Objective To evaluate the results of patients with intercondylar fracture treated with open reduction and internal fixation. Methods Forty- one patients with complete clinical data treated operatively during 1989－ 1998 were followed up for an average of 40 months. They were evaluated with modified Cassebaum rating system. The relationship between final result and the period from injury to operation, fracture pattern, operative approach, the time of initiation of exercise after operation were analyzed respectively. Results One nonunion occurred. 13 rated as excellent, 15 as good, 10 as fair,and 3 as poor. Conclusion The degree of comminution and displacement of fracture hinders the final result. Early operation, with osteotomy of the olecranon, anatomical reduction, rigid fixation and early exercise are the key factors that can improve the final result.

Objective To evaluate the choice of operative method, timing of surgery and the outcome of tibia Pilon fracture. Methods Thirty one patients with unilateral tibia Pilon fracture operatively treated between 1993 and 1998 were followed up. The average age was 39.4 years(range from 15 to 64 years). The average period between injury and surgery was 7.2 days. According to the R?edi Allgwer classification, there were 3 cases of type Ⅰfracture, 14 cases type Ⅱfracture and 14 cases type Ⅲfracture. During operation, 13 patients had the fractures reduced and internal fixation was done with the cloverleaf plate, 15 patients had limited open reduction and internal fixation coupled with external fixation, which included 5 patients with the external fixation apparatus and 10 patients with plaster splint, in the remaining 3 cases, the fibular fractures were fixed with plate and tibia fractures were immobilizated with external fixation apparatus. The average period of follow up of these 31 patients was 30.2 months. Results According to Mazurs criterion, the result of the treatment was evaluated as excellent in 25 patients, good in 5 patients and fair in 1 patient. No poor result was found. Complications included wound dehiscence in 3 cases, infection in 2 cases, delayed union of fracture 1 cases and late degenerative changes of the ankle joint in 8 cases. Conclusion In order to get a satisfactory result it is important to have the right choice and timing of surgery and correct method of fixation in tibia Pilon fractures.

Objective To review our experience of surgical treatment for postinfarction ventricular septal defect. Methods From 1990 to 2004, 22 patients with postinfarction ventricular septal defect underwent surgical treatment. There were 15 males and 7 females with a mean age of (62.2?7.3) years (from 52 years to 72 years),19 had anterior ventricular septal defect and 3 had posterior VSD, and there were 18 cases with left ventricular aneurysm.10 patients also had introaortic balloon pumping in the early experience. In all the patients cardiac function were in NYHA class III～IV. Results There were 8 operative deaths (35%). There were 7 operative deaths before 1999 and 1 case after 1999. The other patients are clinically asymptomatic after surgery, and the cardiac function is in NYHA class I～II. Conclusion Postinfarction ventricular septal defect is an infrequent but serious complication of myocardial infarction. Surgery is the best way to treat this condition. A coronary angiography should be performed in all patients who can be stabilized hemodynamically and myocardial revascularization should be performed in patients with significant coronary artery stenosis.

ObjectiveTo evaluate and compare long-term clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with remnant preservation versus remnant resection.MethodsFrom October 1999 to May 2005,standard ACL reconstruction with autogenous quadrupled hamstring tendons under arthroscopy using remnant resection with transtibial techniques was conducted in 87 patients.From June 2005 to May 2010,ACL reconstruction with autogenous quadrupled hamstring tendons using outside-in bone tunnel establishment and remnant preservation was performed in 221 patients.Only the patients who underwent simple ACL reconstruction together with more than three years follow-up records were enrolled in the study,including 66 patients in remnant preservation group and 39in remnant resection group.ResultsPatients of both groups were all followed up for 36-60 months,which showed insignificant difference between groups ( P ＞ 0.05).Compared with the preoperative data,the latest follow up data demonstrated satisfactory outcomes in both groups.The two groups showed no significant differences regarding the preoperative data including age and gender distribution,average time from injury to surgery,joint instability extent and functional score of the affected knee ( P ＞ 0.05 ).There was no statistical difference in regards of the thigh muscle atrophy and Lachman test between groups ( P ＞0.05).However,the remnant preservation group was superior to the remnant resection group in aspects of the range of motion of the affected knee,Lysholm score,stability in anterior drawer test,stability in pivot shift test and international knee documentation committee (IKDC) grade ( all P ＜ 0.05 ). ConclusionCompared with standard ACL reconstruction using remnant resection with transtibial techniques,the ACL reconstruction using outside-in bone tunnel establishment and remnant preservation has better longterm clinical outcomes including stability and function of the affected knee.

