Objective To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis based on individual condition. Methods Twelve patients with intracranial venous sinus thrombosis were treated with endovascular management according to the severity and course of disease after they failed to respond to anticoagulant therapy. The clinical signs and symptoms,cerebrospinal fluid pressure and arteriovenous circulation time were observed and followed up (including MRV). Intravenous thrombolysis and mechanical thrombus maceration were carried out in all 12 patients,while intravenous thrombolysis, mechanical thrombus maceration in combination with intra-arterial thrombolysis were employed in 3. After the treatment, anticoagulant therapy was carried out for 6 months.The patients were followed up for 12 to 24 months. Results Of the twelve patients, clinical signs and symptoms included slight headache (2 cases), mild hemiplegia (1 case), ambiopia or blurred vision (3 cases). The cerebrospinal fluid pressure returned to under 26 cm H2O (1 cm H2O =0.098 kPa)following treatment from 28 to 38 cm H2O [ mean (32. 4 ±3.0) cm H2O] in preoperative measurement and the arteriovenous circulation time returned to below 10 s in all patients following treatment. Neither recurrence of thrombosis nor new symptoms of neurologic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation with the exception of a subcutaneous bleeding at the venopuncture site. Conclusion Endovascular treatment is effective and safe for patients with intracranial venous sinus thrombosis.

Objective Hepatic artery (HA) reconstruction is one challenging procedure in pediatric liver transplantation (PLT).Here we review the first 115 microsurgical reconstructions of HA in PLT performed by a single surgeon,aiming to demonstrate the learning curve and the problems encountered.Methods From July 2016 to January 2017,a series of 115 microsurgical reconstructions of HA in PLT for end-stage liver disease were finished by one single surgeon with 4-year liver surgery experience and 2-week microsurgical training.HA reconstruction was performed with an operating microscope (Carl-Zeiss S88).Reconstruction was completed with interrupted sutures with 8-0 or 9-0 Prolene using the double clip for fixation.The blood flow was examined by Doppler scan daily after PLTs in first week and then once in 2nd week and first month for patency.A total of 143 artery anastomoses were performed in 115 PLTs.The age ranged from 3 months to 9 years.Indications for PLT included biliary atresia (105/115),Alagille syndrome (5/115),PFIC (3/115),Caroli disease (1/115),methylmalonicacidemia (1/115) and glycogen storage disease (1/115).Most of the PLTs were living donor liver transplantation (107/115),along with OLT (5/115) and split LT (3/115).Results The diameter of the arteries was mostly less than 2 mm (98/115).Up to date,one HA thrombosis (HAT) occurred at D8 after LT and 4 cases suspected as temporal HA stenosis (HAS) around 2 weeks after LT,which manifested as low velocity (<20 cm/s) and resistance index (<0.50) by Doppler.The HAT case failed in emergent re-anastomosis,but had a spontaneous recanalization at 3 weeks and is now in good condition without biliary problem.All the HAS children recovered to normal flows at first month.All children with HA complications started warfarin upon detection,with a targeted INR between 1.5-2.0.There were 6 deaths in this series including 5 cases of infections and 1 case of graft failure.Learning curve suggested a two phases growth (first 44 cases practicing phase vs.next 71 cases mature phase),which can be attributed to experience accumulation in terms of precise of manipulation,choice of inflow arteries for better match and stronger pulsation,avoidance of length redundant,prevention of kink.All the HAT and HASs happened in practicing phase while outcomes were excellent in mature phase.Moreover,time for each anastomosis was significantly shortened in second phase from 45-70 min to 30-55 min.Conclusion Microsurgical technique is highly safe in pediatric HA reconstruction,especially for very tiny arteries.It is possible to achieve low risk of complications for a new surgeon with adequate experience in liver surgery and microsurgical training.However,more surveillance and timing anticoagulation therapy is required before the mature of microsurgical technique.

