Objective To explore the feasibility of endoscopic thyroidectomy without the use of ultrasonic scalpel.Methods Monopolar high frequency electrosurgical unit was used to complete endoscopic thyroidectomy in 6 cases of thyroid benign tumors.Results All the operations were completed successfully.The operation time was 80~200 min(mean,110 min) and the intraoperative blood loss was 25~50 ml(mean,36 ml).The patients got out-of-bed activities and took liquid diets at a mean of 24 hours postoperatively.No complications was found.The drainage tube was removed on 2 days after operation and the patients were discharged from hospital at 3~5 days.Conclusions Use of high frequency electrosurgical unit for endoscopic thyroidectomy is safe and feasible.

Objective To evaluate the accuracy of 3D-CT navigation in guiding pedicle screw fixation in the thoracic spine.Methods Thoracic pedicle screw placement guided by 3D-CT navigation was performed on 24 cases,including 14 patients with thoracic spine fractures,6 thoracic tumors,and 4 scoliosis.CT data was input into the navigation system,and point-matching test was chosen.The optimal position,diameter,and length of the screw were set up using navigation stick after true-up.Then,the screw was placed dynamically in a stereo way according to navigation plan.After the operation,the position of the pedicle screw was assessed with CT using the Rampersaud grading system.Results Under the guidance of 3D-CT navigation,a total of 144 screws were successfully fixed into the 24 patients.According to the Rampersaud grading system,136 of the screws were at grade A(94.4%),6 at grade B,1 grade C,and 1 grade D.No postoperative injury of the nerve or spinal cord was observed.Of the patients,22 were followed up for a mean of 8 months(range,6-14 months).During the follow-up,no loose or breakage of the screw was detected by X-ray and CT.No delayed spinal cord injury was found.Conclusions The thoracic pedicle screw placement can be accurately guided by 3D-CT navigation.

Objective To study curative effects of infrared fluoroscopic navigation guided percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Methods A total of 28 cases of osteoporotic vetebral compression fractures(41 vertebrae) underwent infrared fluoroscopic navigation guided percutaneous vertebroplasty.The fracture was located at T_6～L_4 segment,including 16 thoracic vertebrae and 25 lumbar vertebrae.Fluoroscopic images of the spine were obtained,calibrated,and saved after the reference shelf was fixed on the spinous process of fractured vertebrae.The trajectory,a virtual tool corresponding to the tracked tool,was overlaid onto the saved fluoroscopic views in real time.Postoperative X-ray and CT examinations were performed to observe the vertebral body diaplasis as well as the distribution and leakage of bone cement.The vertebral body volume was measured with CT volumetry preoperatively and postoperatively.The visual analogue scale(VAS) scores were compared before and after operation. Results The bone cement was successfully injected in all the 41 vertebrae.Percutaneous vertebroplasty was performed in 13 vertebrae,while percutaneous kyphoplasty was conducted in 28 vertebrae(including balloon expansion in 12 vertebrae and "sky" expansion in 16 vertebrae).Vertebral body injection was performed via unilateral pedicle in 26 vertebrae and via bilateral pedicle in 15 vertebrae.Of the 28 cases,cement injection was carried out in one vertebral body in 17 cases,in two vertebral bodies in 9 cases,and in three bodies in 2 cases.No intraoperative deaths,nerve root or spinal cord injuries,or pulmonary embolism and cardiovascular or cerebrovascular emergencies occurred.The operative time for each vertebra was 7.7～20.7 min(14.2?3.3 min) in percutaneous vertebroplasty and 11.2～32.4 min(21.8?5.4 min) in percutaneous kyphoplasty.The X-ray exposure dose for each vertebra was 5.4～19.6 dGy(12.5?3.6 dGy).The amount of injected cement for each vertebra was 2.2 ～6.8 ml(4.6?1.2 ml).The vertebral volume was elevated from preoperative 21.4?4.6 cm3 to postoperative 25.8?5.4 cm3(t=5.623,P=0.000).The VAS scores decreased from preoperative 7.6?1.2 to postoperative 2.9?0.7(t=12.946,P=0.000).No serious complications or vertebral collapses were found during follow-up examinations for 3~14 months(mean,8 months) in the 28 cases. Conclusions Use of infrared fluoroscopic navigation for guiding percutaneous vertebroplasty is feasible.

[Objective]To study the effect of semi-constrained total elbow arthroplasty in rheumatoid elbow arthritis.[Method]Eighteen semi-constrained total elbow replacements were performed on 22 rheumatoid patients with 28 elbows(Morrey Stage:6 of Ⅲ Stage,17 of Ⅳ Stage,5 of Ⅴ Stage).The elbows were reviewed retrospectively after a followup of mean 26 months(range12~44 months).Mayo Elbow Performance was used to evalue the function of preoperative and postoperative elbow.The curative effect and complications were observed.The statistically significant differences were analyzed.[Result]Elbow arthroplasty was successful in 22 rheumatoid patients with 28 elbows.After 6 weeks function exercise the Mayo Elbow Performance was improved from(31.6?29.2)to(82.1?24.3)with a statistically significant difference(P

[Objective]To study the means and curative effect of the total hip replacement for ankylosed hip joint with severely flexinal abnormality.[Method]Retrospective analysis of the operative effect and related problems of the total hip replacement for ankylosed hip joint with severely flexinal abnormality.[Result]Through follow up for 6 to 44 months(22 months averaged),the average range of motion of hip joint and of flexion was 220.5? and 103?,respectively.The postoperative Harrris Score was 84.4 versus the preoperative Harrris Score of 14.2.The pain of the hip was disappeared almost completely and pain of lower waist and knee was relieved obviously.Patient got their gait right and could care themselves approximately.[Conclusion]The total hip replacement can eliminate the pain of the joint effectively and meliorate the function of the joint rapidly for ankylosed hip joint with severely flexinal abnormality,but surgeons must grasp the indication and technique of the operation and postoperative functional exercise.

