AIM:To observe the clinical curative effect of different duration of retinal vein occlusion ( RVO ) by laser photocoagulation treatment, discuss the timing of the RVO laser photocoagulation treatment, provide the basis for clinical choice of RVO photocoagulation treatment time.
METHODS: Retrospective analysis. Line selection retinal laser photocoagulation treatment for 103 cases (103 eyes) with RVO, patients were divided into three groups according to the onset time. In group A (46 eyes), course≤ 1mo, 28 eyes with branch retinal vein occlusion ( BRVO ) , 18 eyes with central retinal vein occlusion ( CRVO);30 eyes were ischemic RVO, 16 eyes were non-ischemic RVO. In group B (38 eyes), 1mo RESULTS: The best corrected visual acuity improved rate, retinal hemorrhage, macular edema, absorption, macular center concave thickness decreased of patients with different course after RVO photocoagulation treatment, the early group was better than that of the late, non-ischemic RVO was better than that of ischemic RVO, laser photocoagulation treatment effect BRVO was better than that of CRVO and the difference was statistically significant (P<0. 05).
CONCLUSION:RVO laser photocoagulation in the early intervention treatment can accelerate the retinal hemorrhage, macular edema, absorption, effectively protect the patient's existing vision, improve the long-term vision, and has a certain clinical practical significance.

AIM:To introduce a new method of guiding by using 3D-OCT to treatment central serous chorioretinopathy ( CSCR) with multiwavelength laser.
METHODS:Twenty-three cases ( 23 eyes ) typicality central serous chorioretinopathy were collected in July 2010 to July 2013 in Changchun Aier Eye Hospital, using 3D-OCT model locate central serous chorioretinopathy leakage point and photocoagulation treatment with multiwavelength laser. Postoperative follow-up of 24wk, the postoperative vision and macular area retina neuroepithelial layer detachment height were observed.RESULTS: Twenty-three cases ( 23 eyes ) of central serous chorioretinopathy patients by the 3D-OCT guided multiwavelength laser treatment vision after 24wk of follow-up compared with before treatment. there was statistically significant ( P < 0.05 ) . Visual improved obviously after treatment. OCT macular area before and after the treatment on macular area retina neuroepithelial layer detachment height ( P<0.05 ) . OCT macular area before and after the treatment of macular area retina neuroepithelial layer detachment height significantly decreased, slurry apparent absorption. Except 1 case lost visitors, 23 cases ( 23 eyes ) with central serous chorioretinopathy did not see the whole body or eye local adverse reactions occur.
CONCLUSION: 3D- OCT guided by multiwavelength laser treatment of central serous chorioretinopathy and under the guidance of FFA in the central serous chorioretinopathy laser treatment have the same curative ratio, has certain clinical value.

OBJECTIVETo evaluate the feasibility and efficacy of unilateral pedicle screw fixation in treating thoracolumbar fractures through paraspinal approach.

METHODSFrom January 2006 to January 2009,21 patients with single level thoracolumbar fracture without neurological symptoms were treated with unilateral pedicle screw fixation through paraspinal approach. There were 14 males and 7 females,aged from 21 to 65 years old with a mean of 36.4 years. The duration from injury to operation ranged from 6 h to 5 d with an average of 3 d. According to the classification of Denis fracture, compression fractures happedned in 12 cases and burst fractures happened in 9 cases,including 1 case with T5 fracture, 2 cases with T7 fracture, 2 cases with T10 fracture, 3 cases with T11 fracture, 8 cases with T12 fracture, and 5 cases with L1 fracture. Based on the Flankel grade, all patients were classified as grade E. Anterior vertebral body height ratio, sagittal Cobb angle, condition of internal fixation failure, visual analogue score (VAS) were evaluated.

RESULTSAll patients were followed up from 12 to 36 months with an average of 20.5 months. No internal fixation failure was found. Anterior vertebral body height ratios at preoperative 3 days after operation and last follow-up were 54.3 +/- 2.8, 92.9 +/- 1.5, 93.8 +/- 1.7, respectively;sagittal Cobb angle at the three timepoints were (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; the difference was statistical significant (P < 0.05). VAS was (1.2 +/- 0.4) points at last follow-up and had obviously improved (P < 0.05).

CONCLUSIONTreatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach is safe with the advantages of micro-trauma and less blood loss,which can not only completely retain the posterior spinal complex structure, reinforce the spinal stability, raise the reductional quality, but also improve the strength of fixation and the distribution of stress force.

Adult ; Bone Screws ; Feasibility Studies ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo investigate the effects of locking plate fixation through lateral deltoid approach for proximal humeral fracture combined with micro-invasive percutaneous plating (MIPPO) technique.