Objective To study the postoperative survival rate of elderly patients with hip fracture at different time and its related factors.Methods We conducted the follow-up studies of 255 elderly hip fracture patients from June 2008 to June 2011 in our hospital.The survival rates of patients at 6 months,1,2 and 3 years after operation and their related factors were studied.Results The survival rate was 96.5％,89.8％,78.0％ and 69.4％ at 6 months,1,2 and 3 years after operation respectively in 255 elderly hip fracture patients.Survival analysis showed that many kinds of preoperative comorbidities,low albumin level,old age and severe anemia were the risk factors for survival.Good activity of daily living before injury was a protective factor for survival.Gender,fracture type,the American Society of Anesthesiologists (ASA) classification,time from injury to surgery,anesthesia type,surgical approach,operative time,blood loss and hospital stay periods had no effect on survival after operation.Conclusions The survival rate in elderly patients with hip fracture after surgery is affected by many factors.Preoperative comorbidities,anemia and hypoalbuminemia should be actively treated,the activity of daily living should be improved by the directed therapy and rehabilitation,in order to improve the survival rate in elderly patients with hip fracture.

Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo-rotic thoracolumbar fracture.Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob-served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi-sual analogue scale (VAS) and neurological function score (ASIA) of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured.Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P<0.05), but no significant differences existed on these parameters between 1 week post-operation and last follow-up (P>0.05).Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo-porosis, restore the height of fractured vertebra and reduce the compression of spinal canal, which will help the correction of spinal kyphosis and neurological function recovery. This method can well maintain long-term stability of internal fixation in osteoporosis and height of fractured vertebra, and significantly reduce the risks of long-term screw loosening and vertebral collapse.

Objective:To explore the repairing effects of 3D-printed nano-β-tricalcium phosphate (β-TCP) scaffolds loaded with vancomycin and bone morphogenetic protein-2 (BMP-2) for seawater -soaked tibial bone defects in rabbits. Methods:A total of 27 male New Zealand White rabbits were assigned to the normal group using a random number table method, with each group consisting of 9 rabbits. The rabbit tibial bone defect model was created using the osteotomy surgical method. Eight hours after operation, the wounds in the control group and seawater group were immersed in seawater for 2 hours, and those in the normal group were not immersed. After an observation period of 5-7 days, no significant redness or purulent discharge was observed in the wound appearance, then debridement was performed followed by corresponding implantations: the control group with gelatin sponges loaded with vancomycin and BMP-2, and the other two groups with 3D-printed nano-β-TCP scaffolds loaded with vancomycin and BMP-2. After filling the bone defects with the respective materials, all groups underwent layer-by-layer suturing of the wound, followed by disinfection with iodine and injection of gentamicin to prevent infection. The affected limbs were then immobilized using a plaster cast. The affected limbs were imaged using anteroposterior X-ray at 4, 8 and 16 weeks after operation, and the repair effects were evaluated using the Lane-Sandhu X-ray scoring system. At 16 weeks after operation, the bone defect tissues were collected for HE staining to observe bone tissue growth.Results:At 4 weeks after operation, the Lane-Sandhu X-ray score in the control group was significantly lower than that in the normal group [(2.8±1.1)points vs. (1.1±0.9)points] ( P<0.05), and that in the seawater group [(2.2±1.0)points] was not significantly different from those in the other two groups (all P>0.05). At 8 weeks after operation, the seawater group [(6.1±0.9)points] and the control group [(2.8±1.0)points] exhibited lower Lane-Sandhu X-ray score compared to the normal group [(8.2±1.0)points] (all P<0.05), and the seawater group showed a higher score compared to the control group ( P<0.05). At 16 weeks after operation, the control group [(3.8±1.0)points] exhibited a lower Lane-Sandhu X-ray score compared to the normal group [(10.0±1.3)points] and the seawater group [(9.3±1.2)points] (all P<0.05), while no significant difference was noted between the latter two ( P>0.05). At 16 weeks after operation, histological observations revealed varying degrees of bone tissue formation in three groups, with the normal group showing the best bone defect repair effect, followed by the seawater group. Conclusion:The 3D-printed nano-β-TCP scaffolds loaded with vancomycin and BMP-2 are effective for the treatment of seawater -soaked bone defects, which can promote bone tissue repair.