Objective To compare the clinical effect of simple volar or dorsal plate fixation of intra-articular distal radius fracture.Methods This retrospective study included 42 patients with closed intra-articular distal radius fracture treated surgically using the dorsal or volar plate.Out of the 15 patients in dorsal plating group 5 were males and 10 females at age of (55 ± 7)years (range, 48-62 years), 13 were injured from falls and 2 traffic accidents, 10 were classified as AO type C3 and 5 AO type C2.Out of the 27 patients in volar plating group 8 were males and 19 females at age of (56 ± 6)years (range, 50-62 years), 24 were injured from falls and 3 traffic accidents, 17 were classified as AO type C3 and 10 AO type C2.Between-group differences were compared with respect to wrist range of motion, postoperative radiographic parameters, postoperative complications, disabilities of the ann, shoulder and hand (DASH) score and Gartland-Werley score.Results All the patients were followed up for 11-25 months.There were no significant differences in the wrist range of motion and radiographic parameters between the two groups (P ＞ 0.05).Volar plating group resulted in a significantly better Gartland-Werley score compared to dorsal plating group [1 vs 4 points, P ＜ 0.05], but no significant difference was noted in DASH score (P ＞ 0.05).Four patients (27％) in dorsal plating group developed tendon adhesions and tenolysis was in demand, but one patients (4％) in volar plating group was complicated by median nerve symptoms (P ＜ 0.05).Conclusions Although the DASH score of the two methods was similar, volar plating yields better results in Gartland-Werley score and complication incidence.Thus the volar plating is recommended for intra-articular distal radius fracture.

Objective To investigate surgical outcomes of anterolateral plus posteromedial approaches for treatment of complex tibial plateau fractures.Methods We reviewed 68 patients with tibial plateau fractures of Schatzker types Ⅴ and Ⅵ who had been treated from January 2008 to December 2011 and fully followed up in our department.They were 42 men and 26 women,22 to 64 years of age (average,42.3 years).Fractures occurred at the left side in 24 cases and at the right side in 44 cases.Intervals between injury and operation ranged from 3 to 15 days,7.4 days on average.All of them were operated on through anterolateral plus posteromedial approaches.T-or L-shaped steel plates were used laterally while reconstruction plates or T-shaped plates for distal radius were used medially.Results In this cohort the operation time averaged 3.13 hours,intraoperative blood loss 562.7 mL and hospital stay 20.4 days.All cases were followed up for an average of 18.8 months (range,12 to 38 months).Fractures healed from 4 to 8 months,6.7 months on average.The average tibial plateau angle,posterior slope angle and femorotibial angle immediately postoperation were respectively 87.3°± 1.5°,12.0°± 2.5° and 170.0°± 2.5°,not significantly different from those at one year postoperation (86.8° ± 1.2°,13.0° ± 1.8° and 171.0° ± 1.7°) (P ＞ 0.05).According to The Hospital for Special Surgery Score,the outcomes were excellent in 36 cases,good in 24 cases,fair in 6 cases and poor in 2 cases,with a good to excellent rate of 88.2％.No neural or vascular injury,deep infection,or implant failure was found in this group.Conclusion Anterolateral plus posteromedial approaches are effective for complex tibial plateau fractures,leading to anatomic reduction,stable fixation and early functional rehabilitation.

Objective To evaluate the outcome of posterolateral approach to the fibula for trimalleolar fractures,especially the fracture in posterior malleolus.Methods Thirty-two patients with trimalleolar fractures treated via posterolateral transmalleolar approach from July 2006 to July 2011 were analyzed retrospectively.All underwent open reduction and internal fixation,including 22 Lauge-Hansen grade Ⅳ supination-external rotation ankle fractures and 10 Lauge-Hansen grade Ⅳ pronation-extemal rotation ankle fractures.Results All fractures had bone union after the follow-up of average 15.5 months (range,12-18 months).Average American Orthopedic Foot & Ankle Society (AOFAS) score was 90.75points,suggesting an excellent result.Kellgren grading system for posttraumatic arthritis severity was grade 0 in eight patients,grade Ⅰ in 18,grade Ⅱ in five,and grade Ⅲ in one,which turned out to be satisfactory.Conclusions Posterolateral approach to the fibula for trimalleolar fractures allows direct reduction and fixation of posterior malleolus fragment in treatment of trimalleolar factures and the clinical outcome is satisfactory.Moreover,the approach deserves clinical practice.

