Objective To investigate the clinical results of resection of periacetabular tumors and reconstruction with fibular autograft. Methods Eight patients with tumors around acetabular were treated surgically in Tongji Hospital between January 1999 and April 2003. The series comprised 5 males and 3 females, with an average age of 39.6 years old (range, 21-65 years old). One patient was diagnosed with osteosarcoma, 2 with chondrosarcoma, 3 with metastatic bone tumor, 1 with giant cell tumor(GCT), and 1 with aneurysmoid bone cyst. There were ⅠB in one patient, ⅡB in 3 patients according to Enneking surgical staging in four primary malignant tumors patients. The tumors involved the zones Ⅱ of Enneking classification in 5 patients, the zonesⅠand Ⅱin 3 patients. All the 8 patients with periacetabular tumors underwent resection and reconstruction with fibular autograft(including 3 cases of a free vascularized fibular graft). Functional results were evaluated according to the system of the Musculoskeletal Tumor Society. Results Bony union occurred 15.2 weeks (range 14-16 weeks) in 5 patients reconstructed with non-vascularized fibular graft and 13.6 weeks (range 12-15 weeks) in 3 patients reconstructed with vascularized fibular graft after the initial surgery. Five of them were followed up ranged from 14 to 42 months (mean 28 months). There were continuously disease-free without complications during follow-up. At the final followup, the average functional score was 22 (range 18-27) according to the system of the Musculoskeletal Tumor Society. The good and excellent rate of functional results was 100%. Conclusion Tumor resection and reconstruction by fibular autograft is an effective treatment for patients with periacetabular tumors. Satisfactory postoperative function was obtained, and relief of pain and walking independently could be achieved with a high level of patient satisfaction.

[Objective]To introduce the new concept of "terrible triad of the elbow",and report the preliminary results of 5 clinical cases.[Method]From April 2004 to March 2007,five cases met the diagnosis of terrible triad,with posterior dislocation of elbow complicated with radial head and ulnar coronoid fractures.The radial head fractures were 4 in type Ⅱ and I in type Ⅲ according to Mason classification,and Ⅰ in type Ⅰ,Ⅲ in type Ⅱ and 1 in type Ⅲ according to Schatzker classification.The ulnar coronoid fractures were Ⅰ in type Ⅰ,Ⅳ in type Ⅱ according to Regan-Morrey classification,and all 5 in type Ⅰ according to O'Driscoll classification.Four patients underwent surgical operations.The fractured radial head and ulnar coronoid were reduced and fixed with 3mm titanic lag screws or K wires,the lateral and medial collateral ligaments were repaired with Krachow sutures.A plaster of Paris was applied for 3 weeks after operation,in position with elbow flexion in 90 degrees and forearm rotation in neutral.Then physical exercise and rehabilitation program were carried out.[Result]Four operated patients were followed up for 3 months to 3 years,with healed fractures,stable elbow and no pain movement.The average range of elbow flexion-extension were 120 degrees,and forearm pronationsupination were 110 degrees,respectively.The functional outcome in 3 cases that followed up more than Ⅰ year was excellent in 2 and good in Ⅰ according to Mayo Elbow Performance Score(MEPS).The result of the un-operated case was poor in MEPS evaluation.Elbow instability and pain was the main complaint.[Conclusion]Terrible triad of posterior dislocation with radial head and ulnar coronoid fractures is a severe trauma to the elbow.Operative osteosythesis and ligament repair is mandatory for concentric reduction and elbow stability.

Objective To observe the effect and mechanism of Bush en Tiaojing Decoction (Decocti on for reinforcing the kidney and regulating the menstruation) on ovulation of p olycystic ovary syndrome (PCOS) rats. Methods Eighty fe male SD rats were made PCOS models and randomized into blank group, model group, metformin group, Bushen Tiaojing Decoction high and low dose group s, with 10 ones in each and the remainders removed. The changes of serum leptin, ins ulin and testosterone in each group were observed. Results In Bushen Tiaoji ng Decoction high and low dose groups, serum leptin, insulin and testosteron e were all decreased. The effect of Bushen Tiaojing Decoction high dose group wa s similar with that of metformin group in decreasing leptin, insulin a nd testosterone. Conclusion Bushen Tiaojing Decoction c ould improve the ovulation of PCOS rats through regulating leptin, insulin , and testosterone.

