Objective To compare the clinical effect of locking compression plate and anatomic plate fixation for Pilon fracture.Methods 68 patients with tibial Pilon fracture were selected and divided into two groups according to the random number table method,34 cases in each group,the observation group was given lock plus pressure plate fixation while the control group received anatomic plate for treatment,the clinically relevant indicators,treatment effect and occurrence of complications of the two groups were compared.Results The operation time of the observation group[(46.46 ±3.56)min],incision length[(5.25 ±0.75)cm],blood loss[(36.77 ±5.12)mL],plaster braking time[(13.23 ±1.77)d],fracture healing time [(12.42 ±1.43 )weeks],postoperative hospital stay [(9.89 ± 1.88)d]were less than or shorter than those of the control group [(68.76 ±4.45 )min,(12.78 ±1.54)cm, (84.75 ±8.65)mL,(20.30 ±2.43)d,(18.94 ±2.30)weeks,(15.67 ±2.64)d],the differences were statistically significant(t =6.834,9.455,7.488,6.591,7.033,8.210,all P <0.05).The excellent rate of the observation group was 94.12%,which was higher than 80.00% of the control group,the difference was statistically significant(χ2 =8.238,P <0.05).The postoperative complications occurred in the observation group was 5.88%,which was signifi-cantly increased to 17.65% in the control group,the difference was statistically significant(χ2 =7.657,P <0.05). Conclusion Compared with anatomical plate fixation,the locking compression fixation for Pilon fractures can shorten the healing time and reduce the incidence of complications,so it is safe and has significant advantages for the clinical application.

Objective To observe the effect of acupuncture on patients with vertebral-artery-type cervical spondylosis by means of transcranial Doppler sonography ~TCD) and brainstem auditory evoked potentials ~BAEP), and to explore the mechanism of acupuncture in treatment of cervical spondylosis by means of blood velocity and neuroelectrophysiology measurements. Methods Forty patients with vertebral-artery-type cervical spondylosis were divided into acupuncture treatment group ~20 cases) and routine treatment group ~20 cases). The TCD and BAEP were examined before the rehabilitation treatment and 2 week later. Comparing with the control group, the effect of acupuncture on the blood velocity and cerebral electrophysiology was analyzed. Results ~1)The total efficiency rates in the two treatment groups were 90% and 85%, respectively. The clinical heal rate was 45% in acupuncture group and 35% in routine group. There was no statistic difference with regard to the therapeutic effect and the length of treatment between the two groups. ~2)The blood velocity of vertebrobasilar artery ~VBA) in the patient group was decreased. The abnormal rate of TCD was 77.5% ~31/40 cases), characterized with the decrease of VBA. The abnormal rate of BAEP was 75% ~30/40 cases), characterized with brainstem abnormality type. ~3)The blood velocity in both groups was increased after treatment. Compared with the routine therapy group, the velocity of blood flow in vertebral artery in acupuncture treatment group was increased markedly ~P

Objective To investigate the clinical result, complication and influential factors of lyophilized and radiation-sterilized morselized allogeneic bone. Methods Between December 1995 and December 2000, 778 cases with implantation of bone allograft were performed. There were 188 females and 590 males with an average age of 37.2 years (range, 6-76 years). The lyophilized morselized allogeneic bone was processed according to American Association of Tissue Bank (AATB) standards and was sterilized by radiation. The bone allograft was rehydrated in fresh blood or in physiologic saline before implantation. The morselized allograft was used to fill defects attributable to various causes such as 84 bone tumors (10.8%), 551 fractures (70.8%), 143 joint fusions (18.4%). After implantation of the bone allograft, drainage was carried out for 2~3 days and antibiotics were used to prevent infection. The average amount of the allograft implanted was 24 g (range, 4-64 g). Results All patients were followed up clinically and radiographically. The minimum length of follow-up was 3 years with an average follow-up period of 59.7 months (range, 36-96 months), 722 allograft unions occurred at a mean of 4.5 months postoperatively (range, 3-8 months). There were 137 complications, included 44 of wound effusion (5.65%), 29 of delayed wound healing (3.72%), 2 of profuse liquid accumulation (0.26%), 43 of fracture non-union (5.52%), 4 of tumor recurrence (0.51%), 9 of fusion failure (1.15%) and 6 of fracture (0.77%). Estimated by the combined Mankin and Komender standards, 688 (88.44%) patients were satisfied with their outcomes while the other 90 (11.56%) patients were dissatisfied. Conclusion The lyophilized and radiation-sterilized morselized allograft is of good tissue compatibility and able to promote bone formation, it can be considered as a convenient, safe, and available material for bone transplantation. The important factors affecting allograft healing are the mechanical stability in the recipient region, local blood supply for the site of grafting and the surgical technology. The major complications of allograft are late infection and re-fracture.

