[Objective]To observe clinical value of multi-slice spiral X-ray computed tomography(MSCT)volume rendering technique(VRT)and multi-planar reconstruction(MPR)in classification and treatment of tibial plateau fracture(TPF).[Method]From August 2005 to February 2009,49 fratures in 45 patients with TPF were treated.Their clinical data were studied retrospectively.There were 32 males and 13 females.The patients were aged from 20-65 years(mean 46 years).Four patients suffered bilateral TPF.All patients were examined with standard X-rays and 64-slice spiral CT scanner.Axial CT scans were processed with VRT and MPR.Their X-ray plain films and 64-slice spiral CT seans(including VRT and MPR)were performed to determine their fracture types and protocol.[Result]According to the VRT and MPR findings,13 fractures(13/49)classified by X-ray plain film were corrected,protocols were changed for 9 fractures(9/49),and 15 fractures(46.9%)of intereondylar eminence of the tibia and 6 fractures(28.6%)of proximal fibula were underdiagnozed.[Conclusion]MSCT(VRT+MPR)can clearly show the area and degree of tibial plateau collapse,the details of TPF and the delitescence fracture,help to determine TPF types,decrease the underdiagnosis rate and choose a rational protocol.The use of combined VRT and MPR is a supplementary means for X-ray plain film and axial CT scanning.which has great clinical value.

BACKGROUND:At present, occlusion of the drainage tube was commonly used to reduce the drainage volume after total hip arthroplasty so as to promote the incision healing and hip function rehabilitation. However, the occlusion time is a problem deserving further investigations. OBJECTIVE:To research the effects of temporarily clamping drainage tube on drainage volume in early stage after total hip arthroplasty. METHODS:From January to October 2013, 112 patients received unilateral total hip arthroplasty in the First Ward, Department of Orthopedics, First Affiliated Hospital, Zhengzhou University in China. They were randomly divided into four groups according to the admission time (n=28):occlusion of the drainage tube for 2, 4 and 6 hours and without occlusion of the drainage tube. Al tubes were pul ed out in postoperative 48 hours. Moreover, 48-hour postoperative hemoglobin and drainage volume, the healing of incision and the score of hip joint function when patients were fol owed up at 1.5 months postoperatively were recorded accurately. RESULTS AND CONCLUSION:48-hour hemoglobin drop level and 48-hour incision drainage volume were highest in the non-occlusion group, fol owed by 2-hour occlusion group, 4-hour occlusion group and 6-hour occlusion group (P<0.05). However, no significant differences in the healing time of postoperative incision and the Harris score of hip joint function when patients were fol owed up at 1.5 months postoperatively were detected among groups (P>0.05). Incision infection and tension split were not seen in each group. Six cases affected subcutaneous ecchymosis and swel ing accompanied by pain and four cases suffered from the venous plexus thrombosis of the calf muscle in the 6-hour occlusion group. One case experienced fat liquefaction separately in the 4-hour occlusion group and non-occlusion group. These results suggested that temporary occlusion of the drainage tube in the early stage of total hip arthroplasty could reduce the drainage volume of incision. The suitable time of clamping drainage tube was 4 hours, and there were no adverse effects on healing of incision and recovery of hip function.

[Objective]To explore the surgical technique and clinical results of minimally invasive incision dynamic hip screws (DHS) in treatment of intertrochanteric fractures in the elderly.[Method]From August 2001 to January 2006,37 old cases (15 males and 22 females, aged from 72 years to 92 years, mean 81.5 years) with intertrochanteric fractures were treated with closed reduction and DHS using minimally invasive technique in our hospital. The procedure included following and critical steps:1～2 k-wires was inserted into the upper part of the femoral head through great trochanter percutaneously after operation. A guide wire was inserted into the center of the femoral head according to 135? collodiaphyseal angle; then, a small incision (4～5.5 cm) was made and along the guide wire for inserting a screw into the femoral head. The guide wire was removed and the side plate was slipped under the soft tissue into to tightly contact the lateral surface of femur, and followed by the side plate barrel being seated on the screw.[Result]The operation time was 40～75 minutes (average 60 minutes) The mean amount of blood loss in, operation was 55 ml. The mean amount of hemoaleh:in showed no significant difference between postoperation and preoperation. The following-up period averaged 15 months (11～18 months) The clinical hone healing lasted for 10～15 weeks. Two cases had mild coxa vara, there were no incision infection, fixation failure or lower extremity rotatory deformity. The excellent rate of joint function was 94.6% according to DONG's assay standard. [Conclusion]Minimally invasive incision DHS has the advantages of shorter operation time, less blood loss, little trauma, less complications and quick functional recovery and is an effective and safe method for treatment of femoral intertrochanteric fractures in the elderly.

