Objective To explore and analyze the optimal timing of surgery and clinical efficacy of minimally invasive drilling drainage in the treatment of hypertensive cerebral hemorrhage .Methods 150 patients with hyperten-sive cerebral hemorrhage ,according to a random number table method ,were randomly divided into the three groups , 50 patients in each group.Patients in group A received minimally invasive drainage drilling within 6h after the onset of disease,patients in group B received minimally invasive surgery 6-24h after the onset,patients in group C were given elective minimally invasive surgery 24-72h after the onset.Another 50 patients with hypertensive cerebral hemorrhage who received craniotomy surgery over the same period ,were selected as the control group .The clinical effects were observed and compared in four groups .Results The total effective rate of group B was 88%,which was significantly higher than the other three groups (χ2 =4.00,6.38,12.70,all P<0.05).The early cure rate of the observation group was 40%,which was significantly higher than the control group (χ2 =8.57,P<0.05).After treatment,the number of cases whose activities of daily living degree recovered to grade I in the observation group was significantly higher than the other three groups (χ2 =4.11,5.00,8.32,all P<0.05).The excellent rate of group B was 88%(44/50),which was significantly higher than the other three groups (χ2 =6.83,5.83,15.43,all P<0.05).After treatment,the incidence rate of complications in group B was significantly lower than the other three groups ,the inci-dence rate of complications in the control group was the highest (χ2 =5.32,8.58,32.97,all P<0.05).Conclusion Minimally invasive drilling drainage in the treatment of hypertension cerebral hemorrhage can obtain significant effect , the optimal timing of surgery is 6-24h,minimally invasive treatment has advantages of less invasive ,faster recovery,fe-wer complications ,and less costs ,which is worthy of widely used in clinical practice .

Objective To analyze the effect of cigarette smoking on replantation of amputed digit, investigate the pathologic mechanism of vascular crisis(VC) caused by smoking. Methods 1)The replantation risk factor such as smoking to VC and blood insufficiency of replanted digit was reviewed in 1 685 cases of digit replantation. 2)The complications after digit replantation in short and long terms among patients smoking were compared with those not smoking after operation. The results of management and time of appearance VC was assayed. 3)The possible pathologic mechanism of VC caused by smoking was analyzed. Results 1)A significant correlation between the ratio of VC, blood insufficiency of replanted digit and smoking index(SI, the number of cigarette in a day multiplies the years of smoking) was found. 2)The rate of VC, wound infection and unhealing in short term and the feeling of pain, numbness and cool in the long term in patients smoking after operation (92.6%,55.6%,48.1% and 71.6%) was obviously more than that in non smoking patients(17.8%,9.3%,2.0% and 3.0%,P

Objective To investigate the gene expression of GDNF mRNA on both ends of the severed sections of sciatic nerve in rats. Methods The specimen of sciatic nerve proximal and distal to the cut off site was taken respectively before and after sciatic nerve severance. The level of GDNF mRNA on both cutting sections was observed and compared by using of semi quantitative RT-PCR method with ? Actin as a inner consult before nad after sciatic nerve cut off. Results A minimum expression of GDNF mRNA was found on sciatic nerve before the operation, however, there was an increase of 20% at 24 hours in the distal section after sciatic nerve cut off, 60% at 7th day, 85% at 14th day and 90% at 28th day. While it decreased by 10%, 38%, 45% and 52% at 1st day, 7th day, 14th day and 28th day in the proximal section respectively. Conclusion The decreasing and increasing of GDNF mRNA level at the proximal and distal sciatic nerve section is the result of the disruption of “neuron axon target”axis after sciatic nerve cut off. This may provide a theory basis in treatment of SCI by use of the foreign GDNF.

Objective To investigate the characteristics and the effect of severed hallux replantation.Methods Eighteen completely severed halluces had been replanted since 1991.Injuried foot were kept in extending at 90?-120? position.The sequence of hallux replantation was opposed to the classical order and was so called"the retrograde replantating means(RRM)".The order of RRM was defined as follows: skin of toe abdomen→subcutaneous vein of toe abdomen→inhered toe nerve→inhered toe artery→flexor toe tendon→toe fixation by a single K-needle→extendor toe tendon→artery in the back of toe→subcutaneous vein of toe back→skin of bilateral and back.Results Sixteen of eighteen halluces survived replantation(89.9%).The total flexion degree in replanted halluces was 25?～70?.The appearance of amputated toes restored well.The two-point discrimination was 10～16 mm.Eleven cases walked as entirely usually in gait, and seven cases had basic normal gait.Conclusions Replantation of severed halluces could alleviate wound and remnant greatly.The recovery of foot function and aspect of replanted toes was satisfactory.The RRM gradation showed a distinctive advantage that there was no requiring for injuried foot be moved during operation.

