ObjectiveTo evaluate the clinical effect of the percutaneous fixation for atlas-axis combined fractures in the elderly patients,especially with brain injury.MethodsFrom March 2006 to February 2011,a total of 7 cases with C1,2 combined fractures entered the study,including 5 males and 1 female with an average age of 72.4 years (range,64-84 years).Fracture combinations included two Jefferson/type Ⅱ odontoid,two anterior ring/type Ⅱ odontoid,two anterior and posterior ring/type Ⅱ odontoid,and one anterior and posterior ring+lateral mass/type Ⅲ odontoid.There were 5 patients with head injuries in varying degrees of coma.All patients underwent percutaneous placement of odontoid screw and anterior C1,2 transarticular screws (triple anterior screw fixation),and were immobilized in a hard collar for 3 months postoperatively.Results The average duration of the operation was 56 min(range,36-78 min).Satisfactory results were achieved in all patients,and all screws were in good position.There were no intraoperative surgery-related complications.The mean follow-up period was 10.7 months.During the follow-up,no pullout,loosening,distortion,or breakage of internal screws was observed.Radiographic union occurred in all odontoid fractures and C1,2 stable was found in all case.ConclusionFor elderly patients especially those with brain injury,the triple anterior screw fixation is reliable and effective in dealing with combined atlas-axis fractures.This percutaneous surgery has the advantages of less invasive,less blood loss,less pain and early recovery.

ObjectiveTo investigate the differences and the similarities of clinical presentations and CT features between type B3 thymoma ( atypical thymoma) and type C thymoma ( thymic carcinoma) in the WHO classification of thymic epithelial tumors.MethodsComplete CT findings of thirty cases of type B3 and seventeen cases of type C thymic epithelial tumors confirmed by histopathology according to WHO 2004 Classification System and clinical features including the prognosis of each case were reviewed retrospectively.Statistical analyses of the data for the age and the long diameter were performed with Independent-Samples t test between the two groups.Statistical analysis for gender,association with myasthenia gravis,method of the operation,contours,shapes,calcification,necrosis,enhancement pattern of the tumors on CT,presence of mediastinal lymphadenopathy,invasion of mediastinal fat,chest wall,pericardium,great vessel,pleural mediastinum,metastasis to the plural,pleural effusion,distant metastasis were performed with Fisher exact test.Kaplan-Meier method was employed for survival analysis.Results Clinical data:the average age of type B3 group was significantly younger ( t = - 2.905,P = 0.006).90.0％(27/30) of patients in type B3 group were complicated by myasthenia gravis,while only 5.9％ (1/17) of patients in type C group were complicated by myasthenia gravis.The difference between the two groups was statistically significant ( P = 0.000 ).The ratio of complete resection of type B3 group ( 80.0％ ) was significantly higher than that in type C group ( P = 0.001 ),70.6％ (12/17) of patients in type C group died within 2 years after surgical resection,while only 20.0％ (6/30) of patients in type B3 group died within one to nine years after surgical resection.Three years'survival ratio of C group was 29.4％,and five years'survival ratio of C group was lower than 14.7％,which was significantly lower than B3 group( five years'survival ratio was 94.7％ ),which was statistically significant (P =0.000).CT features:the average long diameter of tumor in type C group was ( 6.4 ± 2.1 ) cm,significantly longer than that in type B3 group,which was (4.6 ± 2.3) cm (t = - 2.778,P = 0.008 ),and the contour of tumor in type C group usually showed irregularity ( 13/17,76.5％ ),while it usually showed lobulated ( 18/30,60.0％ ) in type B3 group (P = 0.019 ),more necrosis found in C group ( 15/17,88.2％ ) than B3 group ( 17/30,56.7％ ),compared with type B3 group on enhanced CT,more tumor in type C group showed heterogeneous enhancement (P =0.042),and more great vessel invasion ( 15/17,88.2％,P =0.001 ) and more distant metastasis (8/17,47.0％,P = 0.028) occurred in type C group.ConclusionMost of type B3 and type C thymoma have a certain significant difference in clinical factor,prognosis and CT findings,which are helpful for differentiation.

