0. 05). The mean survival time in Iodine-125 stent group was 10. 5 months prominently longer than those in group A 4. 4 months (P

Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.

Objective To evaluate the double-arterial phase and portal venous phase scanning in the detection of hepatocellular carcinoma with multi-slice sprial CT (MSCT).Methods Ninety-four patients with hepatocellular carcinoma were examined by abdominal plain CT and early areterial phase (EAP),late arterial phase(LAP),portal venous phase(PVP).Contrast agent of 100 ml (300 mg I/ml) was administrated intravenously by 3 ml/s,for scanning of EAP at 20 to 22 s,LAP at 34 to 37s.and PVP at 60 s.Chi-square test was carried out to compare the sensitivity among various phases.Resuits A total 0f 318 1esions was detected pathologically,with 86 lesions less than 3 cm in size and 232 lesions more than 3 cm.For the early arterial phase,late artefial and portal venous phase,the sensitivity was 39.5%(34),67.4%(58),44.2%(38)respectively for the small tumors,which showed significant differences between phases(X2=15.38,P<0.01).For the large tumors,the sensitivity was 89.6%(208),99.6%(231), 99.1%(230),respectively(X2=39.09,P<0.01).All had positive predictive values of 100%.If the tumors were taken together,the sensitivity was 76.1%(242),90.9%(289),84.3%(268).and the positive predictive value was 88.3%(242/274),86.3%(289/335),93.7%(268/286)for the early arterial phase,late arterial and portal venous phase respectively.There was significant difference of sensitivity and positive predictive value between phases(X2=25.62,9.29,P<0.05).Conclusion Double-arterial phase could improve the detection of tumors,especially for small hepatocellular earcinoma. and late arterial phase scanning is particularly important.

Objective To compare magnetic resonance spectroscopy (MRS) characteristics and changes before and after 5-Fu interventional thermochemotherapy (ITC) as well as to analyze the correlation of Cho/Lip and apoptosis index (AI) in hepatic VX2 carcinoma animal model.Methods 20 rabbit models of hepatic VX2 carcinoma were implanted successfully.Ten days later,as tumor diameter≥ 10 mm,routine scan and 1H-MRS were performed before one day and after 14 days on all of rabbits by Philips 1.5T MR scanner.The changes of Cho peak,Lip peak and the ratio of Cho/Lip before and after the treatment were analyzed.Specimens of AI were examined and compared with the ratio of Cho/Lip.Results The Cho peak and Lip peak were increased before ITC.After ITC,the Cho peak and the ratio of Cho/Lip decreased than before.The Lip peak was further increased than that of before.AI was correlated negatively with the ratio of Cho/Lip (r =-0.56,P =0.02).Conclusions The metabolites of different ROI are matched with the levels and scopes of AI.1H-MRS can be used to evaluate tumor cell apoptosis and energy metabolism changes of the rabbit models of hepatic VX2 carcinoma with the treatment.

Objective To observe imaging characteristics and changes of vivo two-dimension multi-voxel proton magnetic resonance spectroscopy (~1H-MRS) in the rabbit models of VX2 hepatic carcinoma after high intensity focused ultrasound (HIFU) treatment. Methods VX2 hepatic carcinoma models were established in 20 New Zealand rabbits. Routine MR and 2-dimentional ~1H-MRS scanning were performed before and after HIFU treatment. The central regions of interest (ROI) of the VX2 tumor, tumor border and paratumor normal liver tissues were selected. The Cho/Cr and Lip/Cr of the same ROI before and after HIFU treatment were compared. Results Total 28 satisfied spectrogram diagram of ~1H-MRS were brought into statistical analysis. Of all the spectra, 6 metabolite peaks were detected as lipids (Lip), glutamine and glutamate complex (Glx), choline (Cho), lactate (Lac) and creatine (Cr). Cho and Lac peak in tumor center and tumor border regions after HIFU treatment were higher than those before HIFU treatment. Lip peak was lower than before, and major metabolites of paratumor normal liver tissues did not changed significantly. Statistical differences of Cho/Cr and Lipid/Cr of tumor center and border region were found between before and after HIFU treatment (P＜0.05). Conclusion Two-dimension multi-voxel ~1H-MRS can reflect major changes in the level of metabolites of different ROI for hepatic VX2 carcinoma after HIFU treatment.

Objective To summarize the image features of nutcracker syndrome (NCS)on 320 multi-slice spiral computed tomo-graphy angiography (CTA).Methods The clinical and CTA data of 1 5 cases with NCS were analyzed retrospectively.The angle(α) between superior mesenteric artery (SMA)and abdominal aorta(AA)was measured.The ratio(a/b)of the diameters of the most narrow and the most wide at the hilus of left renal vein (LRV)was calculated.Results The angel(α)of 1 5 cases were ranged from 15.5°to 27.6°.The range of a/b was from 0.22 to 0.35.Left renal enlargement were observed on four cases.Collateral circulation were detected on two cases.Duodenal stasis was detected on one case.Conclusion CTA findings of NCS is characteristic,which can noninvasively,rapidly and comprehensively display the surrounding anatomy of LRV.It is helpful in clinical diagnosis.

