesthesia,were retrospectively analyzed.Sclerotherapy with absolute ethanol combined with N-butyl cyanoacrylate (NBCA) was carried out in 137 sick children with high-reflux type venous malformation.The patients were followed up for 6-24 months (mean of 15 months).Results Successful sclerotherapy with absolute ethanol combined with NBCA was achieved in all 137 sick children with high-reflux type venous malformation.Complete cure was obtained in 23 sick children,basic cure in 31 sick children,and effective response (improvement) in 42 sick children;the total effective rate was 70％ (96/137).Ectopic embolization due to reflux of NBCA occurred in one sick child,skin ulceration was seen in 8 sick children and intraoperative transient pulmonary hypertension was observed in 3 sick children.The adverse reaction rate was 8％(12/137).Conclusion For the treatment of high reflux venous malformation in children,sclerotherapy with absolute ethanol plus NBCA is safe and effective,this technique carries low incidence of adverse reactions.(J Intervent Radiol,2017,26:217-220)

[Objective]To explore the surgical technique and clinical results of minimally invasive incision dynamic hip screws (DHS) in treatment of intertrochanteric fractures in the elderly.[Method]From August 2001 to January 2006,37 old cases (15 males and 22 females, aged from 72 years to 92 years, mean 81.5 years) with intertrochanteric fractures were treated with closed reduction and DHS using minimally invasive technique in our hospital. The procedure included following and critical steps:1～2 k-wires was inserted into the upper part of the femoral head through great trochanter percutaneously after operation. A guide wire was inserted into the center of the femoral head according to 135? collodiaphyseal angle; then, a small incision (4～5.5 cm) was made and along the guide wire for inserting a screw into the femoral head. The guide wire was removed and the side plate was slipped under the soft tissue into to tightly contact the lateral surface of femur, and followed by the side plate barrel being seated on the screw.[Result]The operation time was 40～75 minutes (average 60 minutes) The mean amount of blood loss in, operation was 55 ml. The mean amount of hemoaleh:in showed no significant difference between postoperation and preoperation. The following-up period averaged 15 months (11～18 months) The clinical hone healing lasted for 10～15 weeks. Two cases had mild coxa vara, there were no incision infection, fixation failure or lower extremity rotatory deformity. The excellent rate of joint function was 94.6% according to DONG's assay standard. [Conclusion]Minimally invasive incision DHS has the advantages of shorter operation time, less blood loss, little trauma, less complications and quick functional recovery and is an effective and safe method for treatment of femoral intertrochanteric fractures in the elderly.

[Objective]To evaluate the clinical characteristics and effect of operative treatment for the ossification of ligamentum flavum thoracic spinal stenosis (OLF-TSS). [Methods]From October 1998 to February 2007,38 patients with OLF-TSS were treated with en bloc hemi-articular process laminectomy. In this group,25 cases were male,and 13 cases were female. The average age was 48 years (range,29～71 years). Totally 81.6% of the lesion was between T10～L1 intervertebral disc space.The average history was 10 months. There were 5.3 percent with protrusion of intervertebral disc of thoracio spine.[Results]Thirty-eight cases were followed-up for 1～8 years,with an average of 3 years and 6 months. Dural injury occurred in 4 cases of 38,3 cases appeared postoperative cerebrospinal fluid leakage. All cases were cured conservatively mainly with bed rest in the prostrate position. According to WANG's evaluation,25 had excellent results,11 had good results,2 had no change and none was poor,The excellent to good rate was 94.7% in this group. There were no patients with the wrong level. No patient neurological functions were deteriorated.[Conclusion]The chinical features of OLF-TSS are very complex. The common symptoms of the disease are progressive onset of numbness,weakness,low back pain,intermittent claudication of the lower extremities,constriction on trunk or lower limbs and sphincter dysfunction. The clinical presentation and neurological examination associated with X-ray film,MRI and CT were the important means of the diagnosis of the disease. Removal of the posterior wall of the thoracic spinal canal via the technique of en bloc hemi-articular process laminectomy is safe and effective to treat OLF-TSS. The strategy for diminishing fault and complications is to discriminate pathogenic segment (locating-diagnosis) and follow the principles of surgical procedure.

[Objective]To evaluate the surgical management and its results of type A fractures of distal humerus in children utilized with double tension hands(DTB).[Method]From January 1999 to May 2005,52 patients of type A fractures of distal humerus in children were treated surgically through approach of DTB.Seven patients suffered open fractures(Gustilo scale Ⅰ in 5,and Ⅱ in 2).Fourty-five patients suffered closed fractures.According to AO/ASIF classification,type A2 fracture was found in 41 cases and type A3 in 11 cases.The elbows were flexed to 90?and immobilized with long-arm casts for 2 weeks.The rehabilitation exercises began at 2～3 weeks post-operatively.[Result]All the patients were followed up,with the duration from 6 to 18 months(averaged,12.5 months).All the fractures were healed,no cubitus varus deformity.The function of the elbow was evaluated according to Flynnet's scale,the results showed excellent in 41 cases,good in 10cases,and poor in 1 case.[Conclusion]The use of DTB for the surgical management of type A fractures of distal humerus in children has many advantages,it provides a new sufficient internal fixation with simple technical procedure,anatomical reduction under direct vision,reliablestability,facilitates rehabilitation exercises and low complication rate.DTB is a better choice in treatment of type A fractures of distal humerus in children.

Adult ; Aged ; Chordoma ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; surgery ; Surgery, Computer-Assisted ; Young Adult