Objective To investigate the clinical effect of harvesting the free anterolateral thigh flap irregularly for the repair of the multiple and complex skin and soft tissue defect at lower limb.Methods From January,2009 to January, 2014, 7 patients with multiple and complex skin and soft tissue defect at lower limb were treated with transplantation of the free anterolateral thigh flap with harvesting irregularly.The parts of wound defect: 2 cases of medial leg andlateral leg, 3 cases of foot back andankle, and 2 cases of medial malleolus and lateral malleolus.All the cases were operated in fracture fixation and wound without obvious infection.The vascular pedicle of free flaps were descending branch of lateral circumflex femoral artery.The types of the harvesting the free anterolateral thigh flap irregularly: 3 cases of the anterolateral thigh flap and terminal branch of lateral femoral circumflex artery muscle flap, 2 cases of the anterolateral thigh flap and transverse branch of lateral circumflex femoral artery muscle flap, and 2 cases of reconstructed lobar femoral anterolateral thigh perforator flap (vascular anastomosis of pedicle of lobulated anterolateral thigh perforator flap with the main stem branch artery of the lateral femoral circumflex vessels).The area of harvesting the free anterolateral thigh flap irregularly were 6 cm × 4 cm to 16 cm × 12 cm;The donor site were closed directly.All the patientsbegined to early rehabilitative exercise under the protection of orthosis after 4 weeks of the operation.Results All cases were followed up for 6 to 14 months, and the average of 8.2 months.All the flaps survived, besides 2 cases with necrosis of small area in distal, and which were healed by dressing, debridement,skin grafting and so on;The healing time were 12 to 34 days, and the average of 17.1 days.The area of flaps without obvious retraction, color were the same as the region, no obvious scar contracture.Conclusion The anterolateral thigh flap feed by the same source vessels for the repair of the multiple and complex skin and soft tissue defect at lower limb is a safe and effective strategy.The flap can be combinated differently to repair multiple and irregular wound one-time, the donor site is small invasive, shorten the treatment cycle, and relieve the suffering.

Objective To investigate the clinical effect of the free fibula composite tissue flap transplantation to repair the first metatarsal bone with soft tissue defect on foot.Methods From August, 2008 to August, 2013, 6 patients with the first metatarsal bone and soft tissue defect on foot were treated with transplantation of free fibula composite tissue flap.The causes: 2 cases in traffic accident injury, 4 cases in machine injury;3 cases with traumatic defect, and septic defect in 3 patients.Of the 6 cases, the fibular length with transplantation was 6 cm to 12 cm, and the flap area was 8 cm × 5 cm-18 cm × 16 cm;All the cases were followed-up in 3, 6, 12 months postoperatively to observe the fracture healing, and to assess injured limb function in 1 year postoperatively.Results All cases were followed up 12-24 months, and average of 14 months;All the flaps survived, and the metatarsal bone and fibula healing was good visibly in half a year, The surgery function were assessed according to Maryland's scale, and the excellent were 2 and the good were 4.Conclusion The transplantation of free fibula composite tissue flap to repair the first metatarsal bone with soft tissue defect on foot is a safe and effective strategy, and it has the advantages such as covering the wound at foot approvingly, one-time rebuild repair foot weight bearing area and the surrounding soft tissue defect, shorten the treatment cycle, for small area damage in donor area, and the function postoperative is good, etc.

Objective To evaluate the functional features of motor function area in patients with meningioma by blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods fMRI were obtained from 10 patients who suffered from meningioma which was adjacent to the motor function cortex.Probabilistic independent component analysis method was used for data analysis.Preoperative and postoperative line Karnofsky Performance Scale (KPS)score was used to assess the patient’s condition.Re-sults Contralateral primary motor cortex and the supplementary motor cortex motor functions were observed in all the activation clusters,in which one side activation area compared with the contralateral activation zone was symmetrical in 6 cases,and significant shift in 4 cases.In 4 patients with the movement function activated,tumor extrusion function shift forward or backwardwith tensile deforma-tion were found.Conclusion BOLD-fMRI imaging technology can effectively locate motor functional area for patients with meningi-oma,which can provide preoperative surgical planning.

