Fracture of the posterior wall is the most common type of acetabular fractures,but it is often associated with such injuries as dislocation of hip joint,femoral head fracture and lesion of sciatic nerve.Latest researches have found that treatments of fracture of the acetabular posterior wall often lead to unsatisfactory outcomes because its prognosis is influenced by a variety of factors,including its associated injuries,subtypes,and quality and timing of surgical reduction.This review summarizes extensive clinical experiences in treatment of the fracture and available literature concerning management and research of the fracture so as to provide enough information for junior surgeons to have a better understanding of the fracture and its treatment,improving the prognosis of the fracture and effectively avoiding the pitfalls in their clinical practice.

Objectives To put forward the modified Letournel classification of acetabular fractures,and evaluate the guiding role of the modified Letournel classification in clinical work.Methods A retrospective study of 170 patients (178 sides) with acetabular fractures treated at Nanfang Hospital between January 2006 and August 2018 was performed.Among them 129 cases were males and 41 were females.The average age was 40.2±14.2 years (range,14-82 years).According to the Letournel classification,unclassifiable/atypical acetabular fractures were found out with plain Ⅹ-ray and plain CT scan and three-dimensional CT,and then their unclassifiable reasons were analyzed.Based on anatomical landmarks,clear boundaries of acetabular walls were defined on the 3D printed pelvic model.The structure of each column is a trihedron.The wall's fracture and column's fracture were distinguished using a theory that the wall's fracture involved two surfaces of column with interruption of continuity and column's fracture involved three.When column's fracture associated with wall's fracture,lowercase a,p and q were used representing comminuted areas of corresponding anterior and posterior wall,quadrilateral plate respectively.When column's fracture didn't associates with wall's fracture,it is marked with number 0.Finally,all fractures were classified according to the modified Letournel classification.The relationship between fracture type and surgical approach was analyzed.Results There was 51.7％ (92 sides) of acetabular fractures that couldn't be classified by the Letournel classification.Incomplete fracture lines (49 sides,53.3％),comminuted fractures (28 sides,30.4％),both of them (15 sides,16.3％) were their unclassifiable reasons.There were 8 types in the modified Letournel classification,including posterior wall fracture,posterior column fracture,anterior wall fracture,anterior column fracture,transverse fracture,T-shaped fracture,anterior column+posterior hemitransverse fracture,and both columns fracture.Posterior column+posterior wall fracture,transverse+posterior wall fracture had respectively become a form of posterior column fracture and of transverse fracture.According to the modified Letournel classification,the reclassification rate of 178 side fractures was 100％,which was significantly higher than 48.3％ (86/178) of the traditional Letournel classification,and the difference was statistically significant (x2=124.06,P＜ 0.001).100％ of posterior wall fracture and 80.00％ of posterior column fracture were treated by posterior approach.100％ of anterior column fracture and 73.68％ of both columns fracture were treated by anterior approach.Conclusion All acetabular fractures can be classified by the modified Letournel classification.The orientation of the comminuted walls reflects in part severity of the injury,better helps orthopaedic surgeons understand the morphology of acetabular fractures and select appropriate surgical approach.

Objective To investigate clinical application of lateral supraorbital approach in microsurgery for tuberculum sellae meningioma.Methods A retrospective analysis was performed of the 46 patients with tuberculum sellae meningioma who had received microsurgery at Department of Neurosurgery,The First Affiliated Hospital to Soochow University from January 2010 to September 2017.Of the 46 patients,the lateral supraorbital approach was applied in 18 and the pterional approach in 28.The excision of tumor,operation time,hospital stay and visual improvement were compared between the 2 operative approaches.Results There was no significant difference in tumor excision rate between the patients using the lateral supraorbital approach and those using the pterional approach (P＞0.05).The operation time and hospital stay for the patients using the lateral supraorbital approach were significantly less than for those using the pterional approach (P＜0.05).Of the 12 cases with preoperative visual deterioration in the former patients,5 obtained no obvious visual change but 7 visual improvement;of the 23 cases with preoperative visual deterioration in the latter patients,9 obtained no obvious change,12 visual improvement and 2 further visual deterioration.Conclusion Neuro-microsurgery via the lateral supraorbital approach is a safe and mini-invasive treatment for tuberculum sellae meningioma.

Macrophages are vital in maintaining tissue homeostasis in the lungs by modulating and regulating immune responses.Based on different origins and anatomical locations,macrophages in the lungs are categorized into alveolar macrophages,interstitial macrophages,perivascular macrophages,and inflammatory macrophages.Alveolar macrophages are located in the alveolar spaces and are primarily responsible for maintaining alveolar surfactant homeostasis,defending against pathogens and regulating immune responses.Interstitial macrophages can maintain homeostasis,regulate immunity and anti-inflammation in the lung tissue.Perivascular macrophages play a crucial role in inhibiting lung inflammation,improving pulmonary fibrosis,and regulating lung tumor progression due to antigen-presenting and immunomodulatory effects.Inflammatory macrophages,which are differentiated from monocytes during inflammation,regulate the inflammatory process.This article reviews the origins of various subpopulations of macro-phages in the lung tissue and their physiological and pathological functions as well as discusses the underlying mechanisms and potential therapeutic targets.