BACKGROUND:Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE:To explore the repair effect of modified smal “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. Al patients received modified bone graft fusionvia smal “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION:Bone graft fusion was successfuly conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. Al incision was healed wel after operation. Wound infection or flap necrosis did not occur. During folow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last folow-up, AOFAS score of 23 patients was (85.6±3.7), which was significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with smal “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.

Objective To investigate the significance of early blood lactic acid and lactic acid clearance in patients with post-cardiac arrest syndrome(PCAS).Methods 87 cases were divided into the survival group(26 cases) and the death group(61 cases).The clinical data of two groups were analyzed statistically.Results The 6h blood lactate (8.46 ± 2.37) mmoL/L,6h blood lactate clearance rate (34.53 ± 14.75) ％,the residual alkali (-3.08 ± 3.68) mmol/L,6h SevO2 (68.35 ± 6.33) ％,APACHE Ⅲ score (19.64 ± 2.48) points in the survival group were significantly better than those of the death group [blood lactic acid value (12.32 ± 3.56) mmol/L,6h blood lactate clearance rate (27.71 ± 11.38) ％,the residual alkali (-5.61 ± 4.14) mmol/L,6h SevO2 (63.22 ± 5.94) ％,APACHE Ⅲ score (24.32 ± 5.33) points],with significant differences between two groups (t =5.99,2.36,2.73,3.66,5.62,all P ＜ 0.05).The 6h blood lactate clearance rate,6h SevO2 and APACHE Ⅲ score were independent risk factors for the prognosis of PCAS (OR =1.23,1.64,1.28,all P ＜ 0.05).Conclusion The early blood lactate clearance rate can be used as a sensitive indicator for evaluating the prognosis of PCAS.

Objective: To evaluate therapeutic effect of aortic endovascular stent-graft exclusion (EVGE) combined percutaneous coronary intervention (PCI) on patients with descending thoracic aortic dissection (DTAD) complicated coronary heart disease (CHD).Methods: A total of 58 DTAD + CHD patients undergoing aortic EVGE combined PCI were regarded as EVGE group (received aortic EVGE at first, then PCI on 3d after operation).Another 60 DTAD+CHD patients undergoing open surgery combined PCI in our hospital were selected as open surgery group.Both groups were observed and followed up, and their therapeutic effects were compared.Results: Compared with open surgery group, there was significant rise in complete cut closure rate (78.33% vs.91.38%), and significant reductions in bleeding volume during operation [(919.83±242.12) ml vs.(58.17±9.53) ml], postoperative infection rate (15.0% vs.3.4%) and hospital stay [(16.40±0.96)d vs.(9.10±0.83)d] in EVGE group, P<0.05 or <0.01.Success rate of PCI was 100% in EVGE group, and there was no PCI-related severe complications.During follow-up, coronary restenosis rate within 12 months in EVGE group was significantly lower than that of open surgery group (5.20% vs.15.30%, P=0.04).Conclusion:It is safe and possesses significant effective to treat descending thoracic aortic dissection complicated coronary heart disease using aortic endovascular stent-graft exclusion combined percutaneous coronary intervention, which is worth extending.

Radiotherapy and interventional thearapy are the main means for unresectable advanced primary hepatic carcinoma.However,the efficacies are restricted by their respective adaptability.The development of radiotherapy,especially the application of radiotherapy combined with transcatheter hepatic artery chemoembolization provide more suitable treatment means for patients.

