[Objective]To explore the surgical technique for the treatment of different acetabular fractures.[Method]Consecutive 126 cases with displaced acetabular fractures were undergone an open reduction and internal fixation at our hospital from January 1995 to March 2006.Of them,there were 61 cases with simple type of fractures,65 cases with complicated type,and 14 cases with old fracture,112 with fresh fracture.The following precedures were taken according to the fracture type,namely,free fracture fragments in the hip joint were first dealed with,compressed or reversed subcartilage fracture blocks in the weight-bearing area of the joint should be reduced.By assistanee with some particular acetabular surgical instruments,the rotated or anterior/posterior(medial/lateral) displacement of the fracture was first reduced,then apart displacement of fracture was finally repositioned,and then fixed with reconstructed plate.[Result]No perioperative deaths occurred.After operation,anatomic reduction was achieved in 78 cases,good reduction in 42,incomplete reduction in 6.At a follow-up of 1 to 12 years,a excellent and good result was attained in 90.47% of the patients according to the American Academy of Orthopedic Surgeons(AAOS) score.[Conclusion]The different method of open reduction should be taken for different fracture of the acetabulum.The exact methods of the reduction are determined by the fracture type and its displacement direction as well as the operative approach.

Objective To study clinical value of blood glucose, AFP and cholinesterase levels on the diagnosis and prognosis of severe hepatitis. Methods Retrospective analysis of chronic hepatitis B, cirrhosis, chronic severe hepatitis, subacute severe hepatitis was carried out. In severe hepatitis patients, between the improved group and death group, blood glucose, AFP, cholinesterase differences, evaluate blood glucose, alpha-fetoprotein, cholinesterase levels on the diagnosis and prognosis of severe hepatitis value were compared. Results Subacute severe hepatitis, chronic severe hepatitis patients and blood cholinesterase levels were significantly lower than that in patients with chronic hepatitis B and liver cirrhosis(all P ＜ 0.05) ;and alpha-fetoprotein level was significantly higher than the level of chronic hepatitis B patients(P ＜ 0. 01) ;improved levels of blood glucose in patients with severe hepatitis, AFP, cholinesterase levels were significantly higher than the level of death group (all P ＜ 0.05). Conclusion Blood glucose, AFP, cholinesterase levels of liver disease progression and prognosis were important to determine the value.

Objective To study the CT features of the sero-hepatic type of hepatic tuberculosis.Methods This is a retrospective,multi-center and cross-sectional study.17 patients with the sero-hepatic type of hepatic tuberculosis from the Yueqing People' s Hospital (n =5),Second Affiliated Hospital of Wenzhou Medical College (n =5),and Wenzhou People's Hospital (n =7) were studied.All these patients were fasted for 8 h prior to CT scanning.They underwent enhanced after conventional CT breathless scanning with no abdominal pressure.Results The CT scans displayed 41 lesions in these 17 patients with the sero-hepatic type of hepatic tuberculosis,including a solitary lesion in 13 patients and multiple lesions in 4 patients.The diameter of the lesions varied from 0.8 to 4.7 cm,with a mean ± S.D.of 2.38 ± 4.82 cm.The CT features showed a localized spindle-shaped focal lesion just underneath the liver capsule with resultant concave compression of the adjacent liver tissue (n =22),spotted calcifications in the center of the focal nodules (n =1);and aggregation of multiple low density nodular foci (n =19).Additional CT features included focal nodules surrounded by a small amount of liquid (n =15),compression of adjacent liver tissue (n =22),a small amount of ascites (n =8),and retroperitoneal lymph nodes enlargement (n =2).These nodules showed moderate (n =5) and slight enhancement in the arterial phase (n =36);moderate (n =32) and mild enhancement in the portal venous phase (n =9);and moderate (n =32) and mild enhancement in the parenchymal phase (n =9),respectively.The nodules showed ring-shaped (n =26),honeycomb or multiple ring-shaped enhancement (n =15).The enhanced ring-shaped wall thickness varied from 0.2 to 0.9 cm,with a thin wall (n =30) and a thick wall (n =11).The center of the focal nodule was a low density sac-shaped area,with no obvious contrast enhancement.The CT value was 21 to 39 hu.The infiltrative liver tissues which surrounded the focal nodules were shown as lamellar areas of obvious arterial enhancement,with equidensity in the portal vein phase and equilibrium phase.Conclusions CT showed characteristic features of the sero-hepatic type of hepatic tuberculosis.Clinical and laboratory findings could provide important supplementary information to make the diagnosis.

