Objective To study the effect of the continuous pulsing water ball in preventing infection in the multi-level posterior lumbar interbody fusion(PLIF).Methods From June 2016 to December 2016,thirty patients who were treated with multi-level posterior lumbar interbody fusion in our hospital were randomly divided into two groups.The 15 patients in the observation group were given continuous pulsing water ball,and the other 15 patients in the control group were given conventional dumping.The items including the time of intraoperative washing,the C-reactive protein(CRP),the time of suture clearing,postoperative fever cases and postoperative incision healing were oberved and compared between the two groups.Results The time of intraoperative washing was (2.13±0.15)min in the observation group and (5.59±1.24)min in the conrtrol group,and the difference was statistically significant (P<0.05).The postoperative CRP of 1st,3rd, and 5th day in the observation group was declining,whileas the control group was increasing.The time of suture clearing in the oberation group was 11.57 d, which was significantly less than 14.29 d the control group.The temperature of 3rd and 5th day after opreation in the obervation group was (37.1±2.26)℃ and (37.0±0.12)℃ respectively, which were significantly lower than (38.2±3.34)℃ and (37.5±0.25)℃ respectively the control group,and the difference was statistically significant(P<0.05).Conclusion Compared to the the conventional dumping,the continuous pulsing water ball has the some advantages in the multi-level posterior lumbar interbody fusion (PLIF),such as decreasing the washing time and reducing the local inflammatory reponse.

Objective To analyze the operation time,radiation exposure time and the screw placement accuracy of a newly-developed guiding chunnel-assisted percutaneous pedicle screw placement technique for thoracolumbar vertebral fractures not accompanied by nerve injury.Methods The clinical data of 35 patients with thoracolumbar vertebral fractures not accompanied by nerve injury,who were treated with newly-developed guiding chunnel-assisted percutaneous pedicle screw placement technique during the period from July 2010 to October 2012,were retrospectively analyzed.A total of 178 procedures of pedicle screw placement were performed in the 35 patients by the one and the same surgeon.The operation time and radiation exposure time of each pedicle screw placement procedure were recorded,and based on the findings of postoperative consecutive two CT scans of the operated vertebrae the screw placement accuracy was graded and evaluated.Results The technical success rate of screw placement was 100％.The mean time used for a single pedicle screw placement was (11.35±2.82) minutes,the average radiation exposure time was (8.06± 2.15) seconds.Screw placement accuracy of grade A was obtained in 156 screws (87.64％),grade B in 20 screws (11.24％),grade C in one screw (0.56％),and grade D in one screw (0.56％).Conclusion The newly-developed guiding chunnel-assisted percutaneous pedicle screw placement technique is very helpful in localizing the puncture point,in improving the screw placement accuracy,and in reducing both operation time and radiation exposure time.

Objective To observe the changes of TNF‐α,interleukin IL‐6 ,IL‐10 and gas analysis though one lung ventilationone with two different pattern to study the effects lung injury and values of oxygenation on patients undergoing esophageal surgery . Methods 60 patients with esophageal cancer were randomly divided into two groups of A and B with 30 cases each .A term :contin‐ual one lungventilation and 4 cm H2 O peep until the end operate ,B term :intermittent one lung ventilation each 45 min with two lung ventilation 5 min .Blood gas analysis were determined immediately before one lung ventilation ,30 min following OLV ,60 min following OLV ,90 min following OLV ,120 min following OLV ,the end of the OLV ,after operate 24 h observe the MAP ,HR ,P , R ,SpO2 .PETCO2 and airway peak were recorded during operate .Results (1)SpO2 in group A was decreased at T3 and reached lest level at T5 ,which was higher than that in group B at T3 ,T5(P<0 .05) .(2)the levels of IL‐6 ,TNF‐α and IL‐10 in the two groups began to rise at T3(P<0 .01) ,reached peak level at T6 ,and decreased gradually at T7 ,which were still higher than those at T1(P<0 .05) .(3) The levels of TNF‐αand IL‐6 were lower in group A than those in g roup B at T3-T6(P<0 .05) ,T1 ,T2 ,T7 (P>0 .05) .The levels of IL‐10 was higher in group A than those in group B at T3-T7(P<0 .05) .Conclusion Compared with A term ,B term without VT has more lung injury although it increases values of oxygenation .

Nutrition support includes three parts: supplementation, support, and therapy. When? and how? to use nutrition support which should be related with clinical outcome of the patients. Parenteral nutrition became widely accepted in the States since the presentation at American College of Surgeons Congress 1967 by Dudrick et al. More detail study of baby growth and development receiving all nutrients exclusively by vein from Wilmore et al 1968. In China, it was Jiang et al reported the clinical applications of parenteral nutrition at Surgical Congress of Chinese Medical Association 1978. Enteral elemental diet and parenteral nutrition for intestinal fistulae illness by Jiang et al 1979 which enrolled by Medline. Although nutrition support has become a standardized technology in China, but evidences on improving the patients' outcomes were still insufficient. After Kondrup et al estsblished Nutritional Risk Screening 2002 tool, the nutrition support could use an evidence-based approaching with outcome. One prospective cohort study based on hospitals in Baltimore and Beijing, using Nutrition Risk Screening 2002 as the tool, have evaluated the impact of nutritional support (both parenteral and enteral nutrition) on the infective complications among patients at nutritional risk and demonstrated that the overall incidence of complications was significantly lower in patients who had received nutritional support, which was achieved mainly due to the decline of the incidence of infective complications. Therefore, support with appropriate nutrients being necessary for patients at nutritional risks or already with malnutrition. However, more cohort studies and randomized controlled studies with larger samples are still required.