METHODSFrom April 2009 to March 2012,26 patients with proximal humeral fractures were treated with proximal humeral locking system plate fixation through lateral deltoid approach, including 17 males and 9 females with an average age of 58 years old ranging from 28 to 76 years old. The time from injury to operation was 3 to 10 days (averaged 5.6 days). According to Neer typing for the proximal humeral fractures, 7 cases had 2 parts of fracture,15 had 3 parts of fracture,and 4 had 4 parts of fracture. The Neer score for shoulder function was evaluated.

RESULTSAll patients were followed up,and the duration ranged from 10 to 21 months (averaged 13.6 months). All patients were achieved bony union,the average healing time was 12.5 weeks (ranged from 10 to 21 weeks). No humeral head necrosis and axillary nerve injury occurred. According to Neer scoring system,the total score was 88.36 +/- 7.82, pain 30.82 +/- 3.24, function 23.76 +/- 5.71, activity 17.59 +/- 5.36, anatomical position 7.03 +/- 2.39; the result was excellent in 18 cases, good in 5 cases, fair in 2 cases, poor in 1 case.

CONCLUSIONLateral deltoid approach combined with locking plate fixation for treatment of proximal humeral fracture has advantages of small invasion,less blood lossing, short operative time, stable fixation, high rate of fracture healing, and satisfactory functional recovery.

Adult ; Aged ; Bone Plates ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Shoulder Fractures ; surgery ; Treatment Outcome

OBJECTIVETo study operative effects for the treatment of multiple ligament injuries of knee joints.

METHODSFrom 2008 to 2013, 26 patients (17 males and 9 females) with multiple ligament injuries of knee joints were treated surgically. The average age was 40.7 years old, ranging from 29 to 55 years old. All the patients were treated with arthroscopic reconstruction of cruiate ligament with autogenous or allogeneic hamstrings and tendon, and at the same time received repair of medial collateral ligament and lateral collateral ligament, as well as the treatment of exterior and interior complex injuries. Nine patients received second stage operation after the initial operation for mistake or missed diagnosis, and other patients were treated at the first stage. The Lysholm scoring system was used to evaluate function and stability of knee joints before and after operation.

RESULTSAll the patients were followed up for an average duration of 1.6 years (ranged, 0.8 to 3.2 years). The mean awaiting time for operation was 1.2 months. The Lysholm score was improved from preoperative 42.5 +/- 4.5 (ranged, 33 to 48) to the latest follow-up 78.1 +/- 3.9 (ranged, 57 to 95). The function of knee joint was improved obviously in the arthroscopic reconstruction patients, with joint range of motion exceeding 900 and with Varus & Valgus tests near to normal. All the patients had negative findings in the Lachman test at 70 degrees of flexion.

CONCLUSIONArthroscopic reconstruction should be the first choice in treating multiple ligament injuries of knee joints. If the anterior and posterior cruciate ligament injuries can't be treated simultaneously, the posterior cruciate ligament injuries should be treated preferentially at the first stage and the anterior cruciate ligament injuries should be treated at the second stage. The diagnosis of posterior cruciate ligament is easy to be missed.

Adult ; Arthroscopy ; Female ; Humans ; Knee Joint ; physiopathology ; surgery ; Ligaments ; physiopathology ; surgery ; Male ; Middle Aged ; Multiple Trauma ; physiopathology ; surgery ; Range of Motion, Articular ; Treatment Outcome

OBJECTIVETo explore surgical therapeutic strategies and clinical effects for floating shoulder injury.

METHODSFrom March 2010 to December 2013, 12 patients with floating shoulder injury were treated by open reduction and plate screw fixation,including 10 males and 2 females aged from 22 to 45 years old with an average of 31.7 years old. Preoperative X-ray and CT showed 11 cases were ipsilateral clavicle fracture with scapular neck fractures, 1 case was scapular neck fracture with ipsilateral acromioclavicular dislocation. Postoperative complications were observed and Herscvici functional scoring were used to evaluate clinical effects.

RESULTSTwelve patients were followed up from 8 to 26 months (averaged 15 months). All patients obtained bone union, and no inflammation, loosening and breakage of plate and screw were found. According to Herscvici scoring, 9 cases got excellent results, 2 good and 1 moderate.

CONCLUSIONReconstruction of anatomical structure and stability of floating shoulder joint injury could shorten time of shoulder joint brake and fixation, then got excellent clinical outcomes.

Adult ; Clavicle ; injuries ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Scapula ; injuries

OBJECTIVETo evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type II in adults.

METHODSFrom June 2006 to June 2012, a total of 38 feet (in 35 adult patients) with painful accessory navicular with type I underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of (32.4±7.3) years old ranging from 18 to 44 years old. The course of disease ranged from 3 to 10 months. The perioperative complications and radiological outcomes were observed and recorded. The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, and the easement of the pain was evaluated by visual analog score (VAS).

