Objective:To discuss the result of treating valgus or varus knee deformity with fixator assist nailing (FAN)technique and distal femur osteotomy(DFO).Methods:In this retrospective study,14 patients with 17 limbs,12 valgus and 5 varus knee deformity were treated with DFO and FAN.The aver-age age of the patients was 23 (17-44)years .The unilateral external fixator was mounted on the lateral side of femur,the minimal invasive distal femoral osteotomy was performed.After the deformity was cor-rected,the intramedully nail was inserted to fix the femur.None of the patients need bone autograft.The preoperation and postoperation lateral distal femur angle (LDFA ),mechanical axis deviation (MAD ) and range of motion (ROM)were measured and analyzed.Results:All the 14 patients were followed-up for 12 -72 months (average 34 months).The osteotomy site united in 3 -5 months (average 3.5 months)post-operatively.According to Paley’s functional scores,12 patients were excellent,2 patients were good.We achieved desired postoperative MAD (from medial 15 mm to lateral 10 mm)in 15 limbs of 12 patients.The LDFA in 1 1 limbs was corrected to normal (84°-90°).The ROM was not signifi-cantly changed before and after operation in the both groups.No infection or neuro-vascular injury oc-curred.Conclusion:The FAN technique is an effective method to treat valgus knee or varus knee de-formity in young patients with DFO.

Objective To analyze the influence of left atrial dimension (LAD) on the effectiveness of heart valve replacement combined with dipolar radiofrequency ablation in atrial fibrillation (AF). Methods Eighty-one patients with permanent AF and heart valve diseases having undergone surgical treatment were selected. The patients were divided into two groups according to the size of LAD:groupⅠ (45 patients with LAD<60 mm) and group Ⅱ (36 patients with LAD ≥60 mm). All the patients underwent heart valve replacement and douching dipolar radiofrequency ablation, and were given amiodarone therapy after operation. The ultrasonic cardiogram and electrocardiogram after operation were inspected periodically. The changes of cardiac function and electrophysiology activity were observed. The patients were followed up for 12 months. Results The early-stage mortality after operation was 3.7% (3/81), and all of death was caused by postoperative low cardiac output syndrome. Two cases appeared third-degree atrioventricular block after surgery, and they were installed permanent pacemaker. During the follow-up, 1 case died because of sudden cerebrovascular accident. Two cases were loss to follow-up. There was no statistical difference in rate of maintaining sinus rhythm at discharge from hospital between group Ⅰ and group Ⅱ: 75.0% (33/44) vs. 73.5% (25/34), P=0.88. But the rates of maintaining sinus rhythm at 3 and 12 months after operation in groupⅠwere significantly higher than those in groupⅡ:81.4% (35/43) vs. 58.8% (20/34) and 88.1% 37/42) vs. 60.6% (20/33), and there were statistical differences ( P=0.029 and 0.006). Conclusions For the patients in permanent AF and heart valves diseases with LAD <60 mm, the dipolar radiofrequency ablation during heart valve replacement has considerably beneficial effects on rate of maintaining sinus rhythm. But for the patients with LAD≥60 mm, the result is not optimistic and has a lower postoperative sinus rhythm restoration rate.

ObjectiveTo evaluate the effectiveness of correction of posttraumatic flexion contracture of knee(FCK) using Ilizarov technique.MethodsSix male patients with posttraumatic FCK,aging from 9 to 43 years(mean,24.5 years),treated by using Ilizarov technique from January 2006 to December 2010,were retrospectively analyzed.The preoperative flexion deformity of knee ranged from 35° to 85° (mean,47.6°),and the range of motion ranged from 0° to 70° (mean,15.8°).Among them,five patients had old fracture of knee joint combined with equinus foot deformity (deformity ranging from 25° to 37°,with an average of 31.8°); one patient had femoral supracondylar fracture.We used circular external fixator to correct the FCK and equinus foot deformity gradually,the knee arthrodesis operation was performed in 4 patients because of the damaged hone structure and poor soft tissue condition.ResultsAll patients were followed up for 12-22 months(mean,18 months).The flexion of knee joint was recoverd from preoperative 47.67°±18.63° to postoperative 9.33°±3.50°.Plantar flexion of ankle joint in five equinus foot deformity was recovered from preoperative 31.80°±4.65° to postoperative 3.00°±4.47°.The kuee joint was arthrodesised successfully in 4 patients and the other 2 patients got 30° and 75° ROM.All the patients can walk with a cane,and satisfied with the result of treatment.Pin-site infection was found in 4 patients and was controlled within two weeks.ConclusionIlizarov technique is an effective treatment method for posttraumatic FCK.Knee arthrodesis should be performed when patients had damaged bone structure and poor soft tissue condition.

