With ever-increasing knowledge of biomechanics and anatomy of pelvis,more and more findings have been made on the integrated sacroiliac joint system.The sacroiliac complex plays a very important role i n the functions of pelvis due to its specia l biomechanical features.The sacro iliac screw internal fixation is bio mechanically superior to other fixation methods.[

Objective To understand the level of urinary iodine of schoolchildren and salt iodine content of their families in a primary school and to analysis influence between salt iodine content and urinary iodine level in Haimen City,Jiangsu Province.Methods A cross-sectional study was conducted in a primary school of Haimen City in 2012.With the method of stratified cluster sampling,all students aged 9 ～ 12 were extracted in grades 3-5,urine samples and salt samples of their family were collected.Urinary iodine and salt iodine were determined according to Method for Determination of Iodine in Urine by As3+-Ce4+ Catalytic Spectrophotometry (WS/T 107-2006) and Direct Titration of Universal Test method in Salt Industry (GB/T 13025.7-1999).Results Totally,452 students from grades 3-5,including 233 boys and 219 girls were selected by cluster-stratified sampling.The median of children's urinary iodine was 231.90 μg/L,while the median of boys and girls was 235.40 and 222.60 μg/L,respectively.The median of urinary iodine of 9,10,11 and 12 year old students was 253.65,195.70,236.40 and 241.70 μg/L,respectively.The proportion of less than 100 μg/L and ≥300 μg/L was 7.7％ (35/452) and 27.7％ (125/452),respectively.There were no significant differences between different gender and age students.Among the 452 salt samples collected the median of salt iodine was 27.50 mg/kg.The coverage rate of iodized salt,the qualified rate of iodized salt and the intake rate of qualified iodized salt were 98.9％ (447/452),95.1％ (425/447) and 94.0％ (425/452),respectively.After consumptionn of non-iodized salt (＜ 5 mg/kg),unqualified iodized salt(5 ～ ＜ 20 mg/kg or ＞ 50 mg/kg) or qualified iodized salt [(35 ± 15)mg/kg],the median of urinary iodine of children was 177.30,211.95 and 232.90 μg/L,respectively.Correlation analysis showed that there was no relationship between iodine content of salt and urinary iodine level of schoolchildren (r =0.085,P ＞ 0.05).Conclusions Current nutritional level of schoolchildren in Haimen City is higher than the appropriate amount.Household salt iodine content of edible salt does not affect urinary iodine level of the children significantly.

Objective To report the clinical results of surgical treatment of fracture of the anteromedial facet of the coronoid process in terrible triad injury.Methods Of the 59 patients with terrible triad injury of the elbow,17 were surgically treated for fracture of the anteromedial facet of the coronoid process from July 2010 to July 2014.They were 12 men and 5 women,from 29 to 70 years of age (average,50 years).By the Mason classification for the radial head fractures,2 cases were type Ⅰ,13 type Ⅱ and 2 type Ⅲ;by the O'Driscoll classification for coronoid process fractures,one was type Ⅰ,14 were type Ⅱ and 2 type Ⅲ.All patients were treated through combined approaches.The lateral Kocher approach was used to fixate or replace the radial head and to repair the lateral ligament complex;the anteromedial approach was used to fixate the coronoid process fracture and to explore and repair the medial collateral ligament if necessary.Fracture union,implant loosening,ectopic ossification,regression and articular alignment were assessed on the postoperative X-rays.At final follow-ups,the elbow function was evaluated using Mayo elbow performance score (MEPS) and Broberg & Morrey grading system for traumatic arthritis.Results The average follow-up duration for the 17 patients was 32 months (range,from 24 to 60 months).Final follow-ups showed that the mean arc of flexion-extension was 97° (from 70° to 120°),the mean extension limitation 23° (from 0 to 40°),the mean arc of forearm rotation 139° (from 90° to 145°),the mean pronation 71° (from 60° to 90°)and the mean supination 67° (from 60° to 85°).The MEPT scores averaged 87 points (from 80 to 100 points),yielding 7 excellent,8 good and 2 fair cases.By the Broberg & Morrey grading,there were 4 cases of grade 1 and one of grade 2.No evidence of elbow instability,nonunion or implant failure was found.Ectopic ossification around the elbow happened in 4 cases,transient ulnar nerve palsy was found in one,and the Kirschner wire was removed operatively in 2 because it had loosened after fracture union.Conclusion The treatment of anteromedial coronoid fractures in terrible triad injury should be anatomically reduced through direct exposure and fixated rigidly.