AIM: To approach the best therapeutic measures after allochthonous intermingled with autogenous bone transplantation in children with tumor-like legion. METHODS: Forty children received bone transplantation between from March 2003 to March 2006 were selected from First Hospital Affiliated to Zhengzhou University. The guardians of Children all knew and agreed with the items. Subjects were divided into two groups according to the bone grafts with 20 children in each group: Compound transplantation group and autoplastic transplantation group. ① Subjects in compound transplantation group were transplanted with compound bone of allochthonous bone, autogenous bone and marrow with 160 thousands of gentamicin, 400 mg of vacocin and 5 mg of dexamethasone added. Allochthonous bone was obtained from dried radiosteriliaed bone, which was made by Shanxi Aorui Biomaterial Co., Ltd. Autogenous bone was gotten from the iliac bone of children. ② Subjects in autoplastic transplantation group were transplanted with simple illac bone got from subjects. Meanwhile, 16 thousands of gentamycin was adopted in the transplantation without using dexamethasone. ③ 5 mg of dexamethasone was added in to the allochthonous bone used for the surgery of subjects in compound transplantation group, and intervenous drop infusion of hormone was given to subjects after the surgery at proper dose, while children in autoplastic transplantation group received no hormone during and after the surgery. ④ Post-operation draining was performed, and the draining flow within 24 hours less than 20 mL was taken as the index of extubate. ⑤ The allochthonous bone and autoplastic bone were immersed into 160 thousands of gentamicin and 400 mg of norvancomycin used for patients in the compound transplantation group. Patients in both groups were administrated with antibiotic drugs of blue mold for fear of infection. ⑥ The duration of recovery to normal body temperature, leukocyte count and erythrocyte sedimentation rate (ESR) as well as the time of reservation of drainage tube of patients in both groups were observed after the surgery after operation, and follow-up was conducted regularly. RESULTS: Totally 40 patients were involved in the analysis of results, and no one withdrew from the study. ① The duration of recovery to normal body temperature, leukocyte count and ESR as well as the time of reservation of drainage tube of patients in compound transplantation group were longer than those in autoplastic group [(10.95?2.63,13.85?2.68,25.90?2.53,13.15?3.01) days;(6.95?1.57,8.80?1.96,15.30?2.27,6.40?1.98) days,P

[Objective]To evaluate the clinical characteristics and effect of operative treatment for the ossification of ligamentum flavum thoracic spinal stenosis (OLF-TSS). [Methods]From October 1998 to February 2007,38 patients with OLF-TSS were treated with en bloc hemi-articular process laminectomy. In this group,25 cases were male,and 13 cases were female. The average age was 48 years (range,29～71 years). Totally 81.6% of the lesion was between T10～L1 intervertebral disc space.The average history was 10 months. There were 5.3 percent with protrusion of intervertebral disc of thoracio spine.[Results]Thirty-eight cases were followed-up for 1～8 years,with an average of 3 years and 6 months. Dural injury occurred in 4 cases of 38,3 cases appeared postoperative cerebrospinal fluid leakage. All cases were cured conservatively mainly with bed rest in the prostrate position. According to WANG's evaluation,25 had excellent results,11 had good results,2 had no change and none was poor,The excellent to good rate was 94.7% in this group. There were no patients with the wrong level. No patient neurological functions were deteriorated.[Conclusion]The chinical features of OLF-TSS are very complex. The common symptoms of the disease are progressive onset of numbness,weakness,low back pain,intermittent claudication of the lower extremities,constriction on trunk or lower limbs and sphincter dysfunction. The clinical presentation and neurological examination associated with X-ray film,MRI and CT were the important means of the diagnosis of the disease. Removal of the posterior wall of the thoracic spinal canal via the technique of en bloc hemi-articular process laminectomy is safe and effective to treat OLF-TSS. The strategy for diminishing fault and complications is to discriminate pathogenic segment (locating-diagnosis) and follow the principles of surgical procedure.