Objective To evaluate the effect of a bone transport method using unilateral external fixator in treatment of partial bone defect.Methods Three patients with partial bone defect were reviewed,including 2 males and 1 female,and whose ages were 50,50,and 24 years,respectively.The defects were at medial part of the left proximal tibia in 2 cases.In the first case,the defect was 5 cm in length,1/3-2/3 of transverse diameter in width,with a 5 cm×3 cm skin loss.In the second case,the defect was 6 cm in length and 3 cm in width.For the remaining patient,the bone defect was located in lateral part of the right femur,which was 13 cm in length,1/3-2/3 of transverse diameter in width,with a 15 cm×7 cm scar on it.After debridement of the wound,the Orthofix's limb reconstruction external fixation system was mounted medially,initially with 2-3 HA coated screws in the middle clamp to anchor the near cortex of the segment to be transferred.A partial corticotomy was performed with multiple drill hole technique.The gradual segment transport was started 2 weeks after the operation at a rate of 1 mm/d,4 times/d.Results The follow-up time was 14,28 and 24 months,respectively.The external fixator was removed 8 and 6 months after the osteotomy in 2 patients,when radiographs demonstrated bony union of the docking site as well as mature consolidation of the generated callus.The range of motion of hip,knee,ankle on the injured side was similar to the uninjured side.The segment was unable to be transported successfully in the femur,because the compressiondistraction device was misused.Two months after the first operation,the osteotomy was performed at the same site for the second time.The frame was removed at 10 months after the second osteotomy when the new bone formed well and the fracture healed at the docking site.The patient was able to stand independently and walk with a stick at 17 months after the osteotomy.At the latest follow-up,there was no sign of osteomyelitis.Conclusion Bone transport method using unilateral external fixator is a practical option to treat partial bone defect.In addition to shorten the period with fixator,it can avoid malunion and donor injury.

Objective To evaluate the effect of fixator-assisted nailing (FAN) technique for the treatment of femoral deformity,nonunion of femoral shaft fracture with deformity and malunion.Methods The data of 8 patients with nonunion of femoral shaft fracture with deformity,3 patients with femoral deformity caused by Rickets disease and 2 patients with femoral fracture malunion who received treatment FAN technique was retrospectively analyzed.There were 11 males and 2 females,with an average age of 33 years (range,16-50 years).One-stage operation was used in 10 patients:after the fracture was distracted and reduced with external fixator,an intramedullary nail was used for final fixation.Two-stage strategy was used in 3 patients.Unilateral external fixator was used in 12 patients,ring fixator was used in 1 patient.Femoral intramedullary nailing was used in 8 patients,retro-femoral intramedullary nailing was used in 5 patients; autograft from callus of fracture site was used in 1 patient.Results The 12 patients were followed up for 12-48months with an average of 21 months.The fractures of 7 patients united 3-6 months (average,3.9 months)later after the operation.The osteotomy site of 5 patients united 3-5 months (average,3.5 months) later after the operation.The results were evaluated according to the Paley classification of functional results.There were 9 cases rated as excellent,2 as good and 1 as fair.The lower leg discrepancy (LLD) before and after operation was (48.2±23.0) mm and (27.3±24.6) mm,individually; the length of limb increased 4.6-41.0 mm (average,23.3 mm).The pre-and post-operative MAD was (27.5±24.4) mm and (6.3±8.3) mm.There was no neurovascular injury or infection occurred in any of the patients.All the patients were satisfied with the result of treatment.Conclusion FAN technique combines the accuracy,minimal invasiveness and safety of external fixation together with patient compliance of IM nail.It is an effective method to manage nonunion of femoral shaft fracture with deformity,malunion of femur,and femoral deformity cause by rickets.