[Objective]To investigate the chondrogenic ability and feasibility of bone mesenchymal stem cells(BMSCs) in three kinds of cellular carrier.[Method]BMSCs were separated and cultured into the third generation,which were cultivated in three knids of carriers by multi-point injection into and dropping on the surface of carriers(fibrin collagen sponge,group A;fibrin collagen sponge and FGF,group B and gelatin sponge,group C).All samples were analyzed after four weeks.[Result]There were a few chondrogenic cells in group A,much more chondrogenic cells in group B,and no cells in group C.According to analysis with SPSS 10.0 software,There were more cartilage cells(92.75?10.57) in group B than in group A(36.45?8.34).It was statistical different(P

[Objective] To determine the efficacy of one-stage posterior deformity correction with transpedicular screw system and anterior radical debridement following reconstuction with titanium mesh cage for treatment of lumbar tuberculosis. [Methods]Forty-three patients with lumbar tuberculosis were treated operatively through anterior and posterior combined approach.The postoperative neurologic status (ASIA,2000),graft fusion,deformity correction and complications were observed and analyzed respectively.[Results]Forty-one patients were followed up for a duration of 24~36 months (mean 28.3 months).A solid fusion was achived in all cases.The neurologic function was improved in all patients in different grades.The mean kyphotic angle was corrected by 21.3 degrees,the angle loss was 1?~3?,the mean vertebral height was restored by 10.2 mm,the mean height loss was 2.4 mm.There was no recurrence of the tuberculosis infection.[Conclusion]One-stage posterior deformity correction with transpedicular screw system and anterior radical debridement following reconstuction with titanium mesh cage is a safe and effective method in the surgical management of lumbar tuberculosis.

Objective To explore and analyze the effect of standard large trauma improved operation ( slow decompression ) and standard large trauma conventional surgical procedures ( sudden decompression ) in the treatment of elderly patients with severe craniocerebral injury ( SCCI) .Methods 100 elderly patients with SCCI were randomly divided into the control group and the observation group ,50 cases in each group .The control group was treated with conventional methods ( standard large trauma traditional surgical treatment ) , the observation group was treated with standard large trauma surgery improved operation .The effects and postoperative complications were observed and recorded.Results 1d,3d,5d,15d after operation,the intracranial pressure of the two groups were (272.3 ±19.1)mmHg, (285.4 ±18.2) mmHg,(218.2 ±18.3) mmHg,(168.4 ±17.3) mmHg;(302.1 ±23.1) mmHg,(310.3 ± 19.2)mmHg,(221.1 ±19.2)mmHg,(148.2 ±16.4)mmHg,which were changed significantly compared with preop-eration,the intracranial pressure gradually decreased as time passed ,the decrease of intracranial pressure in the con-trol group was more obvious than the observation group .The incidence rates of epilepsy ,cerebral infarction ,hydroceph-alus in the observation group were 2.0%,6.0%,0.0%,which were significantly lower than those in the control group (30.0%,36.0 %,26.0%),the differences between the two groups were significant (χ2 =14.85,13.56,14.96,all P<0.05).The number of patients with good prognosis ,the residual in the observation group were significantly more than the control group , while the number of severely disabled and vegetative state patients in the observation group were significantly less than the control group ,(χ2 =4.88,3.93,4.33,7.44,all P<0.05).Conclusion Standard large trauma improved operation ( slow decompression ) can effectively reduce intracranial pressure in elderly patients with severe fluctuations ,reduce the incidence of complications ,improve treatment prognosis ,it should be popularized in clinical practice .

[Objective]To explore the reason of ulnar impaction syndrome misdiagnosed by tissue injury in wrist.[Method]From December 1998 to December 2005,216 cases who were diagnosed for soft tissue injury in ulnar wrist were checked and discriminated according to X-ray and MRI of the injured wrist,and 48 cases were re-diagnosed for ulnar impaction syndrome.The misdiagnosis rate was 22.2%.[Result]Most cases of ulnar impaction syndrome had positive lunar variance(68.8%).Carpal avascular necrosis were found in about 27.1% of cases through X-ray of wrist and 100% through MRI.Different degree changes of abnormal signal intensity were found in soft tissue,triangular fibro cartilage(TFC) and carpal bones by MRI which displayed swelling of soft tissue in carpal joint,strip-shape high signal intensity or mixed signal intensity at ligament around wrist and enhanced signal intensity at TFC area extending to ulnar carpal articular facet.The appearance of MRI in carpal bones showed local abnormal signal,articular cartilage thickening and hydropsia in bone below cartilage and marrow.[Conclusion]The misdiagnosis can be reduced through elevating acquaintance level of ulnar impaction syndrome basing on clinical symptoms,making the most use of imaging,especially MRI.