Objective To analyze the characters about anticoagulation EDTA on the platelet aggregation ,and discuss the risk factors about EDTA‐PTCP by analyzing the biochemical parameters .Methods 30 700 EDTA‐K3 blood samples were collected from January 2014 to August 2015 .WBC was performed using Sysmex XN‐3000 and 27cases were identified of EDTA‐PTCP .The blood samples of 27 subjects were recollected and WBC was repeated using EDTA‐K3 and sodium citrate blood ,respectively .Manual platelet counting and smear microscope examination on periphery blood were also performed .Biochemical parameters of 27 subjects with EDTA‐PTCP were compared with 50 randomly selected non EDTA‐PTCP controls .Results Platelet counts in citrated blood were significantly higher than EDTA blood ,the difference was statistically significant(P< 0 .05) ,but similar to manual platelet counting(P>0 .05) .ALT ,Glu and TG in patients with EDTA‐PTCP were significantly higher than normal people ,but HDL was significantly lower than control group ,the difference was statistically significant(P<0 .05) .Conclusion EDTA‐dependent pseudo‐thrombocytopenia varies from people with different disease or using different medicine .It may be relative to hyperglycemia and hy‐perlipidemia .Another approach for rectifying ,changing anticoagulant or manual platelet counting is a better way lead to correctly di‐agnose when EDTA‐PTCP occurred .

[Objective]To evaluate the effect of post-operative rehabilitative nursing of patients repaired with acellular nerve allograft.[Method]From April 2003 to April 2006,39 inpatients with peripheral nerve defect were subjected to receive acellular nerve allograft in order to repair nerve defect.The patients were rehabilitated with special nursing after being operated and discharged.Among of them,21 patients were followed up over 6 months,the effect of treatment was analyzed.[Result]Among 21 patients,16 people had excellent and good effect of treatment and the efficient rate was 71.4%.[Conclusion]Post-operative rehabili tative nursing is important and effective for rehabilitation patients of peripheral nerve injuries repaired with acellular nerve allograft.

Objective To investigate the changes of fractalkine (FKN) in rat model of acute liver failure (ALF) and the role of FKN in liver inflammatory injury.Methods SD rats were divided into tWO groups:6 in normal group and 36 in model group.D-galactosamine(D-Gal) was used to induce ALF in model group.The sera and hepatic tissue samples were collected at 12,24,48,72,120 andl68 h.After D-Gal injection.FKN mRNA and nuclear factor(NF)-kB mRNA in hepatic tissue samples were detected by reverse transcription-polymerase chain reaction (RT-PCR).Results The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at 12 h were(208.3±43.5)U/L and (375.2±117.3)lJ/L,respectively,which were both significantly higher than those in normal group[(31.8±2.9)U/L and (90.8±3.1)U/L](t=-9.912 and-5.935,respectively,both P<0.01);the levels of ALT and AST peaked at 72 h after D-Gal injection.The levels of FKN mRNA(O.086±0.009)in model group at 12 h were significantly higher than those (O.044±0.009) in normal group(t=-7.999.P<0.01),and peaked at 72 h (O.333±0.033),then decreased obviously at 120 h. The levels of NF-KB mRNA in the liver of normal rats were very little;and the levels in model group were increased gradually over time,then peaked at 72 h (O.583±0.i01,t=-12.607,P<0.01).FKN mRNA and NF0kB mRNA were positively correlated (r=0.760,P<0.01).Conclusion The FKN expression may play all important role in liver inflammatory injury in rat model of acute liver failure, which could provide a new approach for ALF therapy.

Objective To discuss the short-term clinical effect of K-Rod pedicle dynamic fixation system for multiple segmental lumbar degeneration. Methods From January 2010 to October 2012,28 patients with multiple segmental lumbar degeneration who were accepted K-Rod pedicle dynamic fixation system were retrospectively reviewed. The short-term clinical effect were based on Oswestry disability index score,visual analogous scale ( VAS) ,improvement rate of low back pain,postoperative lumbar hyperextension, hyperbend X-ray film lumbar ROM value ( lumbar flexion mobility) ,average operation time, intraoperative blood loss. Results All of 28 cases were achieved 12 ~24 months follow-up,the difference of Oswestry disability index score and visual analogous scale ( VAS) between 12 months postoperatively and preoperatively were statistically significant,the improvement rate of low back pain was (87. 0 ± 2. 0)%,the average operation time was (99. 6 ± 16. 2) minutes,the average blood loss was (70. 5 ± 31. 5)mL,the average length of stay(ALOS) was (11. 2 ± 2. 6) days after sur-gery. Conclusion K-Rod pedicle dynamic fixation system in the treatment of multiple segmental lumbar degeneration can obtain satisfactory short-term clinical effect.

Objective To discuss the clinical effect and the notes of atlas lateral mass screws combined with posterior epistropheus ped-icle screws for the treatment of atlantoaxial joint instability. Methods In our hospital from January 2006 to January 2011,48 cases of atlan-toaxial joint instability accepted operation of the atlas lateral mass screws combined with epistropheus pedicle screws were analyzed. Results All patients with follow-up time 12~24 months,an average of 17 months,were achieved primary healing and atlanto-axial intervertebral osse-ous healing. Besides postoperative neck pillow area pain improved and nerve function get a degree of recovery,there was no inner fixed damage cases. Complications of operation include venous plexus hemorrhage was in 2 cases,cervical occipital pain and numbness increase in 3 cases,cere-brospinal fluid leak in 2 cases,vertebral artery extrusion occlusion after cerebral ischemic symptoms in 1 case. Conclusion Combination of atlas lateral mass screws and posterior epistropheus pedicle screws technique is one of the effective means of treatment of atlantoaxial joint instabili-ty and can obtain satisfactory clinical effect. Standard operation performance is the key to reduce or even eliminate surgical complications.