For orthopaedic care of patients to continue to improve, new approaches, especially minimally invasive spinal technique, must be continually developed.To verify this technique actually provides improved outcomes, these approachs must be subjected to rigorous scientific study. However, because outcomes of clinical interventions only can be studied in human subjects, this practice must not only meet scientific criteria. it also must meet strict ethical criteria. The author analysised the state of minimally invasive spinal technique in china and foreign countries, and illustrated ethical problems and countermeasure on playing of minimally invasive technique into spinal practice.

Sagittal spinal deformity is one of the common reasons of sagittal disequilibrium which can cause torso forward,cardiopulmonary dysfunction,fiat back syndrome,intractable low back pain and a series of cases,affecting the patients' life quality and increasing huge economic burden on society.The treatment of sagittal spinal deformity has been a hot spot in the field of clinical spinal surgery and its main purpose is to reconstruct the overall balance of the body,which would relieve pain and improve life quality.Pedicle subtraction osteotomy is considered to be one of the most effective and safe method for correcting spinal deformity with excellent reconstruction of sagittal plane balance.However,the calculation of the angle required during surgery is still a problem,because insufficient or excessive correction will lead to the secondary sagittal disequilibrium.Therefore,an accurate calculation of the angle required during pedicle subtraction osteotomy is particularly important.In recent years,scholars believe that the sagittal equilibrium depends on a fragile balance among spinal curvature,pelvic shape and position of the lower limbs.Scholars have developed a standard of sagittal equilibrium based on their own research,and proposed a variety of quantitative analysis methods to calculate the angle required during pedicle subtraction osteotomy:trigonometric method,exact angle calculation method,overall balance method,spine femoral angle measurement method,digital virtual method,graphic method,acoustic meati to hip axis method and hilus pulmonis to hip axis method,which provide important theoretical bases for the treatment of sagittal spinal deformity.

Objective To investigate clinical therapeutic effect of valsartan/amlodipine compound preparation on patients with hypertension. Methods From Juue 2011 to June 2013, a total of 110 columns with hypertension as the research object, according to randomly divided into two groups.Valsartan/amlodipine compound preparation(group A) and amlodipine combined with metoprolol group(group B), continuous administration for 24 weeks, patients symptoms, former state, improve heart function and blood clots compared curative effect were monitored.Results After 24 weeks of treatment with valsartan/amlodipine compound preparation group, compared with group B, SBP and DBP were decreased significantly, the TC, TG and Glu content were also decreased significantly, clinical symptoms improved ratio was 90.91%(P<0.05).Cardiac function improvement recovery was 89.09%(P<0.05).D-Dimer level was decreased significantly(P<0.05), the former state blood clots were effectively prevented.Conclusion The high blood pressure in treatment with valsartan/amlodipine compound preparation has more therapy advantages in clinical treatment .

OBJECTIVE:To investigate therapy efficacy of large-dose of methylprednisolone plus therapy for acute myelitis, and it effects on nerve function recovery,pyramidal tract conduction function and sensory disturbance. METHODS:A total of 116 patients with acute myelitis were randomly divided into observation group and control group,with 58 cases in each group. Both group received conventional treatment. Control group was additionally given Dexamethasone sodium phosphate injection 0.4 mg/(kg·d)intravenously,once a day;7 d later,they were given Methylprednisolone tablet 60 mg,orally,qd,gradually decreasing to 5 mg/d. Observation group was given Methylprednisolone sodium succinate injection 1000 mg intravenously,once a day;7 d lat-er,they were given Methylprednisolone tablet 60 mg,orally,qd,gradually decreasing to 5 mg/d. The treatment course in eaeh group was 1 month. The nerve function recovery time,pyramidal tract conduction function,sensory disturbance scores,clinical ef-ficacy and ADR were compared between 2 groups. RESULTS:After treatment,the response rate of observation group was signifi-cantly higher than that of control group(93.10% vs. 79.31%);the time of muscle strength improvement≥grade 2,walking down the ground,urination and defecation function recovery in observation group were all significantly shorter than control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in lower limb cone conduction latency,am-plitude of pyramidal tract conduction,scores of sensation,sense of pain and touch between 2 groups. After treatment,lower limb cone conduction latency of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,the amplitude of pyramidal tract conduction,scores of sensation,sense of pain and touch in 2 groups were sig-nificantly higher than before,and the observation group was significantly higher than the control group,with statistical significance (P<0.05). There was no significant difference in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on conventional treatment,large-dose of methylprednisolone plus therapy shows good efficacy in the treatment of acute myelitis,which can helps to improve pyramidal tract conduction function of patients with acute myelitis,ease sensory disturbance,promote the nerve functional recovery with good safety.

