[Objective]To evaluate the clinical application and results of the anterolateral acromial approach with minimal incision in the treatment of proximal humerus fracture.[Method]From December 2006 to December 2008,42 patients with proximal humeral fracture were treated by the anterorlateral acromial approach using locking plate.There were 25 males and 17 females.All the fractures were classified with AO/OTA classification.There were 5 A2-fractures,11A3-fractures,7 B1-fractures,12 B2-fractures,3 C1-fractures,4 C2-fractures.Anterolateral acromial approach with minimal incision was applied and the deltoid muscle was seperated to expose the fracture fragments.Under direct vision the direct and indirect reduction of the fractures were performed.The locking plate was inserted distally beneath the deltoid muscle and between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm.Locking screws were inserted to the proximal and distal plate.Operation time,incision length,blood loss,reduction,Neer scores at 1 year were analyzed in different time points.[Result]All the cases were completed with minimal incision.There were significant differences(P

[Objective]To explore the clinical indication and effectiveness of anterolateral mini-incision for the total hip replacement (THR).[Method]A retrospective analysis of the 34 cases of anterolateral mini-incision was conducted from May 2002 to March 2005,among the patients 23 suffered from displaced femoral neck fractures and 11 suffered from femoral head aseptic necrosis.[Result]All the patients were followed up for 12～36 months with an average of 18 months.The obvious advantages of anterolateral mini-incision for the total hip replacement were as following:less blood loss in operation,less post-operative pain and complications,and early rehabilitation training,without cinch and subsidence in X-ray.Harris score was 92.1 point.[Conclusion]Anterolateral mini-incision for the total hip replacement can be used as an effective method to treat the patients who were extenuation,without abnormalities of hip joint,deossification and osteoporis.Appropriate incision combined with precise procedure can reduce the operative trauma and speed up functional recovery.

Objective To evaluate the value of multi-slice spiral CT in nasal endoscopic surgery.Methods The multi-slice spiral CT data of 232 patients who were scanned prior to nasal endosopic surgery were analyzed.Results The nasal and sinus disease could be diagnosed correctly with multi-slice spiral CT.The ostiomeatal complex and the channels of the frontal sinus' drainage could be showed clearly.All the manifestation of the multi-slice spiral CT was in correspondence with the endoscopy showed in the surgery.Conclusion The multi-slice CT has the advantages of short scan time,less radiation dosage and multiplanar reconstruction.So it can display the nasal and sinus structures in detail,and has a great value in guiding the nasal endoscopic surgery.

Objective To report the clinical outcomes of arthroscopic internal fixation by using anchor for tibial eminence fracture.Methods From January 2004 to January 2005,12 cases of tibial eminence were treated by arthroscopy with anchor fixation.Rehabilitation therapy was carried out after the operation.Results The mean operation time was 41 minutes(range 37 to 47).No patient had postoperative complications.They were followed up for 15 to 27 months(mean,23 months).The postoperative Lysholm score ranged from 91 to 98 with a mean of 93.The patients could extend the knee in a normal range,without pain or locking.Conclusion Arthroscopic internal fixation using anchor is a safe,simple,and effective treatment for patients with tibial eminence fracture.

