Prof. SUN Guang-rong holds that how to define the representative clinical case records out of regular ones,what to learn from it,and how to direct other people to learn from it are the key questions to answer before moving to the study; in research process of the project of the Representative Clinical Case Records Collection and Study of Contemporary Eminent and Experienced Chinese Medicine Practitioners,conventional study method and modern information technology are used in conjunction on all the clinical case records of the screened eminent and experienced doctors from all over the country,the defined representative case records are studied and sorted out according to disease or symptom,highlights before and notes and comments following the case record details,guiding people easily to read each great Chinese medical talents,their academic thought and clinical technology; the academic analysis on each eminent and experienced practitioner is the most important part of the project and with it the academic whole story can be seen in a natural and close related way.

Objective To establish an HPLC method for the determination of seven flavonoids from the aerial part of Artemisia frigida.Methods Hypersil ODS-2 (300 mm× 4.6 mm,5 μm) column was used,with acetonitril-0.2％ phosphoric acid (gradient elution) as a mobile phase,and the detection wavelength was at 283 nm with flow rate at 1mL/min.Results All calibration curves showed good linear regression (r ＞ 0.9990) within the tested range.All average recovery was more than 98.00％ and RSD was less than 3.0％ (n =6).Conclusion The method is steady and with good repeatability,and could be used to determine the content of flavonoids in A.frigida from different areas.

Objective To compare the effect of sacroiliac anterior papilionaceous plate (SAPP) and the traditional reconstruction plate for the treatment of sacroiliac joint disruption.Methods 11 consecutive patients with sacroiliac joint disruption associated with pelvic fracture enrolled in our hospital.Detailed physical examination,X-rays,CT and FAST were performed before surgery.11 patients underwent SAPP fixation.Of the 11 patients,there were 5 males and 6 females.Their average age was 39.6 years.12 patients enrolled in last year as control group underwent reconstruction plate.There were 7 males and 5 females in this group.Their average age was 39.1 years.Operation time,blood loss,placing time of SAPP were recorded.X-ray films were performed after surgery to evaluate reduction condition by Matta criteria.X-ray films and Majeed outcome were performed in follow up.Results According to Tile classification,there were 13 Type B and 10 Type C.For SAPP group,operation time was (100.9±32.1) min,blood loss (998.8±365.7)ml,Placing time of SAPP was (6.6±3.2) min.For control group,operation time was (110.8±29.6) min,blood loss was (136.0±279.3) ml,placing time of reconstruction plate was (15.4±1.1) min.According to Matta criteria,8 cases were rated as excellent,11 as good,3 as fair,and 1 as poor.Lumbosacral nerve injury occurred in 1 case,lateral femoral cutaneous nerve injury in 7,and massive blood loss in 2 cases.No posterior infection occurred.Compared with control group,SAPP group experienced shorter placing time,and less blood loss in type B pelvic fracture.Conclusion As a new instrument,SAPP could be well applied in the treatment of sacroiliac disruption.Compared with reconstructed plate,SAPP obviously shortens placing time and facilitated placing procedure,and does not increase blood loss,neurological risk and infection rate and does not need different incision and reduction method.

Objective To evaluate the clinical results of minimally invasive surgery for open tibial plateau fractures using minimally open reduction and Hybrid external fixation.Methods From January 2011 through January 2015,9 complicated open tibial plateau fractures were treated with Hybrid external fixation.They were 6 males and 3 females,with an average age of 33.8 years (range,from 18 to 53 years).According to the Schatzker classification,there were 5 cases of type Ⅴ and 4 ones of type Ⅵ.According to the Gustilo classification,there were 5 cases of type Ⅱ,3 ones of type Ⅲ A and one of type Ⅲ B.All the patients were treated with Hybrid external fixation with or without minimally open reduction.Results The average operation time was 185.6 minutes (from 140 to 240 minutes).The average time for hospital stay was 18.4 days (from 10 to 45 days).The patients were followed up for an average of 15.6 months (from 6 to 36 months).All the 9 fractures got united after an average time of 4.3 months (from 3 to 7 months).The external fixation was removed after confirmation of fracture union.According to Merchant scores,the clinical results were evaluated as excellent in 4 cases,as good in 3,as fair in one and as poor in one.The knee joint was stable in each case.Pin tract infection was observed in one and wire loosening in one.Conclusion Hybrid external fixation with or without minimally open reduction is a safe and feasible surgical method which avoids massive soft tissue dissection for complicated open tibial plateau fractures.