ObjectiveTo explore the therapeutic effect of floating acupuncture on the the processus transverses of vertebrae lumbales Ⅲ syndrome.Methods40 patients with the processus transverses of vertebrae lumbales Ⅲ syndrome were divided into the floating acupuncture group (20 cases) and the traditional group (20 cases). The pain was evaluated with visual analogue scale (VAS) before and after treatment.ResultsCompared with traditional treatment, the floating acupuncture can relieve pain rapidly after 15 min and 1 d of treatment. ConclusionThe floating acupuncture shows preferable clinical curative effect to patients with the processus transverses of vertebrae lumbales Ⅲ syndrome.

Objective To evaluate the impact of donor age on early remnant liver function and regeneration after right lobe adult living donor liver transplantation (LDLT) donation.Methods 43 living donors were divided into 2 groups:donor age ＞ 50,n =8,and donor age ＜ 30,n =35.Alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TB) and liver regenerative ratio (LRR) of donors between the 2 groups were compared.Results There were no significantly different in ALT,AST and TB on days 1,2,3,5 after LDLT between the 2 groups (respectively t =0.147,1.030,-0.903,0.013,0.043,1.362,0.817,0.003,1.121,0.241,1.061 and 0.943,all P＞0.05).There was significant difference between LRR on day 7 (t =-0.965,P =0.042),but the difference was not statistically significant in LRR when evaluated on day 15 after LDLT (t =0.585,P =0.385).Conclusions Remnant liver regeneration on the first week is reversely affected by donor's age after hepatectomy,while the influence of age decreases significantly after 2 weeks.

Objective To evaluate and compare liver regeneration between normal donors and recipients at the different stages after right lobe adult living donor liver transplantation (LDLT) using MSCT.Method Sixty-eight living donors and 63 recipients without complications were included in this study.We did CT volumetric measurement of the liver by using IQQA-Liver workstation.The relationship between graft volume measured by preoperative MSCT and intraoperative actual graft volume was evaluated.The liver regenerative ratio at different stages of donors and recipients after LDLT was calculated and compared.Result Preoperative measurement of total liver and grafts resulted in a mean volume of (1366.99 ± 234.75) cm3 (standard deviation) and (862.73 175.94) cm3 (VCT-right),respectively.Intraoperative volume of the grafts was (654.46 ± 151.23) ml (Vintraop).Corresponding pre-and intraoperative data were correlated significantly each other (r =0.795,P=0.000).Vintraop can be calculated with the equation:Vintraop =64.949 + 0.683 VCT-right.There was significantly difference in LRR between donors and recipients at 0.5,1,3 and 6 months after LDLT (P＜ 0.05).Conclusion The patterns of normal liver regeneration between donors and recipients after LDLT are different.The liver of donors regenerates more significantly and quickly than recipients.Liver volumetric measurement by using MSCT is a valid modality to evaluate liver regeneration after LDLT.