Objective To study method and timing of internal fixation for long bone fractures in polytraumatized patients with fat embolism syndrome (FES). Methods Twenty-eight cases of polytraumatized patients with FES received internal fixation for their long bone fractures in our hospital from January 1990 to August 2004. The method and timing of internal fixation were analyzed retrospectively. The long bone fractures in 27 cases were treated 5 to 7 days after their clinic FES symptoms disappeared, while one fracture was treated five days after the FES symptoms were relieved and the vital signs became stable. Eleven cases of long bone fracture were treated with open fixation by unreamed or slightly reamed intramedullary nailing while 27 cases were fixated with plate internally. Results Of the 27 patients who received open reduction and internal fixation for their fractures 5 to 7 days after disappearance of FES symptoms, 22 cases experienced no postoperative complications but fever and quickened pulse reoccurred in five cases after the first osteosynthesis. However, FES-like symptoms reoccurred in the one case who received the first operation when FES did not disappear. Conclusions Internal fixation by plate and intramedullary nailing without reaming are safe for polytraumatized patients with FES and long bone fractures. Proper timing of the first surgery for this kind of patient should be 5 to 7 days after the disappearance of FES.

[Objective]To study the surgical technique for the treatment of acetabular fractures.[Method]Retrospective analysis on consecutive acetabular fractures operatively treated at our hospital from January 1995 to March 2005 was made to find out the correlation factors influenced on the operative approaches.[Result]A total of 107 cases had surgery for an acetabular fracture in the meamtime.Of them,44 were exposed through a Kocher-Langenbeck approach,5 through an extended iliofemoral route,30 through an ilioinguinal or an anterior extensile approach,and 28 through a combined anterior and posterior incisions.After operation,anatomic reduction was obtained in 66 cases,good reduction in 36,incomplete reduction in 5.According to AAOS score,the satisfactory rate was 89.72% after following-up 1 to 11 years.[Conclusion]To determine reasonable surgical exposure of an acetabular fracture,the key factors are fracture type and its displacement direction,and the important reference factors include associated injuries with the fracture,operative time and complications related to different operative routes.

Objective To assess the reliability of the modified lateral transgluteal approach (modified Bauer approach) to the hip for the joint prosthesis.Method The Bauer approach modification was used for 43 hip endoprosthetic replacement.Results The modified approach provided good exposure of the hip for arthroplasty, and early chance of function recovery.Excellent and good rate was 96.97% according to Harris result evaluation. No evidence of weakness of abductors of the hip and damage to superior glouteal nerve was found at six months.Conclusion The modified Bauer approach is reliable and recommendable for primary hip replacement because of its good exposure of the hip and the least disturbance to the abductor function.

Objectives To learn the bednet use and influential factors among Wa and Lahu ethnics,and further to explore feasible ways of promoting the use of bednets and insecticide-treated nets (ITNs). Methods Questionnaire surveys and statistical analysis with EpiInfo 2000 software package were carried out. Results Only did 2.8% [95% confidence intervals(95%CI):1.2%-5.4%] of Wa and 4.8 % (95%CI:2.8%-8.1%) of Lahu ethnic members use bednets frequently or sometimes. Bednets were not available for 67.7% (95% CI:62.0%-73.1%) of Wa and 59.7% (95% CI:53.1%- 66.1%) of Lahu ethnic peoples. Most people who had bednets did not often use them for anti-mosquitoes. Results of multivariate logistic regression confirmed significant correlation between bednet use and knowledge of malaria prevention. Conclusion The coverage and use rates are very low in the two ethnical minorities. Health education, communication and social marketing are the strategies for promoting the usage of bednet and ITNs.