RESULTSTwo patients had transient superficial inflammation of the incision, no obvious perioperative complications occurred. All patients were follow-up for (53.5±14.7) months (12 to 84 months). Bone union was confirmed on plain radiography in 32 cases (35 feet). The mean time from the operation to union was (13.7±2.3) weeks (9 to 18 weeks). Postoperative pain VAS score was improved obviosly than preoperative (V=12.14,P< 0.01). The talar-to-first metatarsal angle [(9.4±3.5)° vs (8.3±2.7)°, t=0.736, P>0.05)], calcaneal tilt angle [(17.7±2.2)° vs (18.9±3.4)°, t=0.794, P>0.05],talonavicular uncoverage angle [(14.3±3.4)° vs(12.5?4.6)°,t=0.947, P>0.05) ],and height of the first tarsometatarsal joint [(14.8±3.1) mm vs (15.9±2.8) mm,t=0.814,P>0.05)] before and after operations had no statistic difference. The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 (t=3.214,P< 0.01).

CONCLUSIONFor the painful accessory navicular bone of type II in adults, if the patient has a large navicular bone and not complicated with rigid flatfoot, once the conservative treatment fails, fusion of the primary and accessory naviculars may be a successful intervention. Overall, the procedure provides reliable pain relief, definite foot function improvement, and good patient satisfaction.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Foot Diseases ; physiopathology ; surgery ; Humans ; Male ; Tarsal Bones ; abnormalities ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the methods and therapeutic effects of trans-fibular anterior-lateral approach combined with external fixation in the treatment of Gustilo III distal tibiofibula fractures.

METHODSFrom 2007 to 2010,9 patients including 7 males and 2 females with the mean age of 40 years(ranging from 29 to 51 years). All patients received internal fixation of fibula after debridement on the first phase, external fixator were used to fix tibia across ankle joint, and removed after successful skin graft; The second phase tibia was used to fix through the lateral incision used in phase I. Early functional exercise was encouraged ,the union condition and functional results of the ankle joint was evealuated. The criteria of the AOFAS Foot and Ankle Surgery was used to evaluate the effects.

RESULTSAll patients were followed up,and the duration ranged for 8 to 37 months(averaged 21 months). Nine patients were achieved bony union, the average healing time was 24 weeks. No plate rupture or screw loosening was found. According to the AOFAS Foot and Ankle Surgery evaluation system, 3 cases got excellent results, 4 good cases and 2 fair.

CONCLUSIONTrans-fibular anterior-lateral approach combined with external fixation for Gustilo III distal tibiofibula fractures can receive satisfactory reset, debond ankle joint eralier and imporove the clinical effects.

Adult ; Female ; Fibula ; Fracture Fixation ; methods ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Tibia ; Treatment Outcome

Finite element analysis (FEA) is broadly used in engineering, it was initially applied to simulate and solve a variety of engineering mechanics, thermal, electromagnetics, and other physical problems. The principle is a collective to be composed by an infinite number of particles, and an unlimited number of degrees of freedom from the continuum approximation. Brekelmas and Ryblcki firstly applied the finite element method to orthopedic biomechanics research in 1972. The first cervical vertebra finite element model was established in 1982 by Hosey. With the computer and software technology advances in the past 20 years, finite element method in cervical spine biomechanics studies is increased and widespread.
Biomechanical Phenomena ; Cervical Vertebrae ; anatomy & histology ; physiology ; Finite Element Analysis ; Humans ; Models, Anatomic ; Models, Biological ; Movement

OBJECTIVETo design a new 3-dimensional anatomical locking plate internal fixation on the basis of anatomic character of acetabulum for treating complex acetabular fractures except the posterior wall and posterior column fracture, and to investigate its advantages and disadvantages.

METHODSFive fresh adult cadavers and 40 biopsy specimens of pelvic cavity were collected. The length and radian of iliopectineal crest and pecten pubis,the distance from acetabular index to iliopectineal crest were measured to guide the research and development of the 3-dimensional anatomical locking plate internal fixation for complex acetabular fractures through the ilioinguinal approach or combined with Stoppa approach.

RESULTSThe average lengths of iliopectineal crest of male and female were (54.12+/-5.42) mm and (58.24+/-6.60) mm;and the radians were (64.26+/10.28)degrees and(60.32+/-12.26)degrees. The lengths of bow pubic were(122.21+/-8.02) mm and(126.52+/-7.84) mm;and the radians were (66.24+/-13.10)degrees and(63.25+/-12.10) degrees. The distance from acetabular index to iliopectineal crest of male and female were (18.6 + 2.2) mm and (18.9+/-2.5) mm. The 3-dimensional anatomical locking plate was used to treat compound acetabular fractures through ilio-inguinal groove incision or combined with Stoppa incision,including dislocated acetabular fractures at quadratic district,but not including paries posterior and columma posterior fractures.

CONCLUSIONThe self-designed 3-dimensional anatomical locking plate internal fixation has the characteristics of operational convenience, accurate fixation, mini operational trauma,short operational time and low operational risk,therefore it is especially suit for the complex acetabular fractures except the posterior wall and posterior column fracture which is difficult to be solved by contentional internal fixation.

Acetabulum ; injuries ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male