Objective:To evaluate effects of different medication forms of dexmedetomidine on perioperative cognitive function in elderly patients undergoing radical operation of gastric carcinoma, and Ramsay sedation score.Methods:A total of 150 patients aged 65 years and 75 years scheduled for elective radical operation of gastric carcinoma from December 2018 to December 2019 in Shanxi Provincial Cancer Hospital were enrolled, and they were divided into 3 groups according to random number table method: different medication forms of dexmedetomidine groups (group A, group B) and the control group (group C), 50 cases in each group. The patients in group A and group B continued to pump dexmedetomidine at a rate of 0.5 μg·kg -1·h -1 and 0.3 μg·kg -1·h -1 respectively for 15 min before induction of anesthesia. And the patients in group C were given intravenous pumping of an equal volume of 0.9% NaCl for 15 min. Subsequently, patients in group A and group B received continuous intravenous infusion of 0.3 μg·kg -1·h -1 for 30 min before the end of operation, the patients in group C received 0.9% NaCl infusion of equal volume until the end of operation. The cognitive function of the patients was measured by using the Monterey cognitive assessment scale (MoCA) the day before surgery and on day 1,3 and 7 after surgery, and the incidence of perioperative neurocognitive disorder (PND) was counted. Ramsay sedation score at 30 min, 24 h and 48 h after surgery was compared among the three groups. Results:There were 3 patients in group A and 3 patients in group C were excluded because they were transferred to ICU due to serious postoperative complications. There were significant differences in MoCA score among the three groups on day 1, 3, 7 after operation (all P < 0.01); MOCA score of group A, B and C on day 7 after operation was (26.9±0.7) scores, (26.6±1.0) scores, (26.3±1.2) scores, respectively, and the difference between group A and group C was statistically significant ( P < 0.01). The incidence of PND among the three groups on day 1, 3, 7 after surgery had statistically significant differences (all P < 0.05), and the incidence of PND in group A was lower than that in group B and C (all P < 0.05). Ramsay sedation score among the three groups at 30 min and 24 h, 48 h after operation showed statistically significant differences (all P < 0.01), and that in group C was lower than that in group A and group B, and the differences were statistically significant (all P < 0.01). Ramsay sedation score at 24 h after operation in group A was high than that in group B and group C (all P < 0.01). Conclusions:Dexmedetomidine assisted with anesthesia can reduce the incidence of PND in elderly patients undergoing radical operation of gastric carcinoma and enhance the sedative effect. What's more, the most obvious effect is the infusion of 0.5 μg·kg -1·h -1 before anesthesia induction.

Objective To explore the therapeutic effect and application value of the self-made spinal positioning equipment and percutaneous pedicle screw fixation system in the treatment of thoracic and lumbar fracture. Methods To determine the fractured vertebra and pedicle screws entrance point with spinal positioning equipment, 67 patients with thoracic and lumbar fractures were performed percutaneous pedicle screw fixation by using self-made percutaneous pedicle screw fixation system. By contrasting the perioperative indicators, and imaging indicators, to evaluate the therapeutic effect and application value of the system. Results For the spinal positioning equipment, the location time were (15.85±2.45) min and the location accuracy were 95.03%±3.27%. But for the open reduction internal fixation, the location time were (35.46±5.39) min and the location accuracy were 94.02%±2.95%. There was no significant difference in location accuracy, but were significant differences in location time (P＜0.05). Percutaneous pedicle screw fixation had the same effect on three sides with open reduction internal fixation in vertebral height restore,kyphosis deformity and correction and lumbar spinal stenosis's correction. The perioperative indicators of the preoperative and postoperative grope had significant difference (P＜0.05). There were significant differences in all perioperative indicators between the percutaneous pedicle screw fixation and the open reduction internal fixation (P＜0.05). Conclusion The spinal positioning equipment is helpful to determine the fractured vertebra and pedicle screws entrance point accurately and reduce the radiation. The percutaneous pedicle screw fixation system has the advantage of convenient manipulation and accurate implantation. The system can not only reduce surgical damage and post-operation reaction but also make patients recover quickly and face less complications.

Objective Our research aimed to investigate the efficacy and the nursing characteristics of allogenic bone marrow mesenchymal stem cell (BM-MSCs) transplantation in HBV related acute-on-chronic liver failure (ACLF) patients.Methods A total of 91 HBV related ACLF patients were enrolled,among whom 45 patients received allogenic BM-MSCs transplantation via peripheral vein and other 46 patients received medical treatment only.We assessed the 12-week survival rates and the variation of model for end liver disease (MELD) score.Besides,we administrated comprehensive nursing for these patients in different stages of the transplantation.Results The cumulated survival of patients received BM-MSC transplantation was 75.6％,which was higher than the control group (54.5％).The level of total bilirubin and International Normalized Ratio (INR) had greatly improved.41 of 45 patients passed through perioperative period safely,without any severe adverse events.11 patients died due to exacerbation of liver failure,among whom 3 happened in perioperative period.But none was related with the operation.Conclusions Allogenic BM-MSCs transplantation can improve the survival rate of HBV related ACLF patients.The psychological nursing pre-operation,skilled operation,intensive care and observation post operation were beneficial to the patients' recovery after transplantation.