Background and purpose:The morbidity and mortality of lung cancer are currently the highest malignant tumor in China and the world. Most onset age of the illness is after 60 years old. Therefore, surgical resection of lung cancer in the elderly is very worthy of concern. This study aimed to investigate the clinical features, epidemic characteristics and conditions in perioperative period between the elderly and middle-aged patients with lung cancer, and provide the reference for clinical treatment.Methods:Totally 1 019 patients with lung cancer who were admitted to the hospital and accepted the operations in department of thoracic surgery in Shanghai Pulmonary Hospital from Jan. 2007 to Dec. 2012 were analysed retrospectively. The clinical data including gender, pathological type, TNM stage, intraoperative amount of bleeding and post-operative length of hospitalization were compared.Results:There was a signiifcant difference in sexual factors between these two groups (P?0.05), and compared with the middle-aged group, the proportion of male was more higher in the elderly group (76.91%vs 52.81%). Adenocarcinoma was the most common and squamous carcinoma was the next in both two groups. The constituent ratio of the pathlogical type between the elderly group and the middle-aged group was statistically signiifcant (P?0.05). The squamous carcinoma in the elderly group was higher than that in the middle-aged group (37.5%vs 15.6%). On the contrary, adenocarcinoma was more common in the middle-aged group (72.8%vs 50.7%). StagesⅡa,Ⅱb, andⅢa were more common in the elderly group and stagesⅠa, andⅠb were the most clinical stage in the middle-aged group. The clinical stage between two groups was statistically significant (P?0.05).The intraoperative amount of bleeding was higher and the post-operative length of hospitalization was longer in the elderly group, with a signiifcant difference as compared with that in the middle-aged group(P?0.05). And there was a signiifcant difference in incidence of accompanying diseases between the two groups, compared with the middle-aged group, the proportion of accompanying diseases was more higher in the elderly group(58.6%vs42.3%).Conclusion:Elderly patients with lung cancer are more common in males, with adenocarcinoma being the most common. The cancer mostly belongs to a medium or advanced stage. Elderly patients have the trend with more amount of bleeding in operation and lengh of stay.

Objective To evaluate graft regeneration and influencing factors after right lobe adult living donor liver transplantation (LDLT) using MSCT.Method Sixty-three living recipients were included in this study.We measured graft volume periodically by using MSCT and IQQA-Liver workstation.The liver regenerative ratio (LRR) of different stages of recipients after LDLT was calculated and compared,and stepwise regression analysis was done to set up the regression equation.Result Within 0.5 month after LDLT,graft volume was increased rapidly,and LRR reached maximum [(106.11 + 30.90)％],then decreased slowly.There was significant difference in LRR among 0.5,1 month and 3,6 months after LDLT (P＜0.05).The following factors,including whether the graft containing middle hepatic vein or not,age and sex of recipients,had no significant influence on LRR after LDLT (P＞0.05).The status of liver function of recipients preoperatively had significant influence on LRR 0.5 month after LDLT (P＜0.05).There was significantly negative correlation between the graft volume and LRRs of recipients at different stages after LDLT (P ＜ 0.05).Regression equation could be derived.Conclusion Most evident graft regeneration occurs in early stage after adult LDLT.There are many and different factors influencing graft regeneration at the different stages after LDLT.Graft volumetric measurement by using MSCT is a valid modality to evaluate graft regeneration after LDLT.

Objective To explore the comprehensive approach of rhinoplasty using autologous costal cartilage,and to observe the outcome and summarize the possible complications.Methods A 6-7 cm long costal cartilage was taken out mostly from the 6th or 7th rib and then divided into several parts and shapes.A lancet shaped piece was used for dorsal augmentation,several cartilage bars for collumellar elevation and nasal tip elongation.Comprehensive structural rhinoplasty was then done with open rhinoplasty incision.Results 52 patients were treated with this method and satisfying aesthetic contouring of the nasal tip and dorsum was achieved.Among these patients,no such complications as implant extrution or dislocation,cartilage distortion,pneumothorax,hemothorax,infection or hemotoma were observed.The scar on the donor site was not obvius.Conclusions Costal cartilage can meet the demands of patients who consider prosthesis as an unacceptable option.For secondary revision rhinoplasties,costal cartilage provides sufficient materials to ensure a promising outcome with lower risk of infection and other complications.

Objective To explore the comprehensive approach of rhinoplasty using autologous costal cartilage and e-PTFE,and to observe the outcome and possible complications.Methods A 3-4 cm long costal cartilage was taken out mostly from the 6th or 7th rib and then divided into several parts and shapes.Structural reconstruction of the nasal tip was then done with these costal cartilage parts.Radix augmentation was conducted with e-PTFE.Results From Jan.2013 to Sept.2014,48 patients were treated with this method,all females,aged 22-35 years.36 of them had received rhinoplasty before,12 of them received none.Satisfying aesthetic contouring of the nasal tip and dorsum had been achieved in 45 patients.Deviation of the collumella and nostril asymmetry were found in 3 patients.Among all patients,no such complications as pneumothorax,hemothorax,infection,or hemotoma were observed.The scar on the donor site was not obvious.Conclusions Costal cartilage is sufficient,supportive and easily shapable,when applied to the structural reconstruction of the nasal tip,which can meet the demands of patients who prefer more outstanding and delicate nasal tip contouring.