Objective To study the characteristics of DWI in nude mice models of hepatic Bel7402 tumors after treatment with adenovirus-mediated cytosine diaminase-thymidine kinase ( Ad.CD-TK) double suicide gene therapy, and then to identify whether DWI can be used for assessing curative effect of postoperative tumors.Methods Thirty nude mice models of hepatic Be17402 tumors were successfully created using cell suspension method,after the tumor grew to more than 1 cm in diameter,20 tumor models were treated by intratumoral administration of Ad.CD-TK for 3 days plus intraperitonea( i.p.) treatment with 5-Fc and GCV for the duration of the study.Then they were randomly divided into three groups during 5-Fc and GCV treatment.The remaining 10 tumor models were used as controls.MR scanning were performed in 10th day before and after tumor implantation in all models by using EPI-SE series and SENSE technology for treatment group. Tumor volumes and ADC values were calculated pretreatment and posttreatment. Cell apoptosis were determined by using TUNEL method.Analyze the change of ADC and apoptosis index (AI) in different times,t test was used for comparison the difference of AI and ADC values respectively. Results After 10 days,the tumor volumes of the treatment groups and controls were respectively (724.16 ±57.45 ) mm3,( 754.57 ± 66.84 ) mm3,with no significant difference ( t =0.488,P ＞ 0.05 ).The ADC values of the treatment groups were (0.98 ±0.11 ) × 10-3 mm2/s,the ones of the control groups were (0.68 ±0.04) × 10 -3mm2/s;AI of the treatment groups were(23.25 ±6.57)％,the ones of the control groups were (2.57 ± 0.58) ％.There were difference in both groups ( t =4.473,5.874 ; P ＜ 0.01 ).Conclusion DWI can be effectively to monitor the early pathological changes of hepatic Bel7402 tumors after Ad.CD-TK double suicide gene therapy,and provide experimental evidences for clinical application.

Objective To study the DWI characteristics,Bcl-2 gene expression and the relevance of the DWI and Bcl-2 in rabbit models of hepatic VX2 tumors after three-dimensional conformal radiation therapy(3D-CRT).Methods Forty hepatic VX2 tumor models were successfully created.After the tumor grew to more than 1 cm in diameter,28 tumor models were treated with 3D-CRT and then divided into four groups using random number table.The remaining 12 tumor models were used as controls and randomly assigned to each group.MR scanning were performed at different times(1st day,5th day,10 th day,15 th day) for each group respectively.ROIs of the VX2 tumor tissue and normal liver tissue were taken and ADC values measured with calculation of their ratio.Expression of apoptotic Bcl-2 gene was determined by using Rt-PCR method.ADC value with their ratio and the relative gray value of Bcl-2/β-actin were calculated using one dimensional analysis of variance and two samples t-test at different times,compared within the group and between groups.Results On the 1st,5 th,10 th and 15 th day,the ADC ratios of the radiotherapy groups were 0.55±0.13,1.32±0.27,0.96±0.34,0.72±0.17 respectively,the corresponding ADC ratios of control groups were 0.69±0.20,0.78±0.24,0.71±0.23,0.79±0.21.The ratio of ADC values for radiotherapy group and the control group were compared,t value was 1.283(P＞0.05),4.974(P＜0.01),3.191(P＜0.01),0.776(P＞0.05)respectively for each group.On the 1st,5 th,10 th and 15 th day,the Bcl-2 gene relative gray value of the radiotherapy groups were 0.92±0.31,0.56±0.28,0.42±0.24 and 0.31±0.15 respectively,the corresponding Bcl-2 gene relative gray value of control group were 1.18±0.50,1.15±0.43,1.16±0.41,1.46±0.19.The Bcl-2 gene relative gray value for radiotherapy groups and the control groups were compared,with t value 0.987(P＞0.05),3.863(P＜0.01),5.401(P＜0.01),5.894(P＜0.01)respectively.The ADC value ratio and Bcl-2 gene relative gray value correlation analysis showed that there was significant negative correlation(r=-0.493,P＜0.01).Conclusion DWI ADC values can reflect the dynamic changes at the molecular level for hepatic VX2 tumors after radiotherapy at different times.

Objective To explore operative indications,methods and effect of one stage total hip arthroplasty(THA)in treatment of acetabular fractures.Methods One stage total hip arthroplasty (THA)was carried out in 11 patients with acetabular fractures including 10 males and one female(at mean age of 42.4 years)8-37 days(mean24 days)after injury.There were anterior column fractures in three patients,posterior wall fracture in one,posterior column fracture in two,posterior column fracture combined with posterior wall fracture in two,transverse fracture in one,transverse fracture combined with posterior wall fracture in one and two-column fracture in one.Fresh acetabular fractures were first fixed with reconstruction plate or screws to restore shape of acestbular wall;then,granule or bulk of resected femoral head were implanted into acetabulum posterior to placement of acetabular cup prosthesis.While for old acetabular fractures,the resected femoral head was first implanted on acetabular superior wall and posterior wall and then acetabular cup prosthesis was placed.Results Follow-up for 6-45 months (mean 28 months)showed obdous improvement of hip joint function,with average Harris score of 78 points and average active degree of 95°.X-ray film presented loosening of acetabulum and osteolysis in one patient.All patients began weight bearing three months after operation,with no dislocation of joint prosthesis.Conclusions Under strict control of indications,one stage THA can be done for patients who miss operative reduction due to obvious acetabular fracture dislocation and severe articular cartilage injury.Stable aeetabular cup may beget satisfactory short-term clinical results.

Objective To evaluate the role of mangled extremity severity score(MESS)in res-ervation and amputation of crush lower limbs in earthquake. Methods There were 122 patients with crush lower limb injuries,with MESS≥8 points in 34 patients who were primarily amputated,M ESS 5-7points in 19 who were principally preserved and MESS＜5 points in 69 who were preserved by means of debridement,external fixators,plast splints and vaeuum sealing drainage technique.Results All pa-tients were survived.with amputation rate of 29.5%. Conclusion MESS is an important reference for evaluation of reservation and amputation of crush limb injuries caused by earthquake.