Objective:To compare the clinical effects between axillary approach, periareolar approach and inframammary fold approach in breast augmentation.Methods:Two hundred and eleven patients in our department from Jan. 2016 to Jan. 2018 were involved in this study. According to the surgical approach, the patients were divided into the axillary approach group, periareolar approach group and inframammary fold approach group. Postoperative pain, incision scar, drainage fluid and several complications were observed in three groups.Results:Postoperative VAS score of patients in inframammary fold approach and periareolar approach group was lower than that in the axillary approach group ( F=70.93, P<0.05), and postoperative drainage fluid was lower than in the axillary approach group. No diffrences were found in postoperative scar score among the three group ( P>0.05), and the nipple areola sensory disorder in the inframammary fold approach group was less. Conclusions:Breast augmentation of inframammary fold approach has the advantages of relatively hidden incision, short surgical approach, direct vision operation, mild pain, less surgical injury and low postoperative complications. It is worthy of being promoted.

Objective To investigate clinical effect of surgery combined with the rehabilitation treatment for the patients with burn scar contracture on hand,to provide a reference for clinical treatment.Methods 60 cases of hand burn scar contracture patients were selected,according to the digital table they were divided into control group and observation group(n =30 cases),which was underwent surgery in both groups.The control group was treated based on out -patient routine hand exercise methods,while a heated therapy,compression therapy and other profes-sional rehabilitation exercises were performed in the observation group.TAM in patients and ADL were compared. Results The observation group after treatment TAM score was (198.67 ±21.08)point,which was significantly higher than (144.43 ±16.65)point,the difference was statistically significant (t =8.476,P =0.000).Manicure, taking food,combing,brushing teeth,washing face,clothing,shoeing ADL scores in the observation group after treatment were (3.26 ±0.51)point,(3.56 ±0.55)point,(3.68 ±0.72)point,(3.38 ±0.68)point,(3.61 ±0.52)point, (3.55 ±0.61 )point and (2.57 ±0.47)point,which were improved significantly better than those of the control group,the differences were statistically significant (t =4.524,P =0.024;t =5.041,P =0.011;t =4.924,P =0.019;t =4.442,P =0.027;t =5.136,P =0.010;t =5.347,P =0.008).Conclusion Clinical effect of surgery combined with professional rehabilitation on hand burn scar contracture is good,and it is worthy of clinical application.

Objective To summarize the experience of pterional craniotomy microsurgical resection of giant tuberculum sellae meningiomas. Methods A total of 18 patients with giant tuberculum sellae meningiomas were treated microsurgically in this hospital from February 2000 to November 2004. The patients were operated on by use of pterional craniotomy on the side of worse vision. The basal part of the tumor was firstly dissected to control the blood supply of the lesion. Through the cerebral cisterns at the sellar region and the interfaces between the tumor and the adjacent structures, the tumor was removed to the greatest possible extent with minimal invasion to the neighbouring structures. Results[WTBZ] A total resection was conducted in 16 patients (88.9%), and a subtotal resection, in 2 patients (11.1%). No surgery related death was observed. Follow-up examinations in 14 patients for 3 months ~ 4 years (mean, 2.5 years) found no recurrence of meningiomas. Conclusions[WTBZ] The pterional approach provides excellent exposure of the middle fossa and the parasellar area. Pterional approach microsurgical technique can improve the rate of total resection of giant tuberculum sellae meningiomas.

Objective To To evaluate the efficacy of Guglielmidetachable coil (GDC)F embolization in treatment of intracranial aneurysms and summarize the main points of GDC manipulation.Methods Thirty two patients were examined with digital substraction angiography (DSA) and 34 intracranial aneurysms were found, including 15 aneurysms in the anterior communication artery, 13 in the posterior communi cation artery, 2 in the middle cerebral a rtery, 1 in the anterior cerebral artery and 1 Ophthalmic artery. After wards GDC was used for embolization therapy. Results Thirty two patients with 34 aneurysms were successfully embolized with GDCs. Complete embolization achieved in 20 patients and incomplete in 12 patients; while one aneurysm ruptured during the performance, but all curedafter treatment. Vas cular spasm occurred in 2 patients, one of them had slight hemiplegia. Sixpatients with 7 aneurysms were followed up by DSA examinationl year after operation. No obvious change was observed.Conclusions Treatment of intracranial aneurysms with GDC embolization is a safe, reliable, and effective measure. Skillful techniques of the operator and correct management of complications are important factors affecting the outcome of operation. A period follow up is essential to patients with partial embolism.