Objective To compare the efficiency of the pelvic packing and the angioembolization for controlling pelvic fracture hemorrhoea.Methods Data of 43 consecutive patients with pelvic fracture hemorrhoea who were enrolled in our hospital from April 2004 to April 2012 were retrospectively analyzed.There were 26 patients who had undergone pelvic packing,including 15 men and 11 women with an average age of 41.6 years (packing group).The causes of the fractures included road accident injury (12 cases),falling injury (8 cases) and the bruise injury caused by heavy object (6 cases).According to the Tile classification,there were 16 cases of type B and 10 cases of type C.There were 4 cases with open pelvic fractures and 5 associated with the abdomen trauma.There were 17 patients who had undergone angioembolization,including 10 men and 7 women,with an average age of 39.2 years (angio group).The causes included road accident injury (9 cases),falling injury (5 cases) and the bruise injury caused by heavy object (3 cases).There were 2 cases of type A,11 cases of type B and 4 cases of type C.The ISS,operation time,blood transfusion and the complication were all recorded respectively.Results For the packing group,the average ISS was 52.4± 15.3,and the operation time was 42.0±2.1 min.The blood transfusion was 15.0±4.7 U before the surgery and 6.0±1.6 U in the first 24 h after the surgery.The mean ICU stay was (8.0±3.6)d.And for the angio group,the average ISS was 40.6±12.4,and the operation time was 86.0±3.6 min.The blood transfusion before the surgery was 13.0±5.4 U vs.10.0±2.1 U in the first 24 h after the surgery,and the ICU stay was 11.0± 1.8 d.2 cases in the packing group underwent repacking and 6 cases in the angio group had received second angioembolization.Five cases died in the packing group but no one died of the hemorrhoea while 4 cases died in the angio group with one died of the hemorrhoea.There were 3 cases in the packing group suffering the deep infection while 1 suffered the superficial infection in the angio group.Conclusion The efficiency of the pelvic packing is higher than the angioembolization because of its shorter operation time and ICU stay,more effective blood control,less blood transfusion after surgery,and lower postoperative mortality.It is very suitable for the application at the local hospital and the national conditions nowadays.

Objective To compare the effect of ISO-C3D navigation and conventional C-arm fluoroscopy in iliosacral screws insertion for treatment of posterior pelvic ring injuries.Methods Sixty-five patients with posterior pelvic ring injuries managed by minimally invasive percutaneous iliosacral screws from June 2006 to January 2012 were reviewed.There were 37 males and 28 females,at age range of 18-63 years (mean 35.9 years).Pelvic fracture classification based on Tile system was type B1 in 10 cases,type B2 in 15,type B3 in nine,type C1 in 18 and type C2 in 13.Patients were divided into ISO-C3D navigation group (Group A,n =35) and C-arm fluoroscopy group (Group B,n =30) according to the difference in intraoperative fluoroscopy methods.Intraoperative fluoroscopy time,time cost in inserting a screw,patient satisfaction rate for bone reduction,bone union time and excellent-good rate of postoperative function were recorded.Results Eighty cannulated screws were inserted for the 65 patients.Average fluoroscopy time and time cost in inserting a screw were shorter in Group A than in Group B (P ＜0.01),but there was no statistical difference between the two gronps in patient satisfaction rate for bone reduction.No patient presented with infection,vascular nerve injury or other complications.Follow-up was 6-24 months (mean 12.7 months) for all the patients.Functional recovery showed no statistical difference between the two groups at postoperative 6 months.All fractures were healed and no delayed union or nonunion happened.Conclusion As compared with conventional C-arm fluoroscopy,computer-navigated surgery can reduce fluoroscopy time and improve screw insertion accuracy.