Objective To research the changes of regional gray matter volumes in first-episode, medication naive females with major depressive disorder. Methods Magnetic resonance imaging and voxel-based mor-phometry were used to compare regional gray matter volumes between 14 medication-naive female participants with a first episode of major depressive disorder ( MDD) ( age( 29. 5 ±6.8) years, number of education years(11.4 ± 2. 7) years, duration of iIIness(5.4 ±5. 2 ) months, H AMD score(27.6 ±5.5)) and 14 female healthy comparison participants (HC) (age(29.5 ±6.9)years,number of education years( 12. 2 ±3. 3)years,HAMD score(2. 1 ± 1.9)). Results Volumes of bilateral anterior cingulate cortex ( ACC) and right amygdala were significantly smaller in the MDD group than those in the HC group. Conclusion These results suggest that volume reductions in ACC and amygdala in females with MDD are present at illness onset.

Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82％. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis of femoral neck fractures is high and the patients with high energy trauma hould be highly paid attention to.Lengthened PFNA conforms to characteristics of biomechanical fixation and presents short operation time and solid fixation. Lengthened PFNA achieves affirmatory effects for treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures.

Objective To explore the operative methods of open reduction and fixation for the cuboid fractures. Methods The study involved 12 patients with cuboid fractures treated from October 2006 to October 2008. There were seven males and five females, at average age of 38.5 years (range 18-70 years). All patients had closed fractures, including 10 with compression fracture and two with sagittal fractures. The surgical treatments included open reduction, internal fixation by plate, screw or K-wire.Results Ten patients were followed up for 15 months on average ( range 12-24 months), which showed one stage wound healing, with mean time of bone union for 10 weeks ( range 8-15 weeks). No infection was found in any patient. The weight load walk began at 12 weeks ( range 8-18 weeks), with no obvious pain. According to American orthopaedic foot and ankle society (AOFAS) midfoot scale, the mean score was 88.6 (range 73-100). Conclusion Anatomic reduction and stable internal fixation of the cuboid fractures is the key point for recovery of foot form, stabilization and function of the feet.

Objective To measure stress distribution of the main bone architecture of the normal adult cadaveric foot and discuss the effect of plantar ligament injury on stress distribution. Methods Seven fresh adult cadaveric feet were used and 10 strain gauges attached to the bones of the longitudinal foot arch,including the calcaneus,navicular,medial cuneiform,1-5 metatarsal trunk,the distal part of the tibia and fibular,respectively.After the loading Was added to 700 N by almighty test machine,resistance strainmeter was used to measure surface strain of these bones.The results were processed statistically. Results The strain was varied based on different bone segments attached and increased with loading.Tensile force was always found at the medial part of the navicular,the distal part of the tibia and fibular,while the others showed compression all the time.Peak strain was found at calcaneus.followed by the second and third metatarsal.Strain on the surface of the bone segments changed greatly with different ligament injury(P＜0.05).Conclusion The bone surface stress of the longitudinal foot arch changes significantly when the plantar ligament is injured.

Objective To investigate the feasibility and clinical effect of cannulated screws plus separate vertical wirings technique for acute fracture of the inferior pole of the patella.Methods From May 2012 to September 2013,14 patients with fresh closed unilateral fracture of the inferior pole of the patella were treated with the cannulated screws plus separate vertical wirings.Eight patients were injured in traffic collisions and 6 in fall accidents.Fracture AO classification was type 34A1 in 8 patients and type 34A2 in 6 patients.Time from injury to operation was 1-7 days (mean,2.5 days).Number of tie wires was determined according to the degree of fracture comminution.Fracture healing,fixed position and patellar length were evaluated by radiographic examination postoperatively.Knee mobility and Bostman evaluation system were investigated to analyze the clinical effect.Results All the patients obtained average 15-month follow-up (range,12 to 29 months).At postoperative 2 months,the fracture healed with good alignment of the broken bone and proper place of the internal fixation device noted on the X-ray films.At postoperative 6 and 12 months,X-ray films revealed fracture bony healing,good location of the wire internal fixation,and no apparent shortening of the patella.At the 12 months,range of knee motion was (126.0 ± 4.5) ° for flexion and (2.0 ± 1.7) ° for extension.Bostman functional score for patella fracture was (28.1 ± 1.9) points.And 12 patients were rated as excellent and 2 good,with excellence rate of 100％.Conclusion Cannulated screw fixation plus separate vertical wiring is effective to stabilize patella inferior pole fracture and has good results,indicating a recommended surgical method.