Objectives:To compare the effect of glial cell line-derived neurotrophic factor(GDNF) and methylprednisolone(MP) on intracellular free calcium(［Ca2+］i) and capacity of containing water(CCW) after spinal cord injury(SCI).　Methods:Forty-two SD rats were divided into four groups： control, GDNF,MP and GDNF+MP.GDNF and MP were supplied through subarachnoid cavity, tail vein and both of the above after T12 segments spinal cord injury by modified Allen crush method. Animals were executed and specimens were collected at 24 h, 72 h and 168 h after SCI.［Ca2+］i and CCW were measured using Fura-2 method.　Results:Both ［Ca2+］i and CCW of injured spinal cord in GDNF,MP, and GDNF+MP groups were lower than that of the control group at 24 h and 72 h after SCI(P<0.01).Levels of ［Ca2+］i and CCW in GDNF group was much higher than that of MP and MP+GDNF groups(P<0.01),but there was no difference between MP group and MP+GDNF group(P>0.05) 24 hours after SCI. Seventy-two hours after SCI,［Ca2+］i in GDNF group was higher than that in MP group, MP group was higher than MP+GDNF group(P<0.05).CCW of GDNF group exceeded that of MP and MP+GDNF group(P<0.01).［Ca2+］i in GDNF group was higher than that in MP group, and MP group was higher than MP+GDNF group(P<0.01) 7 days postoperatively, but for CCW, there were no differences among GDNF,MP and MP+GDNF groups(P>0.05).　Conclusions: Both GDNF,MP and GDNF + MP groups might reduce ［Ca2+］i and CCW of injured spinal cord. The curative effect of MP for SCI preponderate over that of GDNF, the effect of MP could be enhanced by adding GDNF.

Objective To explore the effects of single rectangle cage interbody fusion combined with pedicle screw fixa?tion for isthmic spondylolisthesis. Methods Data of the 34 cases with isthmic spondylolisthesis hospitalized at our department from March 2012 to February 2015 were retrospectively analyzed. All cases were operated by posterior pedicle screw fixation com?bined with single rectangle cage interbody fusion. There were 21 males and 13 females, aging from 18 to 63 years old (with an aver?age age of 41.6±8.2 years). Lesion segments were L4 in 15 cases and L5 in 19 cases;there were 12 cases in Meyerding I degree, 16 in II degree and 6 in III degree;28 patients had lower back pain associated with lower limb pain;19 patients had lower back pain associated with numbness of lower limb;18 patients had lower back pain associated with lower limb muscle weakness and 2 pa?tients had urination and defecation function disturbance. The surgical operation time, bleeding, postoperative drainage flow, graft fusion rate, complications were measured, and the intervertebral disc height, Japanese Orthopaedic Association (JOA), Oswestry disability indes (ODI), visual analogue scale (VAS) score were compared before and after treatment. Results The operation of 34 patients was successfully completed with the average operation time of 1.8 ± 0.8 h, and the bleeding in operation was 362.4 ± 93.7 ml, while postoperative drainage flow was 116.3±54.2 ml. All patients were effectively followed up for 12 months to 46 months (av?erage, one year and 10 months). Two weeks after operation, the intervertebral disc height were obviously increased (9.85±1.11 mm, 9.63 ± 1.04 mm), and there were significant difference compared with preoperative results (6.53 ± 0.98 mm, 6.24 ± 1.07 mm), but there were no significant difference compared with the latest follow?up results (9.23±1.33 mm, 9.30±1.16 mm). At the latest follow?up, JOA score was 13.19±1.08, ODI score 12.34±7.52, VAS score 2.23±1.51, and there were significantly different in each score compared with preoperative results. The symptoms of low back pain, lower limb nerve dysfunction and quality of life were signifi?cantly improved compared with preoperative situation. At the 16 month follow?up, all postoperative patients with vertebral body bone graft were judged to be fused. There was no pedicle screw loosening, fracture and so on. Conclusion Single rectangle cage interbody fusion combined with pedicle screw fixation for the treatment of isthmic spondylolisthesis is a kind of mini?invasive, less bleeding, safe and effective surgical method.