The paper analyzes different expressions of indirectly associated strong-weak connection in the process of biomedical literature knowledge discovery,defines the effect and function of strong-weak connection on literature knowledge discovery,and indicates that the accuracy rate of the discovery of potential connection through strong connection is obviously higher than the accuracy rate obtained through weak connection,and strong connection can serve as an important factor for improving the application effect of literature knowledge discovery.

Successful pain management of perioperative shoulder arthroscopy may allow patients to go home earlier, improve the quality of life in perioperative period, and facilitate rehabilitation. A comprehensive method to perioperative pain control has three stages including preoperative, intraoperative and postoperative phase. Successful pain reduction should begin preoperatively because of an excellent communication between patient and physician, moreover, preoperative analgesia also should be administered. Intraoperative efforts should include local wound infiltration and the administration of anesthetic medication intra-articularly. Postoperative management should include oral analgesics, constant infusion devices, Patient Controlled Analgesia (PCA), sedative-hypnotic drug, continuous cryotherapy and vicarious treatment.
Acupuncture Analgesia ; Analgesia ; methods ; Analgesia, Patient-Controlled ; Arthroscopy ; Humans ; Pain, Postoperative ; therapy ; Perioperative Period ; Shoulder Joint ; surgery ; Transcutaneous Electric Nerve Stimulation

Objective To explore the changes of pentraxin-3(PTX-3) in the normal left ventricular ejection fraction of patients with heart failure in patients of hypertention heart disease and discuss its clinical significance .Methods 156 outpatients or inpa-tients of department of Cardiovascular ,Geriatrics ,firstly diagnosed primary hypertension ,of Wuchang hospital in WuHan City were selected as research objects .the subjects were divided into two groups based on the results of echocardiography :simple primary hy-pertension(PH) group(42 cases)and hypertention heart disease(HHD) group(114 cases) ,the latter group were divided into with-out syptom of heart failure-NHF subgroup(34 cases) ,with normal left ventricular ejection fraction and syptom of heart failure-HF-NEF subgroup(36 cases)and with decreasing left ventricular ejection fraction and symptoms of heart failure-HFREF subgroup(44 cases) .To measure and analysis the level of PTX-3 ,high sensitivity c-reactive protein (hs-CRP) ,N-terminal pro-brain natriuretic peptide(NT-proBNP) in the blood plasm .Results Compared to HHD group ,the level of PTX3 ,hs-CRP ,NT-proBNP was lower (P<0 .01) .The level of PTX3 ,hs-CRP ,NT-proBNP was increased from NHF group ,HFNEF group to HFREF group ,significance differences were seen between each group .The level of PTX3 was positively correlated to hs-CRP(r=0 .573 ,P<0 .01) ,and was positively correlated to NT-proBNP(r=0 .452 ,P<0 .01) .Conclusion PTX3 increases with the progress of patients with primary hypertention heart disease ,It can be used as a biomarker of heart failure in the patients of hypertention heart disease with normal left ventricular ejetion fraction .