[Objective]To evaluate the surgical management and its results of type A fractures of distal humerus in children utilized with double tension hands(DTB).[Method]From January 1999 to May 2005,52 patients of type A fractures of distal humerus in children were treated surgically through approach of DTB.Seven patients suffered open fractures(Gustilo scale Ⅰ in 5,and Ⅱ in 2).Fourty-five patients suffered closed fractures.According to AO/ASIF classification,type A2 fracture was found in 41 cases and type A3 in 11 cases.The elbows were flexed to 90?and immobilized with long-arm casts for 2 weeks.The rehabilitation exercises began at 2～3 weeks post-operatively.[Result]All the patients were followed up,with the duration from 6 to 18 months(averaged,12.5 months).All the fractures were healed,no cubitus varus deformity.The function of the elbow was evaluated according to Flynnet's scale,the results showed excellent in 41 cases,good in 10cases,and poor in 1 case.[Conclusion]The use of DTB for the surgical management of type A fractures of distal humerus in children has many advantages,it provides a new sufficient internal fixation with simple technical procedure,anatomical reduction under direct vision,reliablestability,facilitates rehabilitation exercises and low complication rate.DTB is a better choice in treatment of type A fractures of distal humerus in children.

In the 30-day period after the rats were inflicted with 30% TBSA full thickness scalding, the main pathological changes of the testes were various degrees of degeneration and necrosis of the spermatogenic cells, Sertoli's cells, lamina propria of the seminiferous tubules and Leydig's cells. The damages on spermatogenic cells, spermatocytes and spermatids were quite severe while spermatogonial cells exhibited little damages. On the 30th day after scalding, the spermatogenic cells restored their normal morphology. The activity of 3?-hydroxy steroid dehydrogenase was rapidly reduced and remained at a relatively low level on the 30th day after scalding. The serum level of testosterone was decreased and remained at a comparatively low level on the 30th day after scalding. No significant changes of serum luteinizing hormone was observed.It is believed that the damages on the lamina propria of the seminiferous tubules and Sertoli's cells espercially the latter could change the microenvironment of the development and differentiation of the spermatogenic cells and the decrease of serum testosterone might result from the increase of glucocorticoids after scalding.

Objective To study the relationship between polyps of middle meatus and the position of the inferior border of the middle concha related to the semilunar hiatus, and to evaluate the diagnostic value of coronal CT scan of the nasal cavity after ephedrine spray by means of comparison of CT images and clinical findings Methods The coronal CT studys of 102 cases clinically suspected as sinusitis and/or nasal polyps were included in this study 1% ephedrine was sprayed in nasal cavity of the patients before CT study and the patient were asked to take supine position with head over extended over 5 minutes Axial and coronal CT scan was taken with supine position, 2 mm slice thickness and high resolution reconstruction Observation was focused on contraction of the nasal mucosa and soft tissue mass of the middle meatus (polyps) The middle concha was divided into 3 types according the position of its inferior border related to the semilunar hiatus: superior hiatus type (the inferior border of the middle concha superior to the semilunar hiatus), hiatus type (the inferior edge of the middle concha at the level of the semilunar hiatus), inferior hiatus type (the inferior edge of the middle concha inferior to the semilunar hiatus) Statistic comparing the occurrence of the middle meatus polyps with different middle conchas type and measuring the length of the middle conchas of inferior hiatus type from the level of the semilunar hiatus to the inferior border were performad Results Good and better contraction of the nasal mucosa with clear manifestation of the lesion was seen in 98 of 102 cases Nasal polyps of middle meatus were diagnosed in 71 sides of nasal cavities of 47 cases and confirmed surgically and/or clinically 39 superior hiatus and hiatus middle conchas were found ipsilateral to the polyps (54 9%) Of 204 sides of 102 cases, superior hiatus type middle conchas was found in 18 sides of nasal cavity with middle meatus polyps in 11 sides (61 1%); hiatus type in 38 sides with middle meatus polys in 28 sides (73 7%); and inferior hiatus type in 148 sides with middle meatus polys in 32 sides (21 6%) The difference was markedly significant statistically Conclusion Coronal CT scan after ephedrine spray into the nasal cavity can depict the mass in the nasal cavity better, especially nasal polyps with swollen mucosa The method is simple and easy to perform The poorly developed middle concha and the exposed middle meatus may be one of the causes of polyps of middle meatus It clues on that the middle concha should be preserved as much as possible during the endoscopic sinus surgery, opening the ethmoidal infundibulum and bullas, to decrease post operative recurrence of middle meatus polyps

