Nonunion is cessation of normal reparative sequence of fracture healing. With an incidence of about 5%to 10%, it is one of the difficult problems in orthopaedics. Definition, classification and location of nonunion are reviewed in this article. Causes of nonunion are analyzed. Traditional and modern treatment methods of nonunion are introduced systemically.

Generalized epilepsy with febrile seizures plus(GEFS+)is a familial in herited epileptic syndrome characterized by phenotypic heterogeneity from the mi lder febrile seizures to the severest epileptic encephalopathy such as severe my oclonic epilepsy in infancy(SMEI).GEFS+ is a disorder with a genetic heterogen eity.Molecular genetics have revealed that four genes are associated with the p athogenesis of GEFS+.These include mutations in genes encoding subunits of neur onal voltage-gated sodium channels(SCN1A,SCN1B,SCN2A)and ?2 subunit of the gamma amino-butyric acid(GABA)A receptor(GABRG2).These genes have be en confir med as having a role in autosomal dominant GEFS+ families.In addition,the phen otypes of the affected members may depend on the types and locations of these ge ne mutations.This review states the molecular genetic progress of GEFS+ in brie f.

Objective To i nv estigate the clinical effect of shape-memory sawtooth-arm em bracing fixator in the management of periprosthetic femoral fracture.Methods Since1994, 21cases of periprosthet-ic femoral fractures had been treated in7hospitals with the shape-memory sawtooth-arm embracing fixator designed and developed b y the Ninth Peoples Hospital,Shanghai Second Medical University(SSMU ).Of the21cases,12were males and9were females,aging from42to83years old. Eighteen of the series ex peri-enced periprosthetic fracture at2weeks to10y ears after joint replacement the fractures were found as oblique,spi ral or comminuted with the fracture lines located between the lesser trochanter and a p oint 5cm distal to the end of prosthetic stem.The other three were revision c ases,in which2cases with osteoporosis had intraoperative spiral fracture and1 case had long segmental osteotomy for removal of the prostheses.One of the 21patients had Z-shaped femoral osteotomy,while the other20cases were clas sified into Jo hannson typeⅠfrac ture in4cases,typeⅡ9cases and typeⅢ7case s.All of them were complete fracture with dis-placement.In practice,the arm s of fixator were expanded firstly by immersing into the ice water to make the tempera ture of the device decrease to4~7℃.After reduction of the fracture ,the body of the fixator was placed on the tensile side of the femur,and th e temperature of the arms was raised with hot saline.With its shape memory ef fect,the sawtooth-arms began to close up and grasped the fracture fragments ti ghtly.Results Surgical process in all of the cases was smoothly done:the frac tures were stable after the fixation,and no ex-ternal fixation was required po stoperatively,except four cases underwent skin traction of the affected lim b for 2weeks.All the patients were able to walk with two crutches at2to4we eks after the operation.The post-operative follow-up lasted from1to7years, and no fracture re-displacement was found.The results of frac-ture healing were good while the functional recovery to the pre-operative level was achieved in the all se ries.Conclusion For periprosthetic femoral fracture,shape memo ry sawtooth-arm embracing fixator is a re liable device being implanted easily and offering stable fixation;it should be the treatment method of the first choice.

This review summarized some hot research fields in pharmacological effects of sinomenine such as anti-inflammatory, immunosuppressive, and anti-tumor effects. In addition to our exploration of its antinociceptive effect, we summarized above-mentioned pharmacological effects of sinomenine and its underly-ing mechanism, in order to provide an evidence for its clinical use.

[Objective]To investigate the method of distal fractures of radius and ulna in children treated with minimal invasive technique.[Method] From 2003 to 2005,titanium elastic nail using descending technique was carried out on 15 children.The mean age was 7.4 years,all of them had been followed up from 4 month to 2 years.[Result]One case had cortex perforation,1 case had soft-tissue irritation at nail insertion.All patients were pain-free,without limitations in activities for daily life after treatment.[Conclusion] Using minimal invasive descending technique,tianium elastic nail is appropriate therapy for distal 1/3 fractures of radius and ulna in children.

Objective To propose measures to reconstruct the massive bone defect in acetabulum in revision hip arthroplasty on the basis of the experience in the cases treated by the authors. Methods Thirty- two hips of 33 hip revision cases with massive bone defect being operated on by the first author were summarized and analyzed. The patients included 17 males and 15 females, with the age of 40 to 90 years. 28 cases (29 hips) underwent revision for the first time, 2 cases (2 hips) for the second time,1 case (1 hip) for the third and the other 1 case (1 hip)for the fourth time. The primary surgery were artificial femoral head replacement in 8 cases (8 hips) and total hip replacement in 24 cases (25 hips). Except of 2 saddle protheses replacement, bone grafts, mainly cancellous bone grafts, were used in 31 hips, of which 22 hips were non- structural bone grafts and 9 hips were allografts of femoral head or autograft of ilium. After grafting, ready- made acetabular prostheses were implanted in 9 hips, while special prostheses were used in 24 hips, chiefly computer- aided custom- made acetabular prostheses, including winged prostheses, 2- layer metal mesh, acetabular reinforcing rings (ARR), bi- spherical prostheses, crested prostheses and saddle type prostheses. Results In the course of 0.5 to 11 years' follow- up, re- displacement or relapse of bone absorption was not found in any of the cases. The Harris hip function score rose to 54－ 89 from the pre- operative level of 17－ 48. The computer- aided custom- made acetabular prostheses could better meet the requirements of different conditions of disease, thereby reducing the difficulties of surgery. Conclusion Special prostheses have the advantages of better compatibility with the individual requirements, prevention of displacement or collapse of the bone graft and higher primary stability. The proper application of bone graft and choice of suitable prosthesis to achieve the reconstruction of acetabular fossa and the integrity of acetabular circumference will markedly improve the success rate of revision surgery.