Objective For developing safe and effective anti-radiation new drugs,the effects of different lipoic acid amino acid salts on radiosensitivity were investigated.Methods The free radical scavenging ability of the above salts was evaluated in Fenton system.CCK-8 assay and flow cytometry assay were performed to evaluate the survival rate of L02 and apoptosis of AHH-1 after γ-ray irradiation,respectively.Results The lipoic acid arginine salt had the best ability of scavenging free radicals in Fenton system with an IC50 of 8.40 μ moL/ml.The survival assay showed that lipoic acid amino acid salts had better stability and equal ability in radioprotection (P ＞ 0.05) compared with lipoic acid.The apoptosis assay indicated that all lipoic acid amino acid salts could inhibit radiation-induced apoptosis,where lipoic acid arginine salt was more effective (t =-6.67,P ＜ 0.01).Conclusions Lipoic acid arginine salt has good radioprotection effect on L02 and AHH-1 cells by scavenging free radicals.

Objective To introduce the technique of metal-on-metal hip resurfacing arthroplasty,evaluate its preliminary clinical results and review the factors which affect the results.Methods From January 2006 to October 2010,104 patients (116 hips) with osteonecrosis of the femoral head,hip osteoarthritis,hip dyplasia,or ankylosing spondylitis were treated with the total hip resurfacing arthroplasty.Among them,59 patients (66 hips) were male,and 45 patients (50 hips) were female,with an average age of 39.7 years (range,16-67 years).Standard operation technique was performed for all patients with Conserve Plus prosthesis.Each patient was followed up at 1 month,3 months,6 months,1 year postoperatively.Results Three patients (4 hips) were lost,so 101 patients (112 hips) were followed up for an average period of 33 months (range,9-66 months).The average Harris hip score was improved significantly from 37.6±6.3 preoperatively to 91.3±5.3 at final follow-up; 104 hips were excellent,7 hips were good,1 hip was poor,and the excellent and good rate was 99.1％.At final follow-up,the average abduction angle of the acetabutar cup was 42.7°(range,36°-55°); the average femoral prothesis stem-shaft angle was 138.5° (range,132°-146°).Two patients presented with heterotopic ossification (Brook Ⅲ and Brook Ⅱ ).One patient presented with prothesis dislocation,which healed after being treated with manual reduction.There was no femoral neck fracture,infection,or prosthesis loosening.Conclusion With strict patient selection criteria and optimized technique,the short-term results of metal-on-metal hip resurfacing arthroplasty are satisfactory.

In order to provide anatomical basis for transoral approach (TOA) in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults' fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2+/-3.5 mm and 39.3+/-3.7 mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1+/-5.2 mm and 50.2+/-4.6 mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0+/-2.9 mm and 24.0+/-3.5 mm respectively, and the distance of bilateral axis screw inserting points was 18.0+/-1.2 mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces: mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.
Atlanto-Axial Joint/*anatomy & histology ; Atlanto-Axial Joint/*surgery ; Bone Plates ; Bone Screws ; Cadaver ; Cervical Vertebrae/*anatomy & histology ; Cervical Vertebrae/surgery ; Equipment Design ; Internal Fixators ; Joint Prosthesis ; Models, Anatomic ; Odontoid Process/*surgery ; Prosthesis Design

Background The histopathological and functional changes are affected by age,gender and axial length (AL).However,whether these factors affect the volume and thickness of various layers of retina is not elucidated.Understanding macular intraretinal layer volume changes and influence factors can offer useful information for relevant clinical study.Objective This study was to measure the influence of age,gender and AL on the volume of individual retinal layers at macula zone with optical coherence tomography (OCT) in normal population.Methods A cross-sectional study was carried out under the approval of Ethic Committee of Tongling People's Hospital.One hundred and thirty-four eyes of 92 healthy individuals who received physical examinations and ocular examinations by slit lamp microscope,90 D pre-set lens,RM-8000A computer automatic optometry and non-contact tomometer were recruited from April to July 2016.The individuals were grouped based on gender or ages (7-14 years group,15-49 years group,50-80 years group).The retinal thickness and volume of different layers within 6 mm circle area around fovea were measured by Spectral-OCT with Posterior Pole mode and processed by the layered software.AL was measured with ODM-2100 A/B ultrasonic apparatus.Results The volume values of whole retinal thickness (WRL),retinal nerve fiber layer (RNFL),inner nuclear layer (INL) and outer plexiform layer (OPL) in males were (8.80 ± 0.38),(0.92 ± 0.09),(1.03 ± 0.07) and (0.79 ± 0.07) mm3,which were significantly increased in comparison with (8.66±0.34),(0.88±0.07),(1.00±0.07) and (0.77±0.06)mm3 in females (P=0.025,0.027,0.012,0.030).The WRL,GCL and IPL volume values were largest in the 15-49 years group and least in the 7-14 years group,and the volume values of RNFL,outer nuclear layer (ONL),retinal pigment epithelium (RPE) and photoreceptors (PC) were significantly lower in the 7-14 years group and 50-80 years group than those in the 15-49 years group (all at P ＜ 0.01).The AL was negatively correlated with WRL,GCL and IPL volumes (r=-0.226,-0.385,-0.373,all at P＜0.01).Conclusions The retinal volume value at macular area is larger in men than that in women.The retinal volume area shows firstly increased and then decreased during aging.The AL shows a negative correlation with the macular volume.

