Objective To study the efficacy of Singhindex and fracture-type-based treatment strategy on inter-trochanter femoral fracture.Methods Sixty four patients who suffered from inter-trochanteric femoral fracture from 2007 to 2010 were recruited into this study.The pattern of fixation was determined according to the preoperative Singh index and fracture type.The efficacy of fixation was compared with that of the previously treated 127 cases in the same condition.Results The healing time of fracture in the study group was 10.5 ± 1.2 weeks,which was significantly shorter than 12.6 ± 2.4 weeks of the control group( t =4.27,P ＜ 0.05 ).Fixationrelated complications were observed in 3 cases in the study group and 17 cases in the control group,which was statistically different between the two groups ( x2 =5.74,P ＜ 0.05 ).The percentage of patients with excellent outcome in the study group was 91％ (58/64),significantly higher than 84％ ( 107/127 ) of the control group ( x2 =6.28,P ＜ 0.05 ).Conclusion Treating the inter-trochanteric femoral fracture according to Singh index and fracture type will create improved clinical efficacy.

Objective To investigate causes and treatments for a fracture of the contralateral femoral neck in the elderly with prosthetic replacement for femoral neck fractures.Methods A retrospective analysis was conducted on 85 cases undergone prosthetic replacement for femoral neck fractures between March 2005 and May 2012,including 12 cases in secondary replacement group due to fractures of the contralateral uninjured femoral neck after primary prosthetic replacement and 73 cases in primary replacement group.Variables were compared between the two groups including causes of injury,age,sex,bone density,complications,quality of life,Harris score of the contralateral hip joint,surgical choice.Refracture reasons were evaluated and treatment plans were proposed.Results Immediate cause of injury in all cases was falling.Primary and secondary replacement groups showed mean age of (68.82 ± 5.18) yearsvs (76.83 ± 3.64) years (P＜0.05),male to female ratio of 0.66:1 vs 0.09:1 (P＜0.05),and bone mineral density of (0.507 ± 0.062) g/cm2 vs (0.461 ± 0.095) g/cm2(P ＜0.05).Moreover,cases in the two groups suffered from the associated complications (hypertension,diabetes mellitus,cataract,stroke,rheumatoid arthritis,and Parkinson' s disease).Except for the diabetes mellitus,incidence of the other five basic diseases presented significance differences between the two groups (P ＜ 0.05).Of primary and secondary replacement groups,quality of life was (76.26 ±14.17) points vs (67.86 ± 16.74) points (P ＜ 0.05) ; Harris score of the contralateral hip was (98.66 ±1.39) points vs (90.75 ± 5.39) points (P ＜ O.05).For treatment choice,32 total hip arthroplasty (THA) and 41 femoral head arthroplasty (FHA) with cement fixation in 44 cases and cementless fixation in 29 cases were performed in primary replacement group; two total hip arthroplasty and 10 femoral head arthroplasty with cement fixation in 11 cases and cementless fixation in one were performed in secondary placement group (P ＜ 0.05).Conclusions Fall remains the immediate cause of the contralateral fractures following prosthetic replacement of femoral neck fractures in the elderly.Aging,females,bone density reduction,high-incidence of complications,decreased quality of life,and joint function impairment after the primary prosthetic replacement are unfavorable factors.Prosthetic replacement is still the preferred choice of treatment and surgical procedure is more likely to be the simple cemented FHA.

Objective To evaluate therapeutic effects and complications of concurrent three-dimensional conformal radiotherapy (3DCRT) and chemotherapy in patients with limited-stage small cell lung cancer (LSCLC).Methods From June 2000 to August 2005, 93 histologically proved LSCLC patients were randomized into two groups:3DCRT group (n =46) and conventional group (n =47).In both groups, patients received one cycle chemotherapy, followed by concurrent chemoradiotherapy and then received consolidate chemotherapy.Chemotherapy was four to six cycles of PE regimen.Conventional irradiation field was setup in conventional group, while in 3 DCRT group clinical target volume (CTV) only involved visible tumor and adjacent lymphatic region.Radiotherapy was delivered at 2 Gy per fraction, 5 fractions per week to a median total dose of 60 -64 Gy.Those who achieved a complete response were treated with prophylactic cranial irradiation (PCI) with 30 Gy in 10 fractions.Results The follow-up rate was 100% in both groups.The number of patients completed 1-, 2-and 3-year follow-up were 36, 34 and 16 in 3DCRT group, 14, 7 and 8 in conventional group, respectively.The complete and overall response rate were 52% and 89% in 3DCRT group, while 47% and 85% in conventional group, respectively.The 1-, 2-and 3-year survival rates were 78%, 35% and 15% in 3DCRT group, 72%, 30% and 17% in conventional group, respectively.The median survival time was 23.2 and 22.8 months, respectively.There was no statistical difference in short-term (Χ~2 = 0.34 ,P = O.759) and long-term outcomes (Χ~2 = 0.18 ,P = 0.92).In 3DCRT group, the incidence of grade 1 +2 acute radiation pneumonitis and esophagitis, grade 1 +2 and grade 3 chronic radiation pneumonitis were lower than those in conventional group.There was no grade 3 or 4 acute radiation pneumonitis or esophagitis, or grade 4 chronic radiation pneumonitis in both groups.There was no difference in grade 1 + 2, grade 3 or grade 4 acute myelo-suppression between the two groups.Conclusions In the treatment of LSCLC, concurrent 3DCRT and chemotherapy can achieve satisfactory short-term and long-term outcomes with acceptable complications.

Objective:To study the clinical effect of internal combined with external fixation in the treatment of pelvic fracture and its effect on the serum alkaline phosphatase (ALP),tumor necrosis factor-a (TNF-α) and transforming growth factor-β (TGF-β).Methods:Eighty-six patients with pelvic fractures admitted in our hospital from August 2014 to July 2015 were selected and divided into the observation group and control group according to the admission order.Conventional internal fixation was used in the control group,and the internal combined with extemal fixation was performed in the observation group.The clinical curative effect,operative time,blood loss,fracture healing time and incidence of complication were compared between two groups.The levels of serum ALP,TNF-α and TGF-β in the two groups were compared before and after treatment between two groups.Results:The excellent rate of observation group was significantly higher than that of the control group [81.40％ (35/43) vs 41.86％ (18/43)] (P ＜0.05).The operative time,blood loss and fracture healing time in the observation group were significantly shorter or less than those of the control group (P＜0.05).There was no significant difference in the serum ALP,TNF-α and TGF-β levels between the two groups before treatment (P＞0.05).After treatment,the serum ALP levels in the two groups were significantly higher than before treatment (P＜0.05).The levels of TNF-α and TGF-β were significantly lowe than those before treatment(P＜0.05),the ALP levels in the observation group was significantly higher than that of the control group (P ＜0.05),and the levels of TNF-c and TGF-β were significantly lower than those of the control group 0.05).The incidence of complications of observation group was significantly lower than that of the control group [0.00％ (0/43) vs 11.63％ (5/43)] (P ＜0.05).Conclusion:Internal and external fixation was effective and safe in the treatment of pelvic fractures,which could significantly increase the serum ALP level and reduce the levels of TNF-α and TGF-β.