Objective To evaluate the efficacy of multimodal-antiemetic therapy on postoperative dizziness,headache,nausea and vomiting (PONV) in patients undergoing thyroidectomy.Methods One hundred patients (39 males and 61 females,ASA physical status Ⅰ or Ⅱ) scheduled for thyroidectomy were randomly divided into two groups according to random number table: control group (group C) and multimodal-antiemetic therapy group (group M).Two groups received total intravenous anesthesia (TIVA) with propofol and remifentanil.Prophylactic dexamethasone 10 mg were given after anesthesia induction and palonosetron hydrochloride 0.25 mg was used 30 min before the end of surgery in both groups.Mannitol 2 ml/kg in group M and the same amount of normal saline in group C were given 30 min before the end of surgery.The incidence of dizziness,headache and PONV were observed for 24 h in two groups.Results The incidence of headache was 5 cases (10%)and PONV was 5 cases (10%) in group M,which were respectively significantly lower than that of group C of 15 cases (30%) and 12 cases (24%) in 24 h after surgery (P<0.05).The additional antiemetic therapy for 24 h after surgery in group M of 2 cases (4%) was significantly lower than that of group C of 9 cases (18%) (P<0.05).Conclusion The multimodal-antiemetic therapy: prophylactic dexamethasone,palonosetron hydrochloride and mannitol were used 30 min before the end of surgery could significantly reduce the incidence of dizziness,headache and PONV after thyroidectomy.

Objective To evaluate the short and mid-term effects of fixing comminuted posterior acetabular wall fractures with structural autologous iliac bone graft combined with mini screws.Methods From January 2010 to January 2014,29 patients with comminuted posterior acetabular wall fracture were treated by structural autologous iliac bone graf combined with mini screws.They were 21 males and 8 females,with a mean age of 44.2 years (range,from 22 to 58 years).The mean time form injury to operation was 7.8 days (range,from 1 to 25 days).The operations were performed through the Kocher-Langenbeck approach,with the patients in the lying position on the uninjured side.The fragments were reduced and fixed by mini screws and the ischemic ones were removed.Structural autologous iliac bone graft was used to reconstruct the posterior wall of acetabulum before a reconstruction plate was applied to compress and maintain it.The functional outcomes were evaluated by the modified Merle d'Aubigne and Postel clinical grading system at the last follow-ups.The radiographs were graded according to the Matta criteria.Results By the Matta criteria,10 cases achieved excellent reduction,16 good reduction,and 3 poor reduction,giving a good to excellent rate of 89.7％.Of this series,29 patients were followed up for 31.5 months on average (range,from 12 to 48 months).By the modified Merle d'Aubigne and Postel criteria,the functional recovery was rated as excellent in 16 cases,good in 9,fair in 3 and poor in one,giving a good to excellent rate of 86.2％.Two cases developed femoral head necrosis according to the magnetic resonance imaging 18 months postoperation.Three patients developed traumatic arthritis two years postoperation.Five patients developed heterotopic ossification postoperation,with no obvious clinical symptoms.Two patient with injury to the sciatic nerve recovered 4 months postoperation.Conclusions Structural autologous iliac graft combined with mini screws can reconstruct the integrity and stability of the fractured acetabular posterior wall,avoiding osteonecrosis of the acetabulum.This surgical technique is effective and safe in treatment of comminuted fracture of the acetabular posterior wall.