Objective To explore the classification system and outcomes of surgical treatment for terrible triad of the elbow.Methods Data of 42 patients with terrible triad elbow injuries who were surgically treated between 2009 and 2015 were retrospectively analyzed.There were 29 males and 13 females with a mean age of 47 years at the time of injury.42 patients of terrible triad injuries were classified into four types:type ⅠA,ⅠB,Ⅱ,Ⅲ,and Ⅳ injuries.Type ⅠA and Ⅱ injuries were treated through an isolated lateral approach,while type ⅠB,Ⅲ and Ⅳ injuries were treated by a combined lateral and anteromedial approach.Operative treatment consisted of repair or replacement of the radial head,repair of the lateral collateral ligament (LCL) and coronoid fracture fixation.Type ⅠA injuries were treated with radial head and LCL repair without coronoid fixation.Type Ⅳ elbow injuries were treated with medial collateral ligament (MCL) repair.Elbow functional status was evaluated using the Mayo elbow performance score (MEPS).Results There were three patients with type ⅠA injuries,7 patients type ⅠB injuries,15 type Ⅱ injuries,10 type Ⅲ injuries,and 7 type Ⅳ injuries.The average follow-up period was 30 months (range,24-56 months).All fractures of coronoid got union at average 11.5 months except for type ⅠA injuries.40 patients with fractures of radial head got union at average 12.4 months and two patients underwent radial head replacement without loosening.The mean flexion-extension arc was 107°±22°,the mean flexion contracture was 20°±10° and the mean flexion was 127°±14°.The average forearm rotation arc was 145°±14°,which included an average pronation of 73°±8° and an average supination of 71°±9°.The mean MEPS was 89±9 points (range,55-100 points),with excellent results in 24 elbows,good result in 17 and poor result in one;the excellence rate was 97％ (41/42).Thirteen patients had radiographic signs of arthrosis according to the Broberg-Morrey system (9 elbows were grade 1 and 4 were grade 2).5 patients had evidence of heterotopic ossification,of which four had minimal periarticular ossification and did not require additional surgery.The remaining patient showed significant heterotopic ossification and required an elbow release.1 patient with type Ⅲ injury developed transient median nerve paralysis and got full recovery after conservative treatment for 8 weeks.1 patient with type Ⅲ injury developed ulnar neuropathy and required an anterior ulnar nerve transposition.2 patients,who had shifting hardware but still achieved union,required a second surgery to remove the implant:one patient had a Kirschner wire shift from the radial head at 6 months after surgery,and the other had a loose screw in the coronoid process at one year after surgery.Conclusion Our classification system of terrible triad of the elbow may provide a guide for the selection of an ideal surgical approach and treatment modality.

ObjectiveTo make a comparison between microsurgical lumbar discectomy(MSLD) and microendoscopic discectomy(MED) in terms of methods,feathers,and effectiveness for lumbar disc herniation (LDH).MethodsA prospective clinical review was conducted.From January 2006 to December 2009,900patients with single segment lumber disc herniation were randomly divided into the MSLD group and the MED group.There were 450 patients in each group.Comparison would be made in terms of the length of skin incision,the operative time,amount of bleeding,incidence of complication,duration of hospitalization,the time of recovery to ordinary work or life,pre- and post-operative assessment based on the criteria of visual analogue scales (VAS),and the Oswestry disability index(ODI).ResultsThe mean lengths of skin incision were (3.8±1.1) cm and (2.4±0.7) cm for MSLD and MED respectively; the operative time were (51.0±14.2) min and (62.0±16.3) min; and the blood loss were (60±35) ml and (106±43) ml,which showed a significant difference(P＜0.05).There was no significant differences in terms of the hospitalization time and the time of recovery to ordinary work or life between the two groups (P＞0.05).The results of VAS and ODI of two groups also showed no significant difference at final follow-up (P＞0.05).As for the complications,the incidence of dural tear,acute hematomas of sacrospinalis,nerve roots and cauda equina injury and recurrence in MSLD group were much lower than that of MED group (P＜0.01).There was no incidence of wrong segment,greater artery injury,or postoperative infection in each group.ConclusionThe clinical effects of both minimal invasive methods are satisfactory.However,MSLD has advantages of simpler maneuvering,shorter learning curve,and less complication than MED.

In order to provide anatomical basis for transoral approach (TOA) in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults' fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2±3.5mm and 39.3±3.7mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2mm and 50.2±4.6mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0±2.9mm and 24.0±3.5mm respectively, and the distance of bilateral axis screw inserting points was 18.0±1.2mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces: mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.