Objective To examine characteristics of patients with blood urea nitrogen (BUN) levels higher and lower than the normal limit.Methods During January 2012 to January 2015,116 patients with upper gastrointestinal diseases were selected to study,according to the patient's blood urea nitrogen level,all the patients were divided into high BUN group and low BUN group,and there were 76 patients in the high BUN group,and 40 patients in low BUN group,compared the biochemical indices,gastrointestinal bleeding forrest grading and disease severity of the two groups,and univariate logistic regression analysis.Results The serum white blood cell count,blood urea nitrogen,creatinine and glycated hemoglobin levels in patients of high BUN group [(9 593±5 012)× 102/μl,368.1±162.3 mg/L,11.2±3.7 mg/L and 6.38±1.08％] were significantly higher than that of low BUN patients [(6 804 ± 2 087) × 102/μl,121.0 ± 39.3 mg/L,8.1 ± 3.2 mg/L and 5.51 ± 0.42 ％] (t =3.645～12.659,all P＜0.05),and the hemoglobin levels (87.3±35.1 g/L) of the patients in high BUN group was significantly lower than that of the low BUN patients (108.0 ± 31.2 g/L) (t=3.252,P=0.032).Logistic regression analysis showed the presence of hemoglobin and glycosylated hemoglobin levelst of wo groups of patients was significantly different (P＜0.05),and showed that showed the highest correlation with BUN.Gastrointestinal bleeding forrest hierarchical data of the two groups of patients showed no significant difference (P＞0.05).The proportion of patients with gastric ulcers of high BUN patients was significantly higher than that of the low BUN patients (x2 =39.655,P=0.000).Conclusion Patients with high expression of serum urea nitrogen had more severe upper gastrointestinal bleeding,and it is worthy of attention in the process of clinical diagnostic.

ObjectiveThe purpose of this study was to analyze the outcomes of surgical treatment of displaced intra-articular calcaneal fractures (ICFs) in children and its characteristics.MethodsBetween January 2004 and October 2008,we review the results of 9 displaced,intra-articular fractures in 8 skeletally immature patients,who were treated with open reduction and internal fixation in our hospital.There were 7 males and 1 female,with the mean age of 13.1 years(range:10 to 15 years).Preoperative radiographs and computed tomographic scans were used to classify fractures.Clinical and radiographic evaluation were performed in postoperative follow-up visits.The functional outcomes were assessed with use of the modified American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score.The published literatures of child ICFs treated with ORIF were reviewed.ResultsIn the series,there were 4 tongue-type and 5 joint depression-type fractures according to Essex-Lopresti classification,and according to Sanders classification,we found 5 type-Ⅱ fractures,3 type-Ⅲ and 1 type-Ⅳ fractures.The mean follow-up time was 47.4 months (range:21 to 72 months).All fractures healed within 2 to 4 months.The average preoperative and postoperative Bohler angles were 5.7 and 33.1 degrees respectively,and the mean Gissane angles were 106.5 and 128.0 degrees respectively.The mean modified-AOFAS score was 65.2 points(range:53 to 68 points).Skin necrosis was found in one foot.After the review of literatures,78.6％ (48/61) of displaced ICFs were male in children.Based on the Sanders classification,36 of 67 (53.7％) were type-Ⅱ fractures,25 of 67 (37.3％) were type-Ⅲ and 6 of 67 (9.0％) were type-Ⅳ; And 15 of 37 (40.5％) were tongue-type,22 of 37 (59.5％) were joint depression-type fractures according to Essex-Lopresti classification.ConclusionMost children with displaced ICFs treated with ORIF had a good clinical outcome with few complications.The children and adolescents that were exposed to high-energy trauma suffer calcaneal fractures that were similar to adult fracture patterns.