Objective To evaluate 3D printing used in the treatment of complex acetabular fractures.Methods Between January 2009 and December 2013,121 patients with complex acetabular fracture were treated at our department.3D printing was used in surgical planning in 53 of them,including 36 males and 17 females with an average age of 41.2 ± 10.4 years (3D group).The other 68 patients received conventional surgery without use of 3D printing,including 42 males and 26 females with an average age of 42.6 ± 8.9 years (conventional group).By the Judet-Letournel classification system,there were respectively 7 and 9 T-type fractures,4 and 6 posterior column with posterior wall fractures,21 and 28 transverse and posterior wall fractures,5 and 6 anterior with the second half transverse fractures,and 16 and 19 double column fractures.Surgical time,blood loss,transfusion,fluoroscopy times and complications were recorded in the 2 groups.At the final follow-ups,the clinical results were assessed by Merle D'Aubigné & Postel scoring and the radiographic results were assessed by Matta records.The 2 groups were similar in preoperative demographic data (P ＞ 0.05).Results In the 3D and conventional groups,respectively,surgical time was 3.5 ±O.9 hours versus 4.5 ± 1.1 hours,blood loss was 1,200.2 ±232.8 mL versus 1,550.4 ±211.6 mL,transfusion was 8.9 ± 3.8 U versus 12.3 ± 2.9 U,and fluoroscopy times were 8.7 ± 2.1 versus 11.9 ± 2.4.The differences between the 2 groups were statistically significant (P ＜ 0.05).The 3D and conventional groups were respectively followed up for 20.3 and 37.8 months on average.All the acetabular fractures healed.The time from surgery to full-weight-bearing walking averaged 3.5 months.Iatrogenic ischiadic nerve injury occurred in 5 and 7 cases and superficial infection in 3 and 5 cases in the 3D and conventional groups,respectively.No iatrogenic vascular injury,nonunion,or implant failure occurred in the 2 groups.By the Merle D' Aubigné & Postel records,the excellent and good rate was 64.2％ (34/53) in the 3D group versus 64.7％ (44/68) in the conventional group.By the Matta records,the excellent and good rate was 73.6％ (39/53) in the 3D group versus 75.0％ (51/68) in the conventional group.The differences were not statistically significant (P ＞ 0.05).Conclusion Since 3D printing can contribute to better preoperative plan,it helps to lead to more accurate operation,shorter surgical time,and enhanced perioperative safety.

Objective To investigate the clinical efficacy of tibiocalcaneal arthrodesis using bone transport technique in the treatment of traumatic talus infection or loss. Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with talus infection or loss admitted to the provincial hospital affiliated to Shandong University from June 2011 to October 2017. There were 13 males and two females, aged from 19 to 47 years, with an average age of 27 years. Thirteen patients had talus infection and two patients had talus loss. All patients underwent tibiocalcaneal fusion with external fixator using bone transport technique, including four patients treated with annular external fixator and 11 with unilateral external fixator. Six patients with severe infection underwent debridement at stage I and osteotomy at stage II, and the other nine underwent debridement and osteotomy at the same time. The length of new bone, the fixation time of external fixator and complications were recorded. The American Orthopedic Foot and Ankle Society ( AOFAS ) score was used to evaluate the efficacy. Results All patients were followed up for 18-35 months, with an average of 26 months. The length of new bone in proximal tibial osteotomy area was 5-16 cm, with an average of 9 cm. The external fixators were removed after bone healing at docking site and maturation of new bone. The fixation time of external fixator ranged from 13 to 27 months, with an average of 18 months. No complications such as needle breakage, recurrence of infection and calcaneal varus occurred, and the length of both lower limbs was equal. AOFAS score was increased from preoperative (42. 0 ± 3. 6)points (31-55 points) to (76. 0 ± 4. 2)points (69-86 points ) at the last follow-up. Conclusion Tibiocalcaneal arthrodesis using bone transport technique is proved to be effective in treating traumatic talus infection or loss, which can repair the bone defect after debridement, improve the ankle-hindfoot function and improve the quality of life.