Objective To detect the preliminary results of combined periacetabular and intertrochanteric osteotomies for complex hip dysplasia.Methods From January 2006 to August 2011,23 patients (25 hips) with complex hip dysplasia were treated with combined periacetabular and intertrochanteric osteotomies (ITO).Valgus ITO was performed on 2 hips and varus ITO on others.The averagc age of patients at the time of index procedure was 20.5± 3.9 years (range:15 to 26).The hip pain period before surgery varied from 5 to 24 months (mean 11±4.7 months).The Shenton's line was broken in every hip and the mean preoperative lateral central edge angle (LCEA) was 5.6°±4.6°.The average preoperative fenoral neck-shaft (CCD) angles were 158°±3.2° and 110° in 23 valgus hips and both of two varus hips respectively.The preoperative Harris hip score was 76.7±3.7.According to T(o)nnis osteoarthritis grades,there were 7 hips at grade 0,12 hips at grade Ⅰ and 6 hips at grade Ⅱ.Results The mean followup period was 40±18 months (range:12 to 78).The CCD angle (130°±2.1°),LCEA (28.6°±2.9°) and Harris hip score (90.8±3.3)were all improved postoperatively,whereas no progression was found in preoperative T(o)nnis grades.The postoperative Harris hip scores were excellent in 17 hips and good in 8 hips.The T(o)nnis osteoarthritis grades were grade 0 in 6 hips,grade Ⅰ in 11 hips and grade Ⅱ in 8 hips.There wcre six cases with lateral femoral cutaneous nerve injury,three cases with limp and two cases with broken Shenton's line.Neither femoral head necrosis nor bone nonunion was found in this study.Conclusion Satisfactory preliminary results could be obtained through combined periacetabular and intertrochanteric osteotomies among patients with complex hip dysplasia.The risk of femoral head necrosis and bone nonunion was low.

Objective To compare the clinical efficacy of different doses of ultrafine extracted granule preparation (EGP) and traditional herbal decoction (THD) of Li Zhong Tang in treatment of epigastric pain. Methods Sixty cases of epigastric pain patients in accordance with the diagnostic criteria of deficiency and cold pattern of spleen and stomach in TCM were randomly divided into THD group, 1/3 dose group and 1/5 dose group, and were given THD, 1/3 dose of ultrafine EGP and 1/5 dose of ultrafine EGP, respectively. The clinical efficacy of the three groups after one course of medication was comparatively analyzed. Results There were no significant differences in age, course of disease, symptom score before treatment, epigastric pain efficacy and syndrome curative effect among the three groups, the differences had no statistical significance (P>0.05). The severity, frequency and duration of epigastric pain were all reduced in the three groups, with significant differences between before and after treatment (P<0.05). Conclusion There are no significant differences in the clinical efficacy on epigastric pain among THD, 1/3 dose of ultrafine EGP and 1/5 dose of ultrafine EGP. In addition, the effect of 1/3 dose group is very close to the THD group.

Objective To obtain the matched parameters between image quality and radiation dose by exploring the influence of the exposure parameters of screening mammography on both the image quality and radiation dose.Methods The correlation between the exposure parameters and average glandular doses to 507 patients undergoing screening mammography were retrospectively analyzed.The influence of breast compression thickness on radiation dose by exposing different thickness of PMMA was obtained.The correlation with image quality was analyzed by combined testing of contrast detail test mode ( CDMAM3.4 )and different thickness of PMMAs.Results The groups aged 30 to 49 years were the main groups in 507examined patients,up to 67.06％ of the total.The mean value of average gland doses ( AGD ) in contrastprior mode was the highest in three kinds of exposure modes,accounting for 137.5％ of standard mode.In standard mode,target material/filtration board combination was Mo/Mo,Mo/Rh and Rh/Rh,accounting for 1/3 respectively.Mo/Rh and Rh/Rh were selected in dose-prior mode,accounting for 50％ respectively.Mo/Mo was mainly selected in contrast-prior,accounting for 52％.Breast compression thickness was positively correlated with average gland doses.Image quality figure inverse (IQFinv) under three kinds of modes (STD,DOSE,CNT) was 98.32,95.41 and 107.02,respectively,and IQFinv of contrast-prior mode was the highest among them.IQFinv was in general agreement in the three kinds of exposure modes when the thickness of PMMA plates plates was greater than or equal to 5 cm.Conclusions In clinical practice,when the breast is of density type and pressed thickness is less than 4 em,the dose-prior mode should be selected.When the pressed thickness is between 4 and 6 cm,the standard exposure mode should be selected.When the pressed thickness is larger than 6 cm,the manual mode should be selected.