[Objective]To explore the clinical indication and effectiveness of anterolateral mini-incision for the total hip replacement (THR).[Method]A retrospective analysis of the 34 cases of anterolateral mini-incision was conducted from May 2002 to March 2005,among the patients 23 suffered from displaced femoral neck fractures and 11 suffered from femoral head aseptic necrosis.[Result]All the patients were followed up for 12～36 months with an average of 18 months.The obvious advantages of anterolateral mini-incision for the total hip replacement were as following:less blood loss in operation,less post-operative pain and complications,and early rehabilitation training,without cinch and subsidence in X-ray.Harris score was 92.1 point.[Conclusion]Anterolateral mini-incision for the total hip replacement can be used as an effective method to treat the patients who were extenuation,without abnormalities of hip joint,deossification and osteoporis.Appropriate incision combined with precise procedure can reduce the operative trauma and speed up functional recovery.

[Objective]To explore the clinical effects of titanium plate and morselized hone grafting for the treatment of severe acetabular hone defect.[Method]A total of 27 patients with acetabular defects were treated with this procedure.According to AAOS,the acetabular defects were classified into various types:type Ⅰ in 6 cases,type Ⅱc in 4 and type Ⅲ in 17.The average preoperation Harris score were 37.The postoperative effect should be evaluated by clinical and X-ray manifestations.[Result]All patients were adopted this method to reconstruct the acetabular bone defects.The prosthetic dislocation was found in one case after operation,which was resulted from over-anteverted titanium plate impacted the greater trochanter.The part of trochanteric bone and impact factors were removed to healing.No complications were found in other patients.The average following up was 3 years and average Harris score was 87.The X-ray showed that none of the patients was presented the radiolucent lines in the acetabular mattress,bone transplantation,reconstructive titanium plate and interface of polyethylene liner.[Conclusion]The titanium plate and morselized bone grafting can repair the acetabular bone defects effectively and provide a solid initial fixation for prosthesis and restore the role of rotational center of hip.

Objective To investigate the clinical application and therapeutic effect of reservation cortical expand resection and reconstruction for extremities bone tumor. Method Twelve cases with extremities invasion bone tumor were reviewed,including 6 male and 6 female.The average age was 37.1 years old.According to the MRI,TypeⅠtumor located in metaphysic and growth eccentricity,and was treated with outside tumor osteotomy with reservation of one side as integumentale,the cut line was shape of "匚".Type Ⅱ tumor was with invasion part articular surface,and was operated with part joint osteotomy with reservation of one side as integumentale,the cut line was shape of"L".Type Ⅲ was with invasion total joint surface and as integmentale,all tumor segment including joint could be cut,but the shape of cut close to the diaphysis was echelonment. Result The operation time was 1~3 h,the operative bleeding quantity were 150~400 ml,all incisions were obtained primary healing.Twelve cases were followed up from 6 months to 8 years.The average extremity functional score according to the system of ISOLS(International Society of Limb Salvage):upper extremity was 22.3 and the lower was 25.3 The average bone healing time of returned deactivation bone graft and bone allograft healing with the osteotomy plane was 3 months,original tumor recurrence in local was 1,the recurrence rate was 7.69%,no malignant change and metabasis was found. Conclusion The reservation cortical expand resection and reconstruction could increase the treatment effect of extremities bone tumor,it is key to decrease the recurrence with strict indication,non-neoplasma and aseptic technique.Tumor shell and osteotomy plane should be deactivated thoroughly.

[Objective]To explore the treatment of intertrochanteric fracture with expandable proximal femoral nail and prevention and cure of some related complications.[Method]Fifty-eight cases of closed intertrochanteric fracture,including 28 male cases and 30 female,average 73.2 years old(range from 42 to 88)accepted treatment.The type of fracture according to Evans classification:5 cases were type Ⅰ,7 were type Ⅱ,28 were type Ⅲ,13 were type Ⅳ,and 5 were type Ⅴ.All cases were treated with expandable proximal femoral intramedullary nail after close reduction.[Result]Thirty-eight cases were followed up,from 12 to 36 months,average 18.5 months,all of the cases got clinical healing after 8-10 weeks postoperatively.Hip Harris score average was 91.8.Some complications occurred in 6 cases:1 case had secondary fracture nearby the greater trochanter needling insertion point,1 case femoral head peg was outside of the lock hole,and 1 case femoral head peg tip was broken during operation.And after operation,1 case had coxa vara deformation,1 case had femoral middle and superior segment fracture,and 1 case femoral head peg was exited.[Conclusion]Expandable proximal femoral intramedullary nail has some advantages as:minimal invasive,manipulation convenient,fixation reliability,remove easily,but surgeons must be familiar with the construction and fixation principle of the nail in the primary stage,and perform the operating instruction strictly,to reduce or avoid the complications occurrence because of mis-manipulation.

