In regional anatomy the appliance of the methods of problem based learning can cultivate students' practical ability,slimulate their motivity and raise their passion for study.It is also effective to improve their capabilities of self-study,cooperation,as well as analizing and solving problems.

Objective To investigate the treatment of complex fractures of distal femur with open reduction and internal fixation with anatomical plate. Methods From January 2001 to June 2004, 67 cases of complex fractures of distal femur were treated with open reduction and anatomical plate internal fixation. The allogeneic bone was grafted for 23 cases, ilium was grafted for 35 cases, ilium and fibula were grafted for 9 cases. Bio- resorbable membranes were used between quadriceps femoris and femur. 13 cases were aided with patella traction. All the patients received fumigation and rinsing with Chinese herbs and CPM(continuous passive motion) after operation. Results All the 67 cases were followed up for 10 to 26 months. All the fractures got united. The postoperative knee functions were excellent in 36 cases, good in 23 cases, fair in 5 cases, and poor in 3 cases according to Kolment standards. The excellent and good rate was 88.1% . Conclusions Open reduction, internal fixation with anatomical plate, bone grafting, local use of bio- resorbable membranes, patella traction when necessary, fumigation and rinsing with Chinese herbs and CPM after operation are good measures to treat complex fractures of the distal femur, because they can provide stable fixation, allow early postoperative functional training, and prevent adhesion of quadriceps femoris and stiffness of the knee joint

[Objective]To investigate the influence of Nitinol modified on its surfaces by the coating of titanium or titanium-niobium alloy on separat ion of Ni~(2+).[Method]The specimens from 1 to 7 days after the experiments were collected and the concentration of Ni~(2+) were cletermined by physiologic saline immersing test,low temperature ashing furnace,Mg(NO_3)_2 as matrix modifier and graphite furnace atomic absorption spectrometry(GFAAS).[Result]Specimens of Nitinol were devided into 3 groups:alloy coated with Ti(Ti group);alloy with Titanium-Niobium(TiNi group);only Nitanol without coating group.Obvious separation of Ni~(2+) was detected in the groups of Nitinol that were not modified and were put in baking oven(37℃),the separating procedure was mainly within 4 days,the separation rate(10~(-7)??g? cm~(-2)?s~(-1)) from the first to the forth days was 18.2,3.45,1.75 and 0.45 respectively,the Ni~(2+)was no more separated from the fifth day.Whereas,Ni~(2+) was not separated in the groups of Nitinol that were modified by the coating of metallic Ti and TiNb alloy.The recovery rate of the experiments was between 94.6%～108.6%.[Conclusion]The coating of Ti or TiNb on the surfaces of Nitinol stopped Nitinol from separating Ni~(2+).

blank group. Conclusion Fangshi capsule combining with Auricular-plaster therapy could prevent the formation of cholesterol gallstone possibly by reducing the calcium ion concentration in the bile.

Objective To investigate the safety and feasibility of laparoscopic pylorus-preserving pancreaticoduodenectomy.MethodsThe data of 59 patients with laparoscopic pancreaticoduodenectomy in Shangjin hospital of West China hospital of Sichuan University from January 2014 to December 2015 were analyzed retrospectively.The general data,operative time,estimated blood loss,conversion rate,time to liquid diet,postoperative hospital stay and complications were analyzed.Results The laparoscopic pylorus-preserving pancreaticoduodenectomy were successfully performed in 56 cases,the successful rate was 94.9%,the other 3 patients were converted to laparotomy for superior mesenteric vein/portal vein involvement.The operative time was 255~510 minutes,with mean operative time (384±145) minutes,the intraoperatve blood soss was 50~800 mL,with mean estimated blood loss (148±28)mL,the time to liquid diet was 1.0~4.0 days,with average time (3.2±1.1)days,the postoperative hospital stay was 5.0~53.0 days,with average time (10.3±2.6)days.After surgery,16 cases suffered from complication,the rate was 27.1%.The most common complication was pancreatic fistula which occurred in 13 cases including 12 cases of grade A and 1 case of grade pancreatic fistula.No grade C pancreatic fistula occurred in this series.Six patients suffered from delayed gastric emptying.One patient suffered from bile leakage.Conclusion Laparoscopic pylorus-preserving pancreaticoduodenectomy was safe and feasible.Pylorus-preserving does not increase the incidence of delayed gastric emptying.