8 cases of inferior vena cava obstruction were treated with intravascular stent insertion,including 3 membranacous obstructions and 5 segmental obstructions.All 8 cases obtained successful results without Severe complications.4 cases were checked up half a year later(2 of which were to checked after one year)with stents still in position and pa- tency of all.inferior vena cavas.In present studies the insertion technique and prevention of complication were discussed.

Objective To explore the surgery and conservative treatment for obstructive sleep apnea hypop -nea syndrome of PSG parameters .Methods According to the treatment method , 60 cases of obstructive sleep apnea syndrome patients for the study were divided into observation group and control group ,the control group were used for non-surgical treatment ,the research group were treated by surgery .PSG monitoring equipment were used to detect the AHI,AHTI,AHT,SAT90%,minimum and average SaO2 so SaO2.Results After treatment,patients were significant-ly lower SAT90%were (38.4 ±13.4)%,(17.5 ±12.5)%,the lowest Sa(O2) were(79.6 ±12.4)%,(83.7 ± 11.2)%,significantly higher average SaO 2 were (85.4 ±16.3)%,(90.8 ±12.4)%,increased significantly com-pared with before treatment difference was statistically significant (t=10.13,22.42,4.76,9.76,3.65,6.65,all P<0.05).And the control group improved more significantly (t=17.32,3.76,3.76,all P<0.05).After treatment,pa-tients were AHI,AHT and AHTI were (22.4 ±3.4)times/h,(14.5 ±2.5)times/h,(9.6 ±2.4)min,(5.7 ±1.2) min,(1.4 ±0.3)min,(0.8 ±0.4)min,significantly reduced compared with before treatment difference was statisti-cally significant(t=9.63,12.12,7.51,19.27,21.42,10.63,all P<0.05).And the control group decreased more significantly,the difference was statistically significant (t=8.97,9.76,6.57,all P<0.05).Conclusion Obstructive sleep apnea syndrome treated by surgery ,each of PSG parameters improved significantly superior to conservative treat-ment,which should be used as their preferred method of treatment .

Objective:To investigate the influences of repeated propofol anesthesia on the hippocampal apoptosis and the long-term learning and memory abilities of neonatal rats.Methods: In the study,45 male Sprague-Dawley rats,aged 7 days,were randomly divided into 3 group (n=15 each): control group (C group) that received intralipid 7.5 mL/kg intraperitioneal (IP) once a day×7 days;group propofol 1 (P1) that received propofol 75 mg/kg IP once a day×7 days;group propofol 2 (P2) that received intralipid 7.5 mL/kg IP once a day×6 days+propofol 75 mg/kg IP on the 7th day.In each group,5 animals were chosen and arterial blood samples were obtained immediately after the animals were fully awake for blood gas analysis.Learning and memory abilities were assessed using Morris water maze when the other rats were 4 weeks old.The animals were decapitated after the tests.The hippocampi were isolated for detection of neuron-specific nucleoprotein (NeuN) expression by immunohistochemistry method and the expression of caspase-3 using the Western blot.Results: There was no significant difference in the indexes of blood gas analysis among the 3 groups.Morris water maze test: compared with group C,the escape latency and the length of searching on the 5th day were significantly prolonged,and the searching time in target quadrant and platform crossing on the 6th day were significantly decreased in group P1 (P<0.05) but not in group P2.Compared with group C,NeuN-positive neurons were decreased,and the expression of caspase-3 was increased in the rats of group P1 (P<0.05) but not in group P2.Conclusion: Repeated propofol anesthesia may destroy long-term learning and memory abilities by inducing apoptosis of hippocampal neurons in neonatal rats,while single dose of propofol has no obvious effect on the hippocampal apoptosis and long-term learning and memory of neonatal rats.