Objective To report treatment of infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type Ⅲ B using free flap and Ilizarov bone transport.Methods Nineteen patients who had suffered from infectious bone and soft tissue defects following tibial shaft fracture of Gustilo type Ⅲ11 B were treated from May 2010 to February 2015.They were 15 men and 4 women,aged from 21 to 58 years (average,45.3 years).Their course of disease ranged from 16 to 21 months,averaging 17.9 months.The area of their infectious defects ranged from 10 cm × 6 cm to 21 cm × 12 cm,and the length of their bone defects from 5 to 11 cm (average,7.4 cm).They were treated with debridement,simple external fixation to reconstruct bony support,coverage of wounds with free flap,and stuffing the dead space with antibiotic concrete beads,followed by Ilizarov bone transport and bone graft after control of infection to reconstruct the defective tibia and function of the affected limb.Results All the flaps survived.Necrosis occurred at the distal margin of one flap but responded to dressing.Pin tract infection occurred in 4 cases but also responded to dressing and antibiotic therapy.Autografts of iliac cancellous bone were implanted into the gliding and traction ends of the bone fragments one month after bone transport had come to rest.All the patients achieved direct bony union.The patients were followed up for an average of 25 months(range,from 19 to 36 months).No secondary fractures or angular deformity was observed.The total treatment time averaged 17.9 months,with no recurrence of infection.According to the Puno score system for functional evaluation at the last follow-up,7 cases were rated as excellent,6 as good and 6 as fair.Conclusion The infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type Ⅲ B can be treated by free flap and Ilizarov bone transport,resulting in definitely positive outcomes.

Objective To evaluate the clinical effect and efficacy of endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips. Metheds The clinical date of 21 patients who treated tissue glue and metal clips were retrospectively analyzed from Jan 2015 to Dec 2016. Results The treatments were completed successfully and reviewed by endoscopy after 1 week, 1 month, 3 months, 6 months. The gastric varices were reduced, and the serious complications of bleeding, embolism were little. Conclusion The endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips is contributed to clinical effect, and the treatment provides a reference for clinical treatment.

OBJECTIVETo evaluate the value of arthroscopy for the diagnosis and treatment of hip joint disease.

METHODSArthroscopy was performed in 54 patients (68 hips) from July 1998 to September 2001. Of the 54 patients, 36 were male and 18 female, aged from 17 to 64 years. The disease was located on the left side in 18 patients, the right side in 22, and both sides in 14. In this group, osteoarthritis was noted in 21 patients, avascular necrosis of the femoral head in 16, infection of the hip joint in 3, chondrosarcoma in 2, synovial-chondromatosis in 7, acetabular labral tears in 2, and spondylitis in 3. The procedures of arthroscopy consisted of removal of loose bodies, debridement, and biopsy.

RESULTSThe operation made accurate diagnosis possible for chondrosarcoma, acetabular labral tears, and infection of the hip joint. After debridement of the hip joint for avascular necrosis of the femoral head, osteoarthritis and spondylitis, most patients in this group were free from pain, function and range of the motion were restored and the pathological process was delayed. The Harris hip scores increased by 27 on average.

CONCLUSIONArthroscopy plays an important role in accurate diagnosis and treatment of hip joint.

Adolescent ; Adult ; Arthroscopy ; Chondromatosis, Synovial ; diagnosis ; surgery ; Female ; Femur Head Necrosis ; diagnosis ; surgery ; Hip Joint ; Humans ; Joint Diseases ; diagnosis ; surgery ; Male ; Middle Aged ; Osteoarthritis, Hip ; diagnosis ; surgery ; Retrospective Studies ; Spondylitis, Ankylosing ; diagnosis ; surgery

Objective To study the incidence and clinical significance of the herniation pits of the femoral neck.Methods 600 cases(299 men,301 women,18～82 years)were collected.The incidence,radiologic finding and clinical significance of the herniation pit of the femoral neck were analysed.Results Of 1200 hip joints in 600 cases,there was 58 cases(64 sides)(5.3%)with herniation pits of the femoral neck,including 39 men(68.7%)and 19 women(31.3%),the lesions localized in the left joint in 25 eases(39.1%),in the right joint in 27 cases(42.2%)and in bilateral joints in 6 cases(18.7%).There were a obvious significant differences on both sexes,and no significant differences on age groups.On X-ray film,the lesions appeared as a round radiolucency with thin clear sclerotic rim.Conclusion The incidence of the herniation pit of the femoral neck is 5.3%,which has a typical X-ray feature,and may indicate the femoroacetabular impingement.

