Objective To compare the effects of surgical versus non-surgical treatment for femoral neck fractures in elderly patients,in order to provide guidance on treatment options.Methods The clinical effects and complications of different approaches from 42 patients with femoral neck fractures who had received treatment at our department from February 2006 to August 2011 were retrospectively analyzed.Results Of the 42 cases,13 cases were treated with artificial hip replacement,18 cases with hollow lag screw fixation,and 11 cases with tibial traction.No death occurred in patients treated with surgery,and 4 patients who had received non-surgical treatment died within 6 months of the followed-up.Conclusions Very elderly patients with femoral neck fractures generally perform well under appropriate perioperative care.Surgical treatment can produce good therapeutic effects,shorten the time for bed rest,improve the quality of life and reduce the mortality rate.

Objective To study the curative effect of anterior cervical discectomy with fusion (ACDF)and anterior cervical corpectomy with fusion (ACCF)for multi segment cervical spondylosis;and to provide effective anterior surgery for the disease.Methods According to digital table,106 cases with multi segment cervical spondylosis were randomly divided into ACCF group of 54 cases and ACDF group of 52 cases.The ACDF group was treated with ACDF,and the ACCF group was treated with ACCF.The operation time,bleeding volume and excellent rate of cervical functional improvement of the two groups were observed,and the bone graft fusion,cervical vertebra height change and the change of cervical curvature of the two groups were evaluated.Results The operation time of the ACDF group was higher than that of the ACCF group,the amount of bleeding of the ACCF group was lower than that of the ACDF group,and the differences werestatistically significant (t =2.857,9.097,all P <0.05 ).After 6 months and 12 months,the segments of the ACDF group were higher than those of the ACCF group,the differences were statistically significant (t =8.157,6.330,all P <0.05).After 6 months and 12 months,the section curvature increases and cervical vertebra increased curvature of the ACDF group were lower than those of the ACCF group,the differences were statistically significant (t =4.707,4.575,4.083,3.987,all P <0.05).The complication rate of the ACDF group was 11.5%(6 /52),which of the ACCF group was 13.0%(7 /54),the difference was not statistically significant (χ2 =0.050, P >0.05).Conclusion For multi segment cervical spondylosis,there are no significant differences in efficacy and stability between ACDF and ACCF;ACCF surgery field is more clear and easy to operate,the operation time is short, and there is the phenomenon of titanium mesh sinking.In the maintenance of cervical curvature,ACCF is better than ACDF.

Objective To study the clinical feature,diagnosis,treatment and prognosis of hepatocellular adenoma(HA).Methods The clinical data of 10 patients confirmed pathologically with HA,were retrospectively analyzed.Results There were four females and six males,aging from 25 to 71 years(mean:42.6 years).Among these 10 patients,6 cases were discovered to have no clinical symptom.Tumors were located in the right lobe of the liver in 4 cases,and in the left lobe in 6 cases.Uhrasonography was performed in all cases.Six cases underwent CT examination and three cases experienced MRI as well as angiography was conducted in one case.All cases were confirmed by complete excision and pathology.All of them were followed up for 5 months to 9 years without tumor recurrence.Conclusion The combination of imaging data is helpful in the diagnosis of HA.Surgery is the best treatment with satisfactory results,and its prognosis is fairly good.

Objective To compare the knee of patient controlled subcutaneous injection of morphine analge-sia after hip joint replacement ( PCSA ) and intravenous morphine patient-controlled analgesia ( PCIA ) effect and safety of postoperative analgesia.Methods 60 patients undergoing artificial total knee arthroplasty patients were selected and randomly divided into PCIA group of 30 cases,30 cases in group PCSA, two patients were completed under epidural anesthesia in the operation.Group PCIA and group PCSA single dose divided into 1mg/and 2.5mg/, lock time divided into 5min,20min,in the postoperative pain perception,from the patient's own pain medication.After 4h,8h,12h,24h record patient morphine dosage,frequency,pain score (VAPS),mean arterial blood pressure and re-spiratory rate,compose degree,analgesic effects were compared between the two groups.Results In group PCSA after 24h treatment for the total dose was (30.41 ±10.00) mg,significantly higher than that of group PCIA (18.03 ± 6.04)mg,there was significant difference between the two groups (t=3.98,P<0.05);but after each time point of the two groups of patients the average dosage had no statistically significant difference (P>0.05).PCIA group after 0-4h and >4-8h analgesia and sedation were better than those in PCSA group (t=3.4,3.2,3.5,3.7,all P<0.05), PCIA group,the incidence rate of nausea and vomiting was 30%,higher than 12%in the PCSA group,there was sig-nificant difference between the two groups (χ2 =5.76,P<0.05).Conclusion The two kinds of methods of analge-sia has a good analgesic effect,but PCSA analgesia is slower,less adverse reactions,should be given a loading dose at the beginning before PCSA,in order to improve the early analgesia effect.

Objective To investigate the effectiveness of surgical resection for metastatic liver cancer in patients of gastric carcinoma, and evaluate the prognosis. Methods Clinical data of 24 gastric cancer cases undergoing hepatectomy for hepatic metastatic tumor were collected retrospectively. There were 18 cases of synchronous resection and 6 cases of heterochronous resection. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses. Results Postoperatively all cases were followed up until the death of the patietns. Counting from the time of liver resection the 1-,3- and 5-year survival rate was 67%, 21% and 13% respectively. Univariate analysis showed lymph node involved, tumor size of hepatic metastases, vascular invasion and R0 margin as significant prognostic factors;Multivariate analysis indicated that tumor size of hepatic metastases and vascular invasion were independent prognostic factors influencing the survival. Conclusion These results suggest that for patients with liver metastasia from gastric cancer, better prognosis can be obtained by surgical treatment.