[Objective]To introduce the clinical experiences and efficiency in surgical treatment of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation with decompression,reduction and internal fixation through anteroposterior approaches.[Methods]A total of 34 cases of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation(25 males and 9 females,with age range of 21-61 years)treated from October 2005 to February 2009 were analyzed.Twenty-one cases showed double joints interlocking and 13 cases single facet joint interlocking,which was indentified by the three dimensional CT scan.All cases were treated with decompression,reduction and internal fixation through anteroposterior approach.Among them,13 cases were done through one stage anterior delompression,posterior unlock,fusion and stabilization as well as anterior fusion and stabilization in turn,21 cases were done through one stage posterior unlock,fusion and stabilization as well as anterior decompression,fusion and stabilization in turn.The Frankel grade scores was used as the judging criteria for the recovery of the spinal cord.[Results]All patients were followed up from 7 to 35 months,and the mean follow-up time was 16 months.Lateral mass screw and pedicle screw insertion were successful in all cases.After operation,the joint interlocking and dislocation were all released and reduced.There were no death,infection,interfixation failure or neurological function deterioration.Solid fusion were obtained in all cases in the follow-up.Incomplete spinal cord lesions had some recovery of nervous function postoperatively.Besides,one grade was improved in 23 cases by Frankel grade scores and 2 grades in 8 case.There were no improvements in 3 cases.[Conclusion]Decompression,reduction and internal fixation through anteroposterior approaches is an appropriate treatment method for the irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet disclocation,with the advantages of relatively safe operation and strong stability.Most complications can be prevented under correct control of anatomic features and adjacent structures of the cervical lateral mass and pedicle as well as careful operation.

BACKGROUND: Gene transfer to study the effect of a exogenous gene on cells is a commonly used technique for molecular biology. Compared with viral vector,pcDNA4.0-TGF-?1 eukaryotic expression plasmid transfection has no inherent toxicity or cytotoxicity,with high safety. OBJECTIVE: To construct and identify eukaryotic expression plasmid carrying recombined TGF-?1 by cloning transforming growth factor (TGF)-?1 gene. DESIGN,TIME AND SETTING: The in vitro cell experiment was performed at the Opening Laboratory of Key Clinical Medical Sciences,Henan Provincial High-learning School from March 2007 to February 2008. MATERIALS: Clean healthy Sprague Dawley rats aged 2 months,of both gender,were used for isolating RNA from cells. METHODS: The TGF-?1 mRNA was extracted from the rat bone marrow cells,and amplified by reverse transcription-polymerase chain reaction (RT-PCR),and cloned into the pGEM-T-vector and identified by PCR. Then TGF-?1 gene was subcloned into pcDNA4.0 plasmid vector. The inserting DNA sequences were analyzed. MAIN OUTCOME MEASURES: Expression of TGF-?1 cDNA,pGEM-T-TGF-?1 and recon pcDNA4.0-TGF-?1. RESULTS: There was an obvious electrophoresis strip of TGF-?1 cDNA by RT-PCR. The obtained pGEM-T-TGF-?1 was confirmed correct with PCR amplification and sequence identification. Recombinant eukaryotic expression plasmid pcDNA4.0-TGF-?1 was obtained and identified by digestion. The inserted sequences were conformity to the designed sequences. CONCLUSION: Rat TGF-?1 gene has been successfully cloned,and recombinant TGF-?1 eukaryotic expression vector has been constructed successfully.