Objective To explore the common factors' influence on serum gastrin level,and reveal the value of serum gastrin in the diagnosis of gastric precancerous lesions and gastric cancers.Methods Serum gastrin level of 3 906 serum samples was detected by ELISA.Results Serum gastrin level of patients over 60 years old was distinctively higher than that of other age groups.Serum gastrin level in antral diseases was higher than that in diseases of the body.HP positive group was higher than the negative one.The level progressingly increased from normal group to superficial gastritis and to gastric erosion or ulcer;and it decreased from gastric erosion or ulcer to atrophic gastritis,while it increased from atrophic gastritis to dysplasia,and it decreased from dysplasia to gastric cancer.Serum gastrin level was distinctively lower in gastric cancer than in other groups.Conclusion For people over 60 years old,their serum gastrin level has the tendence to increase.The location of gastric disease is an important factor affecting serum gastrin level.HP can increase the serum gastrin level.During gastric precancerous stage,the serum gastrin level may gradually increase with the diseases' progression,and decrease when gastric cancer is formed.Serum gastrin is a good marker to differentiate benign and malignant gastric diseases.

Objective To summarize the experience in CAD / CAM custom-made hemipelvic prosthesis and its application in 8 patients. Methods The exact model of pelvis was generated with its CT data by Rapid Prototyping Technique (RPT). Simulated bone resection and prosthesis design were performed on the models. The prosthesis should be fixed simultaneously on the contralateral pubic ramus (or the remainder of pubis), the joint facet of sacrum (or the remainder of ilium) and on the remained ischium if part of it could be preserved. When prosthesis was put in place, the acetabular component should be symmetric with the contralateral acetabulum in terms of the height, lateral distance and abduction angle, after it's fixation on the remained pelvis with cancellous screws, bolts and hooks, conventional total hip implants with cemented acetabular and cementless femoral prothesis were implanted. 8 patients underwent this kind of procedure, of them 7 suffered from large pelvic tumor, including 2 chondrosarcoma, 3 giant cell tumors, 1 cartilaginous fibrodysplasia and 1 metastasis. One patient received this procedure for severe osteolysis after THA. Tumor artery embolization was done in 6 of them 24-48 h before operation. Results Blood transfusion was 4971 ml in average. The implantation of prosthesis was easily accessible. One suffered from remained sinus, and healed after myocutaneous flap transferring. All patients began non-weight bearing walk with double crutches 6 weeks after operation and gradually abandoned crutches in 3 months. One patient with chondrosarcoma died of lung metastasis 9 months after operation. No loosening was found during the 1 to 4 years (2.5 years in average) follow-up of the 7 cases. The position of bilateral hips was symmetric. They all recovered to self-care. Two of them returned to work 7 and 8 months after operation respectively. One local recurrence happened and was resected again. Conclusion The custom-made hemipelvic prosthesis generated with RPT and CAD/CAM can improve the prosthesis fixation, ensure the exact orientation of acetabular component and make the operation easy.

Objective To evaluate the clinical outcome of total hip arthroplasty (THA) for protrusio acetabuli. Methods Between 2003 to 2008, 31 patients(35 hips) with protrusio acetabuli were treated with THA, including 16 males (18 hips) and 15 females (17 hips). The age ranged from 36 to 71 years (average age 52.2 years). The femoral heads were moved out with retrograde method when necessary via posterior-lateral hip incision. The acetabular loops and bottoms were prepared respectively. Auto-bone grafting was used to repair acetabular defects and cementless prostheses were planted with press-fit skills. At follow-up visit,the hip functions were evaluated by Harris score. The loosening, re-protrusion and the union of graft bone was judged by X-ray. Results The mean follow-up was 46.5 months (19-152 months). One patient developed DVT on the second day post-operatively who recovered well after anticoagulation treatment. One patient complained of gentle thigh pain which disappeared at 6 months. No other complication was found. The mean Harris scores had improved from 48.9±6.5 pre-operatively to 91.2±5.7 post-operatively. All prostheses acquired bone stabilization with no sign of loosening and re-protrusion and the grafts bone were healed at a mean 6 months according to X-ray. Conclusion THA with acetabular bone grafting and cementless component for protrusio acetabuli have acquired excellent results and prevented loosening and re-protrusio effectively.

Purpose To explore the multislice spiral CT (MSCT) features of renal chromophobe carcinoma, and to improve the understanding and diagnosis of the disease. Materials and Methods MSCT features of 17 patients with renal chromophobe carcinoma confirmed by surgical pathology were retrospectively analyzed, plain MSCT and multi-phase dynamic contrast-enhanced scan were applied to these patients. Results Single substantive round or oval-shaped soft tissue mass was demonstrated in 17 cases. The lesions were all uniform density on plain MSCT, and mild to moderate homogeneous enhancement in 11 cases on enhanced MSCT, including 9 cases with significant enhancement above the renal medulla and below the renal cortex, and 2 cases with similar enhancement to renal medulla in corticomedullary phase. On nephrographic phase the lesion showed significant lower density than renal medulla. Heterogeneous enhancement presented in 6 cased, including 1 case with small necrosis and 1 case with stellate scar lesion in low-density. Conclusion Renal chromophobe carcinoma demonstrates a round solid mass of uniform density on plain MSCT, and mild to moderate homogeneous and heterogeneous, which can provide the reference value for preoperative diagnosis.