Objective To explore the roles of insulin in the early treatment of acute brain injury and its administration methods.Methods 253 patients were randomly divided into the intensive insulin therapy group and the conventional therapy group.Infection rates,the short-term effect (APACHE Ⅱ assessment),and long-term efficacy (GOS prognosis) was compared between two groups.Results The results of the strengthen treatment group in the rate of infection (25.95％ vs 39.34％,x2 =5.17,P ＜0.05),the short-term effect (11.33 ± 7.66 vs 16.49 ± 14.97,u =3.42,P ＜ 0.05) and the long-term efficacy (40.46％,55.73％,3.82％ vs 25.41％,68.85％,5.74％,x2 =7.62,P ＜0.05) were significantly better than the conventional therapy group with the statistically significant differences (P ＜ 0.05).Conclusions The hypoglycemic effect,neuroprotective effect,regulatory role,and nutrition role of insulin occurred in the early treatment of acute brain injury.After acute brain injury,patients with hyperglycemia should be treated early with an enough volume,continuous,and uniform insulin.

Objective To observe the efficacy of open - door expansion laminoplasty in treatment of 36 cases with cervical stenosis. Methods 36 cases with cervical stenosis were all carried out open - door expansion laminoplasty. Then the efficacy and JOA17 scores were observed. Results 36 patients were followed up, the surgery fine rate was 85% ,JOA17-score of peroperation and postoperation was 5.23 and 10. 25 respectively. Conclusion The open - door expansion laminoplasty was a safe and effective surgery methods in treatment of cervical stenosis

Objective To investigate the effeit of Reconstruction of tantalum metal rod implantation in the treatment of early ischemic necrosis of femoral head( Steinberg Ⅰ～Ⅱ period) ,to explore the early femoral head ischemic necrosis of minimally invasive treatme(n)t. Method 24 patients( Steinberg Ⅰ～Ⅱ period) using C-arm fluoroscopy machine,under the greater trochanter through the neck hole to avascular necrosis zone,the first zone of the medullary sclerosis core decompression, re-implantation of tantalum rod to the subchondral bone is about 0.5 cm, through the Harris score before and after surgery for comparison. Results After follow-up 9(2 ～ 12) months,preoperative pain and function were significantly limited nuitigation. The excellent rate was 83% after opertion. MRI manifestations in patients with stable,non-ischemic necrosis increased performance. Conclusion Core decompression can significantly reduce the pressure on the femoral head hardening region, tantalum rod weight-bearing area of femoral head implant provides a structural support for subchondral bone. This method has the characteristics decompression,structural support,minimally invasive,it is worth for clinical use.

BACKGROUND: As a bone graft, coralline hydroxyapatite (CHA) has uniform and interacted pore structure, which is suitable for vascular regeneration, bone regeneration and bone deposition. It displays good biocompatibility and no immunogenicity. OBJECTIVE: To explore the clinical results of CHA in the treatment of benign osteolytic bone defects. DESIGN, TIME AND SETTING: A retrospective analysis was performed in the Department of Orthopaedics, Affiliated Hospital of Hainan Medical College from May 1996 to May 2007. PARTICIPANTS: A total of 32 cases of benign osteolytic bone defects were enrolled from Department of Orthopaedics, Affiliated Hospital of Hainan Medical College. Pathological diagnosis showed that the cause of bone defect included bone cyst for 8 cases, fibrous hyperplasia of bone for 9 cases, aneurysmal bone cyst for 4 cases, osteoenchondroma for 1 case; fracture complication for 5 cases consisting of femoral complete fracture for 2 cases and humeral complete fracture for 1 case, and humeral incomplete fracture for 2 cases. CHA was prepared by the Biomaterials Laboratory of Hainan Medical College. METHODS: According to routine approach of the operation, 32 cases of benign osteolytic bone defects were implant with CHA granules, chips or blocks after deleting tumor tissue and thinning cortical bone. Then the periosteum was sutured. Three cases with complete fracture received internal fixation, while other cases were untreated. None was fixed with plaster for external fixation. MAIN OUTCOME MEASURES: The X-ray films were observed to evaluate the bone healing at different time. RESULTS: All cases were followed up for average 6-24 months. No general abnormal reactions were found. The incisions were healed in two weeks. The lesion range of bone defect was from 3 cm?2 cm?2 cm to 12 cm?4 cm?4 cm before operation; At 1-3 months after operation, bone graft began to fuse with bone tissue around defects and fused completely at 3-6 months, which indicated the bone defect was almost repaired; At 6-24 months, bone graft was moulded and rebuilt, gradually substituted by newly formed born. CONCLUSION: The CHA is an idea bone graft substitute material for its good results in the treatment of benign osteolytic bone defects, shorter operating time and fewer complications.

The clinical data of 147 patients with carcinoma of ampulla of Vatar at our hospital from January 1998 to December 2012 were retrospectively analyzed.The neutrophil-to-lymphocyte ratio ( NLR) was calculated from pre-operative complete blood count.They were divided into low NLR group (NLR<5,n=121) and high NLR group (NLR≥5,n=26).The 5-year survival rates of two groups were compared and the prognostic risk factors examined by univariate analysis and Cox model.The 5-year free survival rates of low and high NLR groups were 57.9%and 27.6%respectively ( P=0.005 ).Univariate analysis revealed that depth of invasion (P=0.006),pancreatic invasion (P=0.002),lymph nodal metastasis (P=0.008), poor differentiation ( P =0.008 ) , tumor stage ( P =0.003 ) and per-operative NLR ( P =0.005 ) were significant prognostic factors.Multivariate analysis showed that per-operative NLR significantly increased the risk of recurrence (P<0.05).Pre-operative NLR represents a significant independent prognostic indicator for patients with carcinoma of ampulla of Vatar.