Objective To evaluate the clinical effectiveness of the combined use of S1 pedicle screws and the iliac screws in treatment of sacroiliac dislocation and fracture. Methods 11 patients with sacroiliac dislocation and fracture were treated with S1 pedicle screw and iliac screw fixation technique. In this group, the dislocation was associated with vertical displacement of the sacroiliac joint and rotational deformity of the pelvic ring. They were classified as type B or type C pelvic disruption according to the Tile's classification. 7 patients with disruption of the symphysis pubis or pubic branch fracture underwent additional fixation of the pelvic ring using a reconstruction plate. The remaining 4 patients were treated by the posterior procedure alone. Results The vertical displacement was completely reduced in 7 patients, and the rotational deformity completely corrected in 4 patients. The reduction was maintained at the time of final follow up evaluation. No perioperative complications were found. The combined use of S1 pedicle screws and the iliac screws provided immediate stability and sufficient reduction for sacroiliac dislocation in the 11 patients in this study. Conclusion This hybrid internal fixation procedure is useful for reduction and fixation of sacroiliac dislocation associated with the vertical and rotational instability of the pelvic ring.

With ever-increasing knowledge of biomechanics and anatomy of pelvis,more and more findings have been made on the integrated sacroiliac joint system.The sacroiliac complex plays a very important role i n the functions of pelvis due to its specia l biomechanical features.The sacro iliac screw internal fixation is bio mechanically superior to other fixation methods.[

Objective To discuss the anatomical and radiographic parameters of medullary screw fixation of anterior acetabular column so as to provide reference for clinical application. Methods Thirty cadaveric pelvic specimens (including 18 males and 12 females) were involved in the study and fixated re-spectively with 30 retrograde medullary cannular lag screws through pubic tubercle to acetabular posterosu-perior on the left side and with 30 anterograde medullary cannular lag screws through acetabular posterosu-perior to pubic tubercle on the right side. Then, two-dimensional multiplanar CT reconstruction was done to measure the angle and length of the anterograde and retrograde medullary screw trajectory, the relationship of screws with acetabular bone and penis and determine optimal point and angle of screw insertion. Re-suits The entrance of the retrograde medullary screw was located at pubic tubercle, with vertical dimen-sion of ( 17.15±1.82) mm to pubic symphysis and that of (20.51±2.19) mm to superior margin of pu-bis. For the anterograde medullary screw, the distance from the entrance of the screw to greater sciatic notch was (33.25±2.35) mm, with safe insertion angle of (32.1±2.7)°of cephalon tilting at the sagittal plane and (46.5±3.6)°of lateral tilting at the coronal plane. The entrance angle of the anterugrade and retrograde medullary screw trajectory was similar, with only opposite direction and minor difference between the left and the right sides (P>0.05). The length of medullary screw trajectory was (119.5±2.2) mm, with insignificant difference between both sides ( P >0.05). The maximum diameter of the screw was 7.2 mm. Conclusions Medullary screw fixation of anterior acetabular column is clinically feasible but needs rather high accuracy and can be used as an alternative to plate fixation.

Objective To study the incidence of ventilator-associated pneumonia(VAP)and antimicrobial resistance of pathogens in an intensive care unit(ICU).Methods The occurrence of VAP in hospitalized patients with mechan-ical ventilation>48 hours between January 2011 and December 2012 were investigated,species and antimicrobial re-sistance of pathogens causing early onset-VAP (E-VAP,mechanical ventilation≤4 d)and late-onset VAP(L-VAP, mechanical ventilation>4 d)were compared.Results A total of 1 76 patients were investigated,incidence of VAP was 44.32% (78 cases);With the prolongation of mechical ventilation,incidence of VAP increased gradually (χ2=52.561,P<0.001).The incidence of L-VAP was significantly higher than E-VAP (58.33% [70/120]vs 14.29%[8/56])(χ2= 30.02,P<0.001).A total of 178 pathogens were isolated,gram-negative bacteria,gram-positive bac-teria and fungi were 104(58.43% ),46(25.84% ),and 28(15.73% )isolates respectively;97(54.49% )multidrug-resistance/pandrug resistance organisms (MDRO)were isolated. MDRO isolation rate in L-VAP patients was high-er than E-VAP patients([58.86% ,n= 93]vs [20.00% ,n= 4]),resistance rate of major pathogens causing L-VAP was significantly higher than E-VAP patients(allP<0.05).Fungi infection only occurred in L-VAP patients,the total antimicrobial resistance rate was 12.14% .Conclusion The prolongation of mechanical ventilation can increase the incidence of VAP,and resistance rate of pathogen in L-VAP is high.

Chromatography, Gas ; Humans ; Hydrocarbons, Brominated ; urine

Objective To investigate the optimal trajectory of posterior occipital condyle screw fixation via radiological and anatomical study.Methods Twelve adult craniocervical junction complete specimens were selected.The length,width and height of occipital condyle and the inclination angle of the longest axis were measured by CT scanning and reconstruction.Subsequently,occipital condyle screws were inserted with reference to CT measurements.After screw fixation,accuracy and safety of the placement of occipital condyle screw were verified by gross observation and CT scanning.Results Preoperative measurements of height and width of the occipital condyles indicated the placement of 4.0 mm bicortical screws was secure.Left vertebral artery horizontal sections of 2 specimens were slightly pressed without damage.CT scanning identified no damage to the inner or outer wall of the occipital condyle and the hypoglossal canal.Trajectory parameters between the right and left sides were slightly different,but no significant difference was observed (P ＞ 0.05).Average screw channel length and inclination angle were (20.8 ±2.6)mm and (37.1 ± 4.7)°respectively.Angle between screw and skull base tangent was observed as (8.5 ± 1.7) °.Distance between screw axis and hypoglossal canal was observed as (3.1 ± 1.1) mm.And the distance averaged (4.6 ± 1.4) mm between occipital condyle screw entry point and skull base and (6.1 ± 1.5) mm between entry point and inside edge of the occipital condyle.Conclusion Occipital condyle can be used as a new alternative fixed point in occipitocervical fusion.