Objective To study the safety and feasibility of laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS) in the diagnosis and treatment of benign splenic tumors by comparing the perioperative and follow-up data between these two operative approaches.Methods We retrospectively analyzed the clinical data of 57 patients who underwent laparoscopic surgery for benign splenic tumors from December 2009 to April 2016.These patients were divided into the LTS and the LPS groups.The clinical data including the preoperative,intraoperative,postoperative and follow-up data were analyzed.Results When compared with the LPS group,the LTS group had shorter operation time [(97.0 ± 22.1)min vs.(135.0 ± 24.6) min,P ＜ 0.05] and less blood loss [(33.3 ± 19.5) min vs.(90.6 ± 55.1)min,P ＜ 0.05],but there were no significant differences between the two groups in the length of hospital stay,the duration of drainage tube placement,the amount of postoperative analgesics as well as the incidences of pulmonary infection,postoperative pancreatic fistula and other complications after surgery.These incidences were low in the two groups.Conclusion Laparoscopic surgery,including LTS and LPS,were safe and feasible in treating benign splenic tumors.

Objective To assess the surgical skills and clinical outcomes of selective splenic pedicle occlusion (SSPO) in laparoscoic partial splenectomy.Methods Between May 2011 and Nov 2016,40 patients undergoing laparoscopic partial splenectomy were devided into selective splenic pedicle occlusion group (14 cases) and conventional laparoscopic partial splenectomy group (26 cases).Results There were no significant differences in preoperative patient characteristics between the two groups.Significantly less intraoperative blood loss (82 ± 36) ml vs (178 ± 81) ml (t =-4.2,P =0.001) were observed in group of SSPD,There were no significant differences between the groups in operative time (111 ± 17) min vs (127 ±40) min(t =-1.4,P =0.19),transfusion rate (0/14,0/26) (P =1),conversion rate (0/14,0/26) (P =1),postoperative complications (1/14,2/26) (Fisher =0.063,P =0.80) and length of postoperative hospital stay (7.1 ± 2.3) d vs (6.0 ± 1.3) d (t =1.28,P =0.22).Conclusions SSPO is feasible and safe for patients receiving laparoscopic partial splenectomy.

objective Using iodimetric analysis of dual-energy CT,to explore the dual perfusion amount and proportion of hepatic artery and portal vein in different hepatic lobes on normal living bodies.Methods A total of 77 patients without hepatic diseases underwent contrast-enhanced upper abdomen dual-energy CT scanning.The raw data were transferred to the workstation for postprocessing.ROI were selected,then the iodine content in arterial phase,portal phase and delay phase were calculated automatically.The differences of these measures (iodine content and hepatic artery to portal vein perfusion ratio of the left hepatic lobe,right hepatic lobe and caudate lobe) in the left,fight and caudate lobe of liver were detected by using ANOVA test.Results The iodine concentration in the caudate lobe was(851 ± 35)μg/L from hepatic artery and (2912 ± 78) μg/L from portal vein.The iodine concentration in the left hepatic lobe was (445 ± 34) μg/L from hepatic artery and (2373 ± 77) μg/L from portal vein.The iodine concentration in the right hepatic lobe was(504 ± 30)μg/L from hepatic artery and(2515 ± 78) μg/L from portal vein.The perfusion condition (amount of blood supply) of caudate lobe showed a significant statistic difference from the left and right hepatic lobe (P ＜ 0.05),and the amount of blood supply from both sources were more than those of the left and fight hepatic lobes.There was no significant statistic difference in the amount of hepatic artery and portal vein blood supply between the right and left hepatic lobe(P ＞ 0.05).The proportions of blood supply from hepatic artery and portal vein (hepatic artery/portal vein) were different among the three hepatic lobes,which was (28.41 ± 3.42) ％ in left lobe,(35.76-± 5.80) ％ in fight lobe and (49.92 ±4.63)％ in caudate lobe,respectively(F =5.36,P ＜0.01).Conclusion Dual-energy CT can be used to study the dual-perfusion condition of the liver.On normal living bodies,the hepatic artery and portal vein perfusion in caudate lobe are different from those in left and right lobes.