Objective To evaluate the safety and efficacy of microsurgical resection of large acoustic neurinoma via the suboccipital retrosigmoid approach.Methods Forty-nine patients with large acoustic neurinoma(≥4 cm) underwent microsurgical resection through suboccipital retrosigmoid approach.The craniotomy was performed by way of an unilateral S-shaped suboccipital incision.With microsurgical techniques the outmost layer of the arachnoid membrane was preserved in order to avoid damaging to the surrounding vital structures.The tumor was resected intracapsularly from the superior pole and the internal auditory meatus was finally opened.The last pieces of tumor were removed by sharp dissection from the facial nerve bidirectionally,and were resected cautiously in a piecemeal fashion.Results Of the 49 patients,45 patients(92%) received a total resection of the tumors,and 4 patients(8%) subtotal resection.No patients died.The facial nerve was preserved anatomically in 42 patients(86%) and functionally in 36 patients(73%).The acoustic nerve was preserved anatomically in 7 patients(14%) and functionally in 3 patients(6%).One patient experienced a postoperative haematoma,and a re-operation was required.No recurrence was seen in 37 patients during a follow-up for 6 months ～ 5 years(mean,2.8 years).These patients had recovered for normal work and daily activities.Conclusions Microsurgical operation through suboccipital retrosigmoid approach is a favorable treatment for large acoustic neurinomas.The procedure can improve the rate of total resection,decrease the morbidity and mortality,and effectively protect the function of the acoustic and facial nerves.

Objective To explore the outcomes of endoscopic minimally invasive surgery as a new technique for the treatment of glossopharyngeal neuralgia.Methods From January 2000 to May 2008,16 cases of primary glossopharyngeal neuralgia were treated by endoscopic minimally invasive surgery through suboccipital retrosigmoid approach in our hospital.We made a 6-to 8-cm vertical incision within the inner hairline to drain the cerebrospinal fluid from the cerebellopotine angle cistern(CPA) so that to form an operational path.And then,the adherent arachnoid membrane was freed and the structure of the glossopharyngeal nerve and local arteries were detected.Results After the endoscopic surgery,pharyngeal pain disappeared in all of the 16 cases.Follow-up was available for 3 months to 8 years in the patients(1-3 years in 4 cases,and 3-8 years in 2 cases).Two patients had hoarse voice after the operation.No one had dysphagia or recurrence during the follow-up.Conclusion Endoscopic surgery through suboccipital retrosigmoid approach is a minimally invasive method for primary glossopharyngeal neuralgia with good outcomes,mild surgery-related complications,and quick post-operative recovery.

BACKGROUND:Orthopedists should pay more attentions to nonunion prevention in view of nonunion treatment, that is, active interventions should be taken to avoid bone delayed union and nonunion.
OBJECTIVE:To explore the effect of composite tissue-engineered scaffold constructed by nano-hydroxyapatite/polyamide 66 (nHA/PA 66) combined with bone marrow mesenchymal stem cels to repair a femoral fracture with severe nonunion.
METHODS:Rat bone marrow mesenchymal stem cels were isolated and culturedin vitro, and then they were divided into three groups: bone marrow mesenchymal stem cels without osteogenic induction, with osteogenic induction or combined with nHA/PA 66 folowed by osteogenic induction as control group, test group or composite group, respectively. Then osteogenic differentiation of bone marrow mesenchymal stem celsin vitrowas analyzed by measuring alkaline phosphatase activity and alizarin red staining, cel adhesion on the nHA/PA 66 was observed using scanning electron microscopy, and the celgrowth and proliferation were detected by MTT assay. In the meanwhile, established Sprague-Dawley rat femur nonunion models were randomly divided into three groups: the areas of nonunion were implanted with nothing as blank control group,those were with nHA/PA 66 as simple scaffold group, and the others were with nHA/PA 66 combined with bone marrow mesenchymal stem cels as composite scaffold group. Afterwards, X-ray examination, micro-CT and Masson staining were used to evaluate the femoral healing.
RESULTS AND CONCLUSION:At 6 and 12 days after osteogenic induction, alkaline phosphatase activity in the test group was significantly higher than that in the control group; at 14 days, compared with the control group, the amount of mineralized nodules in the test group was significantly higher, which indicated that bone marrow mesenchymal stem cels after osteogenic induction could differentiate into osteoblasts. Attached cels spread wel on the scaffold with good proliferation activity, suggesting that nHA/PA 66 is suitable for cel adherence, proliferation and osteogenic differentiation. Besides, at 12 weeks after modeling, in the blank control group, no calus appeared in the nonunion region. In the simple scaffold group, the broken femur did not heal at 8 and 12 weeks after surgery. In the composite scaffold group, the broken femur did not heal at 8 weeks, but a lot of calus appeared; at 12 weeks, bone healing achieved and the scaffold was encased and absorbed.These findings demonstrate that the tissue-engineered bone scaffolds constructed by bone marrow mesenchymal stem cels and nHA/PA 66 effectively prevent bone nonunion by accelerating femoral healing in a rat femur nonunion model.