Objective To evaluate the efficacy of three-dimensional conformal radiotherapy(3D-CRT) combined with transcatheter hepatic arterial chemoembolization(TACE) for patients with primary liver cancer.Methods From July 2003 to July 2006,followed by transcatheter hepatic arterial chemoembolization(TACE,mitomycin + 5-fluorouracil + pirarubicin) 3 times in 6 weeks,59 patients with primary hepatic cancer received noncoplanarity multifield 3D-CRT by using Leibinger three-dimensional stereotactic conformal radiotherapy planning system,Varian 600C/D 6MeV X liner accelerator and multileaf collimator at a dose of 60-65Gy/9-11 fractions/15-22 days.Results Of 59 patients,58 cases received a complete course of 3D-CRT combined with TACE.CT results showed that the rates of complete response(CR),partial response(PR),no change(NC) and progression(PD) rate were 57.6%(34/59),35.6%(21/59),3.4%(2/59) and 3.4%(2/59),respectively.Overall response rate(CR+PR) was 93.2%(55/59).Jaundice occurred one week after treatment in one patient,who died of acute hepatic function failure.No serious adverse effects or intoxication were found in the remaining 58 patients.Conclusions The combination of 3D-RCT with TACE was an effective treatment for patients with primary hepatic cancer.

Primary hepatic carcinoma is one of the common digestive tract tumors.Surgical operation in clinic is still the most effective way to treat it so far.The caudate lobe has often been considered the forbidden zone of hepatic operation in the past due to complicated anatomy.In resent years,with the deepening of knowledge of anatomy and advanced radiological technology,many new operative approachs and operation methods have been explored to improve the situation of caudate lobectomy which is already not rare in clinic now.This article summarized the anatomy of caudate lobe and reviewed the therapy progress of the hepatic carcinomas located caudate lobe.

Objective To compare the effect of different analgesia methods on the treatment of pain after total knee arthroplasty (TKA),and find the ideal analgesia way for peri operation period of TKA.Methods A total of 79 patients was randomly divided into three groups:cocktail,spinal,and multimodal analgesia groups.A comparative study among three groups was conducted on the postoperative visual analogue scale (VAS) of pain score,range of motion,and adverse reaction.Results The motion pain score of using multimodal analgesia patients 24 hours after operation and the resting pain scores 48 hours after operation were less than the other two groups.The postoperative joint range of motion in 1 ～ 2 weeks of multimodal analgesia group was significantly better than the other two groups.Conclusions Multimodal analgesia was an effective way to treat pain after knee arthroplasty.

Objective To investigate the feasibility of unilateral neck exploration for parathyroid adenoma. Methods The clinical data of preoperative image localization and intraoperative unilateral neck exploration of 15 cases of parathyroid adenoma from 1996 to 2002 in our hospital were analyzed retrospectively. Results Unilateral neck explorations of the 15 cases were performed successfully with the guidance of preoperative ultrasonography , CT, MRI and 99m Tc MIBI scans, and the treatment effect was satisfactory. Conclusion Unilateral neck exploration of parathyroid adenoma could be feasible if accurate preoperative image localizations are available.

Purpose:To observe the toxic reactions of all trans retinoic acid in the treatment of acute promyelocytic leukemia. Methods:Analysis of toxic reaction was done for 38 patients who suffered from acute promyelocytic leukemia treated with all trans retinoic acid. Results:In the treatment of acute promyelocytic leukemia with all trans retinoic acid, the common toxic reactios are dry mouth, skin desiccation, desquamation, rhagadia (100%). 19 patients had gastro intestinal symptoms with higher ALT(50%),18 patients had hyperleukocytosis syndrome (47.5%), 16 patients had headache and dizziness (42.4%),8 patients had pain in muscle and joint (21.2%). The rare toxic reactions included 4/38 who had intracranial hypertension syndrome, 2/38 had hyperglycemia, 1/38 and hyperhistaminemia syndrome. Conclusions:The toxic reactions of all trans retinoic acid in the treatment of acute promyelocytic leukemia usually have dry mouth ,skin desiccation, desquamation, rhagadia, gastro intestine symptom with higher ALT, and hyperleukocytosis syndrome ets. THe treatment with lower dose of all trans retinoic acid(20～30 mg/d)for acute promyelocytic leukemia could decrease the toxic reactions without influencing its effectiveness.