Objective:To compare the efficacy and safety of robotic surgery and open surgery in the treatment of hilar cholangiocarcinoma.Methods:PubMed, Embase, Cochrane Library, Web of Science, CNKI and Wanfang database were searched to compare the treatment of hilar cholangiocarcinoma by robotic surgery and traditional open surgery. Literatures were searched from the establishment of the database to July 2023. Compare operation time, intraoperative blood transfusion rate, R 0 resection rate, lymph node metastasis rate, postoperative complication rate and hospital stays between the two groups. The combined odds ratio ( OR) and mean difference ( MD) and 95% confidence interval (95% CI) were calculated using RevMan 5.4 software. Results:A total of 4 studies were included, including 267 patients with hilar cholangiocarcinoma. There were 177 males and 90 females, aged (58.8±5.7) years. A total of 267 patients were divided into open surgery group ( n=165) and robotic surgery group ( n=102) according to the surgical formula. The extract results show: operative time ( MD=-103.96, 95% CI: -216.90-8.98, P=0.070) and intraoperative blood transfusion rate ( OR=1.32, 95% CI: 0.43-4.07, P=0.630), R 0 resection rate ( OR=1.41, 95% CI: 0.71-2.81, P=0.330), lymph node metastasis rate ( OR=1.62, 95% CI: 0.46-5.63, P=0.450), postoperative complications ( OR=0.60, 95% CI: 0.28-1.31, P=0.200), and postoperative hospital stay ( MD=2.17, 95% CI: -11.56-15.90, P=0.760). Conclusion:In the treatment of hilar cholangiocarcinoma, robotic surgery is as safe and feasible as open surgery. However, due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Objective: Ban Fenghe recorded in the Quality Standard of Yao Medicine of Guangxi Zhuang Autonomous Region (Volume 1) is derived from the dried stems and leaves of Semiliquidambar cathayensis. It is usually confused with medicinal herbs from Pterospermum heterophyllum and Dendropanax dentiger. However, they are very different in chemical composition, and should not be used as the same drug. To ensure their safety and efficacy, a method based on macroscopic and microscopic characteristics was developed to distinguish them. Methods: A total of 14 batches of Ban Fenghe samples from three species were collected from different producing areas in China. The macroscopic characteristics were examined by observing external traits. The tissue structures of transverse sections of stems and leaves, the leaf epidermis, and the powder were observed microscopically. Results: The branchlets and leaf surfaces of S. cathayensis and P. heterophyllum were hairy, especially the lower leaf surfaces of P. heterophyllum were densely covered with hairs, but those of D. dentiger were hairless. The pericyclic fibers of S. cathayensis stems were intermittently distributed in a circular shape and accompanied by stone cells, whereas those of P. heterophyllum and D. dentiger were bundled without stone cells. So stone cells and hairs were present in S. cathayensis powder, stone cells were not found in P. heterophyllum and D. dentiger powder, and hairs were not present in D. dentiger powder. The distribution sites, sizes and types of secretory tissues of these three species were also different in transverse sections of stems and leaves. Stomata on the lower epidermis of S. cathayensis leaves were paracytic, whereas those of P. heterophyllum and D. dentiger were anomocytic. Conclusion: Ban Fenghe drugs derived from S. cathayensis could readily be distinguished from those of P. heterophyllum and D. dentiger by macroscopic and microscopic features.

ObjectiveTo evaluate the clinical efficacy of TDP （specific electromagnetic wave） combined with Osteoking in the treatment of knee osteoarthritis of Qi stagnation and blood stasis type. MethodA total of 104 patients with knee osteoarthritis of Qi stagnation and blood stasis type， who received conservative therapy in The Third People's Hospital of Xinjiang Uygur Autonomous Region from July 2019 to December 2021， were randomized into the control group and study group with the random number table method， 52 cases in either group. The control group was treated with TDP， and the study group with TDP and Osteoking. The treatment lasted 1 week for both groups， with 1-month follow-up. Subjective indexes of visual analog scale （VAS） score and Western Ontario McMaster Universities Osteoarthritis Index （WOMAC） score， and objective indexes of visual tenderness index and visual knee range of motion were determined before and after treatment to evaluate the pain and functions of patients. Traditional Chinese medicine （TCM） syndrome score was calculated. The serum erythrocyte sedimentation rate （ESR） and high sensitivity C-reactive protein （hs-CRP） were detected before and after treatment， and the total clinical effective rate was calculated. ResultBefore treatment， the baseline information and all the scores of the two groups were comparable. After treatment， the VAS score， WOMAC score， tenderness index， knee range of motion， and TCM syndrome score were improved in both groups （P<0.01）. After the treatment， the VAS score and WOMAC score of the study group were lower than those of the control group （P<0.01） and the improvement of tenderness index in the study group was better than that in the control group （P<0.05）. The knee range of motion in the study group was better than that in the control group （P=0.061）. The TCM syndrome score of study group was lower than that of control group （P<0.01） after treatment. The post-treatment serum ESR and hs-CRP level in the two groups decreased significantly after treatment， and the study group were lower than those of the control group （P<0.01）. The total clinical effective rate of the study group was 90.4%（47/52）， as compared with the 53.8%（28/52） in the control group （P<0.05）. No obvious adverse events occurred during treatment in both groups. ConclusionThe clinical efficacy of TDP combined with Osteoking in the treatment of knee osteoarthritis of Qi stagnation and blood stasis type is remarkable， which can improve knee pain and functions， alleviate TCM syndrome， and reduce inflammatory indexes， with high safety.