Objective To explore the biocompatibility of nano-hydroxyapatite/polyamide 66 (nHA/PA66) with human bone mesenchymal stem cells (hBMSCs) after osteogenic induction.Methods After hBMSCs were isolated and cultured in vitro,the experiment was conducted in 3 groups.Group A were hBMSCs subjected to no osteogenic induction,group B hBMSCs subjected to osteogenic induction,and group C was the composite of nHA/PA66 with hBMSCs subjected to osteogenic induction.Adhesion of the cells onto the nHA/PA66 in group C was observed by electron microscope scanning.Growth and proliferation of the cells in groups B and C were detected by MTI test at 1,2 and 3 weeks.The ability of osteogenic differentiation of hBMSCs in vitro was analyzed by alkaline phosphatase (ALP) activity and alizarin red staining.The ability of osteogenic differentiation of hBMSCs on nHA/PA66 was tested by ALP activity.Results Electron microscope scanning showed that the cells spread and attached well on the surface of the composite scaffold in group C;the proliferation of the cells in groups B and C showed no significant difference (P ＞ O.05).These suggested that the proliferation of hBMSCs was not affected by nHA/PA66.The number of mineralized nodules in group B was significantly larger than in group A (P ＜ O.05);the ALP activity of the cells in group A was significantly lower than in group B at 6 and 12 days (P ＜ 0.05);no significant differences were observed between groups B and C (P ＞ 0.05).These indicated that the hBMSCs were capable of osteogenic differentiation which was not affected by nHA/PA66.In groups B and C,the ALP activity of the cells at 12 days was significantly higher than at 6 days,indicating the ALP activity increased with increased induction time (P ＜ 0.05).Conclusion nHA/PA66 can be used as a carrier of hBMSCs in bone tissue engineering because hBMSCs can well adhere to,proliferate,and differentiate into bone on nHA/PA66 scaffolds.

Objective To explore the application and clinical effect of bipolar hemiarthroplasty with bipolar prosthesis on unstable intertrochanteric fracture in the elderly patients.Methods The study involved 53 patients aged over 75 years with intertrochanteric fracture treated with bipolar hemiarthroplasty in our hospital from April 2003 to January 2010.According to Evans-Jensen classification,there were 24 patients with type Ⅲ fractures,eight with type Ⅳ and 11 with type Ⅴ.Osteoporosis degree was at Singh degree Ⅰ in 13 patients,degreeⅡ in 18,degree Ⅲ in 12 and degree Ⅳ in 10.Most patients underwent operation within three days after injury.Results The operation duration was(75 ±10)min,with intraoperative blood loss of(350 ± 68)ml.Three patients were lost to follow-up after discharge and one patient was died of respiratory failure caused by chronic bronchitis five months after operation.Forty-nine patients were followed up for 12-93 months(mean 38 months),which showed no joint dislocation,or loosening,subsidence or rupture of the prosthesis.According to the Harris score of hip joint,the result at final follow-up was excellent in 29 patients,good in 13 and fair in seven,with excellence rate of 86％.Conclusions Bipolar hemiarthroplasty is an effective treatment for osteoporotic and unstable intertrochanteric fractures in the elderly patients.However,as the complemented therapeutic method of proximal femoral nail antirotation(PFNA),bipolar hemiarthroplasty has severe secondary trauma and its indications must be strictly mastered.

Objective To study and evaluate the ability of allogeneic bone marrow stromal cells(BMSCs) to survive and regenerate bone in muscles without using immunosuppressive agents. Methods A complete mismatch between donor BMSCs and recipient rabbit was confirmed by one way mixed lymphocyte reaction assaysprior to implantation. And then bone marrow aspirates were obtained from donor rabbits.BMSCs were isolated from the bone marrow, cultured in conditional medium to be ubdyced to become osteogenic, and then to examine these characteristics. After that the donor BMSCs were transplanted into the recipient rabbits. Immunological tests such as lymphocyte transformation rate and cell mediated cytotoxity, histological observation, seeding cells survival and bone formation were performed following transplantation. Results Allogeneic BMSCs transplantation did not actually elicit an adverse immune response, and bone regenerated at the transplantation area, and then the transplanted BMSCs marked with BRDU preoperatively were founded to be living 8 weeks later after transplantation using immunohistochemistric technique. Conclusion Allogeneic BMSCs would not elicit an adverse immune response in vivo without the immunosuppressive therapy, which could survive and form new bone tissue with the help of BMP-2 in the muscles.