BACKGROUND:Enriching material for bone marrow stem cells is a current research hotspot. Preparation and screening of a new type of bone marrow stem cells-enriched material is crucial for the development of tissue engineering and clinical applications. OBJECTIVE:To observe the surface character and effect of a new type of bone marrow stem cells-enriched material on enriching bone marrow stem cells of decalcified bone matrix decorated with poly-L-lysine by selective cellretention technology. METHODS:Decalcified bone matrix was decorated with poly-L-lysine as the scaffold material. Bone marrow mesenchymal stem cells were col ected by using selective cellretention technology. Control group was decalcified bone matrix and experimental groups were Decalcified bone matrix decorated with poly-L-lysine at different concentrations (0.01%, 0.05%, 0.1%, 0.5%, 1%) with freeze-drying method. Material components were analyzed by Raman spectrum and infrared spectrum. Pore size, porosity, surface and cross section were observed under three-dimension video microscope and scanning electron microscope. The number of bone marrow nucleated cells, fibroblast colony-forming units and platelets were counted pre-and post-enrichment. RESULTS AND CONCLUSION:Decalcified bone matrices were covered with wel-distributed and dense poly-L-lysine. The poly-L-lysine/decalcified bone matrix had a high porosity with much more internal y connected pores. After enrichment with enriched material prepared by 0.1%poly-L-lysine, the number of bone marrow nucleated cells, fibroblast colony-forming units and platelets were increased (3.18±0.31), (5.25±1.40) and (3.88±0.68) times, respectively;the binding efficiency were (53±12)%, (73±13)%and (34±10)%, respectively;the selective rate of fibroblast colony-forming units was 1.41±0.34. The new constructed poly-L-lysine/decalcified bone matrix has good three-dimension space with high selective retention. It is an effective enriching material for bone marrow mesenchymal stem cells.

Objective To explore the most effective formula to predict the catheterization length of the right internal jugular vein by an-terior approach. Methods Sixty-seven cases performed with right internal jugular vein catheterization from January 2013 to June 2013 were enrolled in this study and 4 formulas were selected to predict the catheterization lengths. Comparing their predicted lengths with the actual lengths defined as the lengths of the internal catheters which terminals were inserted to a accurate position,and analyse their predictive validi-ty. Results The predictive error percentages of the 4 formulas were all less than 15%. Comparing the predicted lengths and the actual lengths, there was no difference between the predicted length of the 1st formula and the actual one(P>0. 05),and the predicted lengths of the other three formulas were significantly less than the actual ones(P<0. 05). Comparing the mean absolute predictive errors of the 4 formu-las in the 3 height groups of 150~159 cm,160~169 cm and 170~179 cm,respectively,those of the 4th formula were all significantly higher than those of the 1st formula in all the 3 groups(P<0. 05);and no differences between those of the 2nd or the 3rd formula and those of the 1st formula were observed(P>0. 05). Conclusion The predictive error of all the 4 formulas is less than 15%, and the 1st formula is simple,practical and associated with a much smaller error,more suitable to estimate the length of the right internal jugular vein catheterization by anterior approach.

Objective To analyze clinical outcome of anterior atlantoaxial transarticular screw fixation in treatment of atlantoaxial instability.Methods Thirty-two patients with atlantoaxial instability treated between March 2004 and June 2009 were enrolled in the study.The patients consisted of 21 males and 11 females,at age of 22-64 years (mean 49 years).Atlantoaxial instability was attributed to old odontoid fracture in 10 patients,free odontoid malformation in 16,transverse ligament rupture in two,and rheumatoid arthritis in four.Anterior atlantoaxial transarticular screw fixation under monitoring of cortical somatosensory evoked potential (CSEP) was performed for all patients.Operation time,intraoperative blood loss,and complications were recorded.Japanese Orthopedic Association (JOA) scoring system was used to evaluate neurologic function preoperatively and at one year postoperatively.Results Operation lasted for average 98 minutes and intraoperative blood loss averaged 110 ml.Injuries on esophagus,nerve and vertebral arteries as well as leakage of cerebrospinal fluid were not observed in operation.All patients received a follow-up of 12-31 months.JOA score was increased from preoperative 9.8 points to 15.8 points at one year postoperatively,with improvement rate of 83％.Bone fusion and satisfactory internal fgxation were achieved in all patients.Hypoglossal nerve injury symptom was found in two patients postoperatively and was recovered two months later.Conclusion Anterior atlantoaxial transarticular screw fixation is an effective treatment for atlantoaxial instability.