Objective To study the therapeutic efficacy and the application value of microsurgical shunt in varicocele (VC) with oligospermia. Methods Funicular vein elevatus ligation and microsurgical shunt were applied in 66 patients. Improvements of the symptom, sign,semen quality and the couple's pregnant rate in prognosis visiting were observed. Results in 71 sides by microsurgical shunt,symptom disappeared in 51 cases and obviously improved in 20 cases after 7 days. Half and one year later,symptom and sign were disappeared in 69 cases (97% );semen quality was improved in 52 cases (78% ). In 37 cases (56. 3% ),sperm density was ≥20 ? 109/L, progress sperm was ≥50% and morphologically normal sperm was ≥30 %. In 11 cases (16. 7% ),sperm density was increased from 5 ? 10,/L- 15 ? 109/L before operation to 10 ? 109/L- 19 ? 109/L after operation,and both of the sperm motility and viability were increased. In 4 cases (5% ),sperm density was increased from less than 5 ? 10s/L before operation to more than 5 ? 10,/L after operation. In 26 cases,the couple was pregnant;the pregnant rate was 39. 4%' Conclusion Vein elevatus ligation and microsurgical shunt blocked the vein blood reflux,established the new vein circuit and improved the blood supply of testis in the mean time. It was approved that the method was effective in diminishing the local symptom and sign, improving semen quality and preventing recurrence' It was especially suitable for classⅢ exudative VC patients

Objective To probe the effects of the size and location of cranial defect on the neurological symptoms of patients with skull bone defect.Methods The patients were classified into the following groups according to the influence to symptoms by changes in body position and changes of symptoms before and after craniectomy: True syndrome of the trephined(ST,Ⅰ), partial ST patients(Ⅱ), other patients or symptom-free patients (Ⅲ).Results The group I consisted of 33 cases, their defects were located in the parieto-occipital region in 23 cases, frontoparietal in 10 cases. All these patients had flaccid skin flaps that became concave while in the upright position. The group Ⅱ was composed of seven cases, their defects were located in frontoparietal and parieto-occipital region in three respectively. All these patients had flaccied skinflap in defects pars.Group Ⅲ included twelve patients, flat and rigid skin flaps were usually demonstrated , predominantly in the tempora and parietal regions.Conclusions The size and location of the cranial could play an important role in the development of the neurological symptoms.

Humans ; Infant, Newborn ; Intestinal Perforation ; complications ; diagnosis ; Mycoses ; complications ; diagnosis

Objective To evaluate the levels of neutrophil gelatinase associated lipocalin (NGAL) in prediction of acute kidney injury (AKI) in children with burn. Methods Forty seven children with burn were selected in this study and thirty healthy children were enrolled as a control group. Levels of blood routine, urine routine, serum creatinine (Scr), serum NGAL (SNGAL), urine NGAL (UNGAL), blood urea nitrogen (BUN) and C-reactive protein (CRP) were measured. Receiver operating characteristic (ROC) curve were used to estimate the AKI diagnostic value of serum NGAL, urine NGAL and Scr. Results On the day of admission, serum NGAL and urine NGAL were significantly increased in patients with AKI , while Scr did not change significantly as compared with those in non-AKI patients and the healthy controls. In AKI group, serum NGAL and urine NGAL were positively correlated with WBC and CRP on the day of admission , and positively related with Scr on the seventh day. ROC analysis showed the AUC of serum NGAL, urine NGAL and Scr on admission were 0.737(95%CI: 0.653 ~ 0.779, P < 0.05), 0.772(95%CI: 0.632 ~ 0.793, P < 0.05), and 0.508(95%CI: 0.454~0.618, P < 0.05) respectively. The cut-off value of serum NGAL and urine NGAL were 318 μg/L (sensitivity of 72.8% and specificity of 81.6%) and 105 μg/L (sensitivity of 75.6% and specificity of 83.7%). Conclusions Elevation in levels of serum NGAL and urine NGAL occurs earlier than that in Scr level in children with burn. Both serum and urine NGAL level can be used as a biomarker for early prediction of AKI.