Objective To discuss methods and clinical efficacy of patients treated with arthrolysis for posttraumatic elbow stiffness with heterotopic ossification.Methods The study involved 16 patients with posttraumatic elbow stiffness combined with heterotopic ossification treated by arthrolysis between June 2007 and June 2011.There were 11 males and 5 females,at average age of 29.6 years (range,18-53 years).Time from injury to surgery averaged 10.7 months (range,8-14 months).Other than medial approach for only one patient,the rest adopted medial to lateral approaches to have a complete clearance of periarticular heterotopic ossification tissue and hyperplastic tissue as well as partial resection of articular capsules and ligaments.Besides,seven patients were fixed using hinged external fixators.After surgery,three weeks of oral celecoxib was given for the patients.Rehabilitation was started immediately after operation.Range of motion (ROM) of the elbow and Mayo elbow pcrformance score (MEPS) were used to determine clinical results.Results All patients were followed up for 8-17 months (mean 13.4 months).ROM of the elbow (extension lag,flexion,pronation and supination)showed an improvement from (45.2-3.5)° to (27.2 ±8.4)°,(68.1-11.8)° to (106.8 ± 16.4)°,(55.8 ± 8.2) ° to (80.5 ± 3.3) °,and (53.7 ± 6.3) ° to (83.1 ± 5.3) ° respectively (P ＜ 0.01).MEPS increased from (46.8 ±7.0) points to (83.2 ±9.4) points after operation (P ＜0.01).According to MEPS criterion,the results were excellent in seven patients,good in five and fair in four.Conclusion With respect to posttraumatic elbow stiffness with heterotopic ossification,satisfactory therapeutic results can be achieved by thorough preoperative evaluation,strict control of surgical indications,appropriate selection of intraoperative techniques and early systematic rehabilitation.

Objective To discuss the feasibility on building lewis lung carcinoma mouse models through different methods and improve the methods. Methods The method of culture LLC cells in vitro, trypsin digestion method, Ⅳ collagenase method and homogenate method were compared to make the different dose of cell suspension injected into C57BL/6 mice. The feasibility of the improved method was determined through observing the cell count, the tumor formation ratio, the tumor formation time, tumor volume, weight and life habit. Results The method of culture LLC cells in vitro could get needed cells and its tumor formation ratio was 100 %. Trypsin digestion method and homogenate method could get less cells and its tumor formation ratio was about 80 %～90 % and 60 %～75 %. Whereas 1V collagenase method could get most cell count and its tumor formation ratio was 100 %. Conclusion IV collagenase method is a preferred method which is simple,high efficiency and make a strong base on the cancer experimental study.