Objective To explore the effect of exposure of the recurrent laryngcal nerve(RLN) in prevention of RLN injury during thyorid surgery.Methods The clinical data of 810 cases of thyroid operation in which the RLN was exposed in 252 cases(group A) and was unexposed in 558 cases(group B) were analyzed.Results Although the extent of thyroid resection was greater in group A than in group B,the rate of RLN injury in group A(1.19 %) was significantly lower than that of group B(3.05 %,P

Objective To investigate the application value of enhanced recovery after surgery(ERAS) in laparoscopic pancreaticoduodenectomy (LPD).Methods The retrospective cohort study was adopted.The clinical data of 64 patients who underwent LPD from January 2014 to January 2016 in the Shangjin Hospital of West China Hospital of Sichuan University were collected.Of the 64 patients,41 patients managed with ERAS program between March 2015 and January 2016 were allocated into the ERAS group,23 patients managed with traditional perioperative treatment between January 2014 and Febuary 2015 were allocated into the traditional group.The following indexes were observed:(l) intraoperative status:operation time,volume of intraoperative blood loss,conversion to open surgery,pylorus preservation.(2) Postoperative status:the time to out-of-bed activity,time to postoperative flatus,time of drainage tube removal,postoperative complications (pancreatic leakage,bile leakage,hemorrhage,delayed gastric emptying,abdominal infection,cardiovascular complications),duration of postoperative hospital stay,death within the postoperative 30 days.(3) Follow-up status:incidence of complications after discharge and survival of patients.The follow-up including incidence of complications after discharge and survival of patients was conducted by outpatient examination and telephone interview up to March 2016.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test.Count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Intraoperative status:the operation time,volume of intraoperative blood loss,number of patients with conversion to open surgery and pylorus preservation were (377 ± 38) minutes,(164 ± 48) mL,1,40 in the ERAS group and (392 ± 53) minutes,(152 ±31)mL,2,21 in the traditional group,showing no statistically significant difference between the 2 groups (t =5.02,8.43,x2=1.29,1.29,P ＞ 0.05).(2) Postoperative status:the time to out-of-bed activity,time to postoperative flatus,time of drainage tube removal and duration of postoperative hospital stay were (1.7 ± 0.6)days,(2.5 ± 0.6) days,(5.3 ± 1.7) days,(9.1 ± 1.3) days in the ERAS group and (2.1 ± 0.9) days,(3.8 ±1.2) days,(8.2 ± 2.6) days,(11.9 ± 1.8) days in the traditional group,showing statistically significant differences between the 2 groups(t =-5.28,-7.01,-16.20,-10.67,P ＜ 0.05).The numbers of patients with pancreatic leakage in stage A,B and C,bile leakage,hemorrhage,delayed gastric emptying,abdominal inflection,cardiovascular complications and death in the postoperative 30 days were 8,0,0,0,1,3,0,1,1 in the ERAS group and 5,1,0,1,1,3,2,1,0 in the traditional group,respectively,showing no significant difference between the 2 groups (x2=0.37,1.81,0.18,0.57,3.68,0.18,P ＞0.05).(3) Follow-up status:the 64 patients were followed up for a median time of 11 months (range,1-25 months).During the follow-up,number of patients complicated with diabetes,local tumor recurrence,liver metastasis and death were 5,4,1,0in the ERAS group and 2,5,2,3 (2 died of tumor recurrence and 1 died of myocardial infarction) in the traditonal group.Conclusion Application of ERAS in the perioperative management of LPD is safe and effective,meanwhile,it can accelerate the recovery of patients who underwent LPD and shorten the duration of hospital stay.