Objective To evaluate the clinical efficacy of universal self-locking anatomical plate for acetabulum and pelvis (USAPAP) in the treatment of posterior acetabular fractures.Methods Data of 55 patients with posterior acetabular fractures who were treated with the USAPAP from January 2014 to January 2016 were retrospectively analyzed.There were 39 males and 16 females with an average age of 38.5 years old (range,17-82 years).There were 35 fractures on the left side while the other 20 fractures were on the right side,including 52 fresh cases and 3 old cases.According to Letournel-Judet classification,there were 32 cases of posterior wall,9 cases of transverse and posterior wall,5 cases of anterior column and posterior wall,2 cases of posterior column,2 cases of transverse,2 cases of two columns,1 case of anterior column and posterior hemitransverse,2 cases of Pipkin type Ⅳ.All patients were managed operatively by the USAPAP,which allows simultaneous fixation for two columns and quadrilateral surface fractures through a single Kocher-Langenback approach.The quality of reduction was assessed by Matta's score system.The mean follow-up period was 18.5 months (range,12-24 months).Average operation time was 95 min,and average blood loss was 350 ml.Average operation time of plate and screws fixation was 19 min,and average fluoroscopy times in the surgery was 2 times.The mean time of bony union was 4.3 months.According to the criteria described by Matta,the excellent and good rate of radiological score was 92.7％ (51/55),including 39 cases excellent,12 cases good and 4 cases poor.The excellent and good rate of Merle d'Aubigne-Postel score was 87.3％ (48/55),including 35 cases of excellent,13 cases of good,5 cases of fair,and 2 cases of poor.Heterotopic ossification occurred in 1 patient (Brooker type Ⅱ) at three months postoperatively.One case with Pipkin type Ⅳ fracture underwent total hip arthroplasty due to femoral head necrosis at seven months postoperatively.Complications including wound infection,sciatic nerve injury,screw invade joint,redisplacement of the fracture,avascular necrosis of bone fragment,hardware failure,nonunion or malunion was not found in any case at the latest follow-up.Conclusion The USAPAP through the single posterior Kocher-Langenback approach provides strong and stable fixation for complex acetabular fractures associated with posterior region including posterior wall,both columns and quadrilateral surface.Satisfactory clinical results can be achieved by the use of this method.

OBJECTIVE: To study a surgical and repairing method for defects after the resection of basal cell carcinoma of external nose. METHOD: There are 26 cases of basal cell carcinoma that tumors have been resected completely after operation. For defect repairing in those 26 cases, 2 cases adopt direct suture method; 2 cases use skin graft repairing methods; 18 cases employ naselabial skin flap repairing method; 4 cases choose forehead pedicle skin flap repairing methods. RESULT: the wound of all the 26 cases was primary healed. Additionally, skin flap and skin graft were all survived. Follow-up studied in patients 1 to 3 years after the surgery showed that the local scar was not obvious and no tumor recurred or transferred. CONCLUSION Different surgical and repairing methods are performed to obtain a satisfactory results based on the area of defect and its location in nose. Naselabial skin flap is especially an ideal method to repair defects.
Carcinoma, Basal Cell ; surgery ; Cicatrix ; Forehead ; Humans ; Neoplasm Recurrence, Local ; Nose ; Nose Neoplasms ; surgery ; Reconstructive Surgical Procedures ; Skin ; Skin Neoplasms ; surgery ; Skin Transplantation ; Surgical Flaps ; Wound Healing

Humans ; Sphenoid Bone ; anatomy & histology ; diagnostic imaging ; Tomography, Spiral Computed

Objective:To understand the clinical features and computed tomography (CT) imaging performance of mediastinal giant malignant synovial sarcoma (SS) and to improve the clinicians′ diagnosis and treatment of this disease.Methods:We report the clinical data of 2 cases of primary mediastinal giant malignant SS, and reviews the literature for CT presentation and differential diagnosis.Results:Primary giant malignant SS of mediastinum is rare in clinic. CT showed irregular cystic and solid mass with mural nodules, adjacent osteolytic destruction, unclear boundary with adjacent tissues. The enhancement showed that the solid components of the tumor and mural nodules were enhanced, while the cystic necrosis area had no enhanced uneven enhancement. The two cases in this paper showed " borehole-like" growth above the clavicle and growth into the left thoracic cavity, with pulmonary metastasis and lymphatic metastasis respectively.Conclusions:Mediastinal malignant SS is a rare disease with high malignancy and easy to metastasize, which emphasizes " early detection, early diagnosis and early treatment" . It should be taken into account in the differential diagnosis of mediastinal tumors, but the confirmation of diagnosis needs to be combined with pathological and immunohistochemical findings. Clinicians need to take advantage of imaging examinations to provide auxiliary guidance on the diagnosis, metastasis assessment and surgical treatment options of SS.