Objective To study the method and clinical results of Infrared Fluoroscopic Navigation Guiding system guided percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures.Methods Twenty-two cases with 32 osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty guided by Infrared Fluoroscopic Navigation Guiding system.The fracture segment was within T6-L 4(14 thoracical vertebrae,18 lumbarver vertebrae).The compression ratio was from 20% to 90% in which 5 vertebral bodies were 75%.12 vertebral bodies underwent PVP,and 20 vertebral bodies underwent PKP in which balloon expansion were used in 12 vertebral bodies and sky expansion were used in 8 vertebral bodies.Single vertebral body injection were in 14 cases,two vertebral body injection were in 6 cases,three vertebral body injection were in 2 cases including 18 vertebral bodies injection via unilateral pedicle of vertebral arch and 14 vertebral bodies injection via bilateral pedicle of vertebral arch.Restoration of vertebra height and cement leakage was observed by postoperative X-ray and CT scan.Changes of preoperative and postoperative vertebral body volume measured by CT volumetry was compared.Preoperative and postoperative Vasual analogue scale(VAS)score was compared.Results PVP was successful in 22 cases with 32 vertebral bodies.No nerve and spinal cord damage,lung embolism and heart and brain vessel acute reaction occurred.Operative time was(18.4?4.5)mins per vertebral body.X-ray dosage was(12.2?3.4)dGy per vertebrae.The amount of bone cement was(4.4?2.5)ml per vertebrae.The vertebral body volume was improved from preoperative(22.2?8.6)cm3 to postoperative(24.8?6.9)cm3 with a significant differences(P

Objective To study the possibility and safty of laparoscopic partial cholecystectomy in difficult cholecystectomy. Methods The operative procedures,efficaey and complications of 26 laparoscopic partial cholecystectomy between 1999 and 2001 were reviewed retrospectively.The operative indications were empyema cholecystitis, Mirris syndromeⅠtype,frozen Calot's triangle,shrunken gallbladder. Results operative time was (51?16 5) minutes;The time to recovey activity was (11?4 3) hours;food-intake began (22?8 5) hours after operation; The hospital stay was (4 5?1 5) days;bile leakage after operation was found in 2 cases and recovered after conservative management.Following-up period lasting 6 to 25 months showed no complecations occurred. Conclusions Laparoscopic subtotal cholecystectomy may simplify the operation and decrease the risk in difficult cholecystectomy,and can get the therapeutic result of cholecystomy combined with standard cholecystectomy.

Objective The effects of laparoscopic management of indirect ingunal hernia in adults were studied. Methods 17 patients with indirect inguinal hernia underwent laparoscopic high ligation of hernial sac and 12 patients with indirect inguinal hernia underwent traditional hernial repair between November 2000 to February 2002.The outcomes of two groups were compared retrospectively. Results Comparison between laparoscopic and open group showed that the operating time was (89 9?25 8)min vs(63 5?22 4)min( t =2 8612, P

Purpose:To evaluate the accuracy of diagnosing the gastrointestinal vascular malformation and the value of treatment of the hemorrhage of the interventional radiology.Materials and Methods:The superior mesenteric arteriography or/and the inferior mesenteric arteriography or arteriography of coeliac axis were performed by applying Seldinger's techniques in 22 cases with the gastrointestinal bleeding which were suspicous of the gastrointestinal vascular malformation,otherwise were negative or equivocal in di- agnosis by performing with non-interventional study.Results:Focci were detected in 31 arteriographies (22 cases)with the positive gastrointestinal vascular malformation.Operative treatment were performed in 14 of 22 cases,with confimation of the vascular malformation pathologically.Conclusion:The se- lective coeliac arteriography may be a reliably unique method in detection of the gastrointestinal vascular malformation.

Objective To study the incidence and clinical significance of abnormal neuroendocrine hormone in patients with the syndrome of brain injury.Methods 67 cases with the syndrome of brain injury were included in the study group,and 95 cases without the post traumatic syndrome after brain injury were included in the control group.The level of FT3,FT4,TSH,growth hormone(GH),andrenocortico hormone(ACTH),cortisol (Cor),prolactin(PRL),testosterone (T),estradiol (E2),follicular stimulating hormone (FSH),luteotropic hormone (LH),and progesterone (P) in peripheral blood were measured by radioimmunoassay.The incidence of the abnormal neuroendocrine hormone after brain injury was statistically analyzed.Patients with abnormal hormone were given hormone replacement therapy and the curative effects were observed.Results The incidence of neuroendocrine hormone abnormalities was 38.8％ in patients with the syndrome of brain injury,while it was 10.5％ in the control group.There was significant difference between the 2 groups(P＜0.05).The symptom remission rate was 88.5％ after hormone treatment.Conclusions There was a high incidence of abnormal neuroendocrine hormone secretion in patients with the syndrome of brain injury.The hormone level may be used as an important index to guide clinical therapy.