Objective To investigate the chondrocyte proliferation and extracellular matrix biosynthesis of electrospun PCL scaffolds seeded with rabbit chondrocytes under flow perfusion culture in vitro.Methods Nonwoven PCL microfiber mats were fabricated,and contra-aperture cylindrical glass equipment as a perfusion bioreactor was designed and manufactured on our own.The experiment included peffusion culture group and static culture group.Primary chondrocytes were isolated from the knee joints of two-month-old New Zealand white rabbits and seeded into scaffolds.The scaffold-cell complexes were harvested at 3,7,and 14 days of culture for scanning electron micrograph (SEM) analysis,biochemical assay,real-time PCR and histology analysis.Results Electrospun PCL scaffolds were composed of microfibers with a diameter of 1.67±0.76 μm and pores with a diameter of 17.65±7.11 μm.SEM showed a better cell proliferation with typical morphology of chondrocytes under perfusion culture.At 7 days of culture,DNA content in perfusion culture group was higher than in static culture group.At 3,7 and 14 days of culture,compared with the static culture group,glycosaminoglycan (GAG) content and GAG/DNA ratio in perfusion culture group were higher,and the differences were statistically significant.At 14 days of culture,real-time PCR showed aggrecan and collagen type Ⅱ gene expression and collagen type Ⅱ to collagen type Ⅰ ratio were higher in perfusion culture group than in static culture group; HE and safranin O staining showed a significant cell proliferation,infiltration,as well as extracellular matrix biosynthesis in perfusion culture group.Conclusion Under flow perfusion culture,the electrospun PCL scaffolds seeded with rabbit chondrocytes can enhance chondrocyte proliferation and extracellular matrix biosynthesis,which is a promising method for cartilage tissue engineering.

Objective To explore the causes of secondary breast deformity after breast conservative therapy and its preventive methods.Methods 30 cases were selected from the patients with secondary breast deformity of more than 1 year after breast conservative therapy,and more than half a year after radiotherapy and chemotherapy,and no local recurrence and distant metastasis occurred.After cicatrectomy and contracture loose solution,different methods were used according to varying degrees of the secondary breast deformity to reconstruct and repair the deformity.Results Three reconstructive methods were conducted.Local mammary flaps were used in 7 patients,latissimus dorsi myocutaneous flap in 21 patients,and transverse rectus abdominal musculocutaneous flaps in 2 patients.The shape and feeling were satisfactory in 30 patients with reconstructive breasts,in which 23were excellent (76.7 ％),and 7 were good (23.3 ％).All the patients were followed-up for average 2.5 years,and they were survived without tumor recurrence.Conclusions The secondary breast deformity after breast conservative therapy could be effectively prevented,and successfully reconstructed and repaired with different procedure according to varying degrees of the secondary breast deformity.As a result,the shape and feeling of reconstructive breasts are satisfactory.

Objective To investigate the effects of improved end-to-end invagination pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 396 patients who received pancreaticoduodenectomy at the Cancer Hospital of Shandong Province from January 2001 to January 2011 were retrospectively analyzed.All patients were divided into the improved group(235 patients)and traditional group(161 patients)according to different anastomotic methods.All the operations were done by the same surgical group,and the digestive tract was reconstructed by the Child method.Patients in the improved group received improved end-to-end invagination pancreaticojejunostomy,and patients in the traditional group received traditional end-to-end anastomosis.The volume of operative bleeding,operation time,incidence of pancreatic fistula and duration of hospital stay of the 2 groups were compared.All data were analyzed using the t test,chisquare test or Fisher exact probability.Results The operative blood loss,operation time and duration of hospital stay were(383 ±56)ml,(7.2 ± 1.0)hours,(21 ±3)days in the improved group,and(381 ±39)ml,(7.0 ± 0.5)hours,(22 ± 5)days in the traditional group,with no significant difference between the 2 groups(t =0.388,1.680,-1.835,P ＞ 0.05).No operative death was detected in the 2 groups,and the overall incidence of pancreatic fistula was 7.6％(30/396).The incidence of pancreatic fistula of the improved group was 0(0/235),which was significantly lower than 18.6％(30/161)of the traditional group(P ＜ 0.05).Patients complicated with pancreatic fistula in the traditional group were cured by drainage,somatostatin administration and parenteral nutrition.Conclusion Improved end-to-end invagination pancreaticojejunostomy can significantly reduce the incidence of pancreatic fistula after pancreaticoduodenectomy.