Objective To investigate the therapeutical effects of somatostatin in nonoperative treatment of different kinds of intestinal obstruction.Methods 338 cases of intestinal obstruction accepted by our hospital were retrospectively analyzed,which were divided into adhesive intestinal obstruction,inflammatory intestinal obstruction and malignant tumor intestinal obstruction.With nonoperative treatment,the control group were treated with routine therapy,including fasting,gastrointestinal decompression,intestinal lavage,intravenous replacement of fluid and electrolytes,disturbance of acid-base balance and the application of antibiotics.As for the treatment group,they were pumped with 6mg of somatostatin and 120mL physiological saline as well as routine therapy for 24 hours.The effects of the two groups were compared.Results The remission rate of abdominal distension and abdominal pains was 80.2％ in the treatment group and 62.3％ in the control group,the difference was statistical significance (x2 =250.446,P ＜ 0.05).The remission rate of nausea and vomiting was 84.1％ in the treatment group and 87.7％ in the control group.The passage of gas and defecation by anus was 64.7 ％ in the treatment group and 61.6％ in the control group,there was no clear difference between the two groups (x2 =0.902,0.349,all P ＞ 0.05).The gastrointestinal decompression amounts reduced clearly,the treatment group was (328 ±229) mL/d and (694 ± 381) mL/d in the control group,there was significant difference (t =2.883,P ＜ 0.05).After nonoperative conservative treatment,the effects between the two groups were as follows:the effective percentage was 95.7％ in the treatment group and 94.0％ in the control group,there was no significant difference(x2 =0.007,P ＞ 0.05).Except intestinal obstruction patients with external tumors,the rates of transferring to operation was 2.4 ％ in the treatment group and 2.8 ％ in the control group,there was no statistical significance(x2 =0.051,P ＞ 0.05).And except patients of intestinal obstruction with external tumors and transferring to operation,the hospital stay was (10.6 ±4.9) d in the treatment group and (15.3 ± 4.1) d in the control group,the difference was significant (t =2.528,P ＜ 0.05).As for the treatment group with somatostatin,there was no significant difference(x2 =0.008,0.230,t =0.117,all P ＞ 0.05) in abdominal distension and abdominal pains of adhesive and inflammatory intestinal obstruction,promoting the passage of gas and defecation by anus,the improvement of gastrointestinal decompression amounts in 24 hours.The improvement of tumor intestinal obstruction was worse.Conclusion Somatostatin treatment can help to ease the symptoms and physical signs of different kinds of intestinal obstruction rapidly and cut down hospital stay clearly,but can not reduce the rates of transferring to operation.If the time of treatment is ignored,it can not improve the therapeutical effective percentage of intestinal obstruction obviously.There is no significant difference for the application of adhesive and inflammatory intestinal obstruction.However,it can not completely and well improve the symptoms of tumor intestinal obstruction and the symptoms can recrudesce easily.

Objective To investigate comparability between Sysmex different hematology analyzers.The consistency of all he-matology analyzers with the same fresh sample.Methods Selected Sysmex XE-2100 as reference instrument which attend external quality assessment.Fresh high,medium and low blood were detected in Sysmex XS-800i,Sysmex XT-4000i and Sys-mex XT-1800i,compared results of WBC,RBC,HGB,HCT,MCV and PLT.Results The bias of XS-800i and XE-2100 was WBC 2.85%,RBC 1.44%,HGB 0.75%,HCT 2.11% and PLT 5.53%.The bias of XT-4000i and XE-2100 was WBC 1.26%,RBC 0.95%,HGB 0.68%,HCT 1.35% and PLT 2.68%.The bias of XT-1800i and XE-2100 was WBC 5.21%, RBC 1.96%,HGB 1.60%,HCT 1.96% and PLT 4.95%.It had good compatability.All various parameters was in the al-lowed range.Conclusion Should maintenance and compare the hematology analyzers periodically,found the problem then calibration instruments in time,ensure the consistency of measurement results between different instruments and guarantee accuracy of the results.