Objective:To investigate the importance of measuring and restoring distal radius tear drop angle in the treatment of distal radius middle column fracture with anterior collapse of lunate fossa joint.Methods:Thirty one cases of distal radius fractures in 29 patients was reported for 2 years from January 2018 to January 2020. Two patients with both distal radius fractures were included in this study. All cases in this group were treated by operation. Among the 29 patients, there were 20 males and 9 females. Their ages were 44.9±15.1 years (ranged from 20 to 78 years). Two patients with both distal radius fractures were included in this study, due to both teardrop angle (TDA) reduced. The time from injury to operation was 4-17 d, with an average of 6.9 d. Except for 2 cases of fracture with simple volar approach, the other cases were treated with combined volar and dorsal approach. All patients were treated with open reduction and internal fixation with plates and bone grafting. The teardrop angle was measured before and after operation, and the effect of surgical recovery of teardrop angle was compared. The wrist function was evaluated by Gartland-Werley scores.Results:The wounds of all patients healed in one stage without postoperative infection. The follow-up time of 29 patients were 15.1±5.2 months, ranged from 7 to 31 months. The healing time for all fractures was 10.3±2.9 weeks (from 8 to 16 weeks). No fracture nonunion or redisplacement. In 31 cases, the tear drop angle was 33.4°±5.83° (20°-45°) before operation, and 58.9°±9.89° (35°-70°) after operation. At the end of follow-up, Gartland-Werley scores was 4.7±4.6, ranged from 0 to 17. Among them, 10 cases were excellent, 16 were good, 5 cases were fair, and the excellent and good rate was 83.9%. The Gartland-Werley scores of the two subgroups with postoperative tear drop angle recovery ≥50° and <50° were compared, and the results were significantly different (the excellent and good rate for two subgroups were 96.2% and 20.0% respectively ( P=0.001). Conclusion:The distal radius fracture with significantly reduced tear drop angle should be actively treated. The measurement and recovery of tear drop angle is an important factor affecting the functional outcome of distal radius fracture with anterior edge collapse of lunate fossa joint, which should be highly concerned by clinical doctors. The recovery of teardrop angle mostly requires dorsal approach.

Objective To explore the specific cellular and humoral immunity induced by dendritic cells (DC) vaccine loading allogenic microvascular endothelial cell bEnd. 3 antigen against U14 cervical cancer cell of mice. Methods Mouse brain microvascular endothelial cell bEnd. 3 was cultured and identified for preparation endothelial cell bEnd. 3 antigen. The level of mRNA expression of vascular endothelial growth factor receptor 2 (VEGF-R2) and integrin αV was detected by reverse transcription (RT)-PCR. The BALB/c mice were immuned with DC loading bEnd. 3 antigen 4 times in 4 weeks (bEnd. 3-DC group), while the mice only were immuned with DC or injected with phosphate buffer saline (PBS group) as control group. One week after last vaccination, U14 cervical cancer cells were injected subcutaneously into the mice. The tumor size, cytotoxic T lymphocyte (CTL) response of spleen lymphocytes in vitro, the percentage of CD3+ CD+8 surface markers of spleen lymphocytes, and the titer of serum antibody were detected. The specific immunity was examined by immunocytochemistry and western blot. Results The expression of VEGF-R2 and integrin αV gene in bEnd. 3 cells were expressed highly.After the vaccine was injected, the tumors of mice in PBS group grew faster than those in other groups, while the tumors in bEnd. 3-DC group grew slowly and disappeared after 2 weeks. The volume of tumors in DC group grew slower than those in PBS group [(0.11± 0.13) cm3 versus (3.38 ±0.34) cm3]. The CTL response of spleen iymphocytes in vitro showed that bEnd. 3-DC cells could kill bEnd. 3 cells, the special lysis rate was more than 60% . The percentage of CD+3 CD+8 spleen lymphocytes in bEnd. 3-DC group[(38.6 ± 0.7) %] was higher than those in other groups (P ＜ 0.05). The titer of serum antibody of Immunocytochemistry analysis indicated there were specific antigen-antibody reaction to bEnd. 3 cell in bEnd. 3-DC group. Western blot analysis revealed that there were specific bands at 220 000 (VEGF-R2).Conclusions bEnd. 3-DC vaccine can inhibit the tumor growth of U14 cervical cancer cell of mice, which indicates that the special cellular and humorai immunity are induced by bEnd. 3-DC antigen which maybe have some antigens in bEnd. 3 cells that reacts with endothelial cell proliferation-related antigens.

This paper described the market reform′s influence and the healthcare reform on medical behaviors of both doctors and patients.It is held that the healthcare reform should ensure the public welfare nature of public hospitals and focus on medical quality and patient′s health,so as to promote the harmonious development of the doctor-patient relationship from the policy and practice aspect.

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.

Objective: To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas. Methods: Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis. Results: This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms. Conclusions The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.