Objective To discuss the clinicopathologic features, diagnosis and treatment of pri-mary prostatic signet ring cell carcinoma (PPSRCC). Methods Clinical data of 23 PPSRCC cases were retrospectively reviewed. The mean age was 74 years and majority of them had aggravated dysu-ria. The mean serum PSA was 45.3 ng/ml (7.4-126.8 ng/ml). To exclude the metastasis from stomach and colon SRCC, upper gastric tract endoscopy and barium enema were carried out. Seven pa-tients received radical prostatectomies and 2 patients who had positive margins received hormonal and radiation therapy. The rest of patients received maximal androgen blockade therapy. Photoselective vaporization of the prostate was performed on 11 patients who had lower urinary tract symptoms. All cases were investigated by routine pathological, immunohistochemical studies. Results Seventeen cases of PPSRCC were associated with concurrent high-grade prostatic carcinoma, only 6 cases were pure SRCC. Immunohistochemical stains were positive in all cases for PSA and PAP. Stains were ne-gative for AB/PAS (23/23) and CEA (21/23). The clinical TNM stages were 7 of Ⅱ , 10 of Ⅲ and 6 of Ⅳ. Follow-up was available on 20 cases with a mean 24 months and 3 cases were lost during follow up. Eight cases died of metastasis. Five cases had evidence of recurrence 12-21 months from presen-tation. Conclusions The diagnosis of PPSRCC depends on pathological and immunohistochemical studys after metastasis from stomach and colon SRCC is excluded. Early diagnosis and combination treatment for PPSRCC might improve its prognosis.

Objective To analyze the clinical characteristics,diagnosis and the surgical treatment experience of the pulmonary sequestration.Methods The clinical data from 26 patients with pulmonary sequestration undergoing surgical operation were reviewed and analyzed retrospectively.Results Pulmonary sequestration was diagnosed in 16 out of 26 patients before the operation with the diagnosis rate of 61.5%(16/26).Pre-operation chest X-ray and plain CT-scan were performed in 26 cases.Enhancement CT scanning and CTA imaging were performed in 8 cases, magnetic resonance imaging were performed in 5 cases.21 patients with intralobar sequestration underwent lobectomy and 8 patients with extralobar sequestration underwent local lesion resection.Abnormal supply arteries were intraoprat-ibely found in 21 cases originating from the thoracic main artery,3 cases from the celiac artery,2 cases from the dia-phragm artery.Smooth recovery was achieved in all patients.No peri-operative death occurred.Symptoms disappeared were followed-up for 6 months.Conclusion Enhancement CT scanning,CTA imaging and magnetic resonance ima-ging ( MRI) may improve the diagnosis of pulmonary sequestration.Operation is a safe and effective method for the treatment of pulmonary sequestration.But intraoperative abnormal blood supply arteries should be paid attention to the treatment and prevention of intraoperative and postoperative bleeding.

This study examined the effect of subcellular localization of P21 on the proliferation and apoptosis of HepG2 cells. The coding genes of the wild and the mutant P21 were amplified by mega primer PCR from the plasmid pCEP-WAF1 which contains human P21 cDNA in the nuclear localizational signal (NLS) sequence, and then inserted into the eukaryotic expression vector pDsRed1-C1. The recombinants were transfected into HepG2 cells. The transcription and expression of P21 were determined by RT-PCR and fluorescence microscopy. The cell proliferation was measured by MTT, and the cell cycle and apoptosis of HepG2 cells by flow cytometry. The results of restriction analysis, DNA sequencing and fluorescence microscopy confirmed the construction of the wild and the mutant P21 in the eukaryotic expression plasmid. The plasmid containing the mutant P21 was found to accelerate cell proliferation and the wild P21 plasmid to inhibit cell proliferation. Cell cycle analysis showed that the cell ratio of G(0)/G(1) in the wild type group was significantly increased as compared with that in the mutant type group, and cell apoptosis analysis revealed that the apoptosis rate in the wild type group was much higher than that in the mutant type group. It was concluded that the subcellular localization of P21 may contribute to the development of hepatic cancer.

Objective To evaluate the medial submuscular plating of the femur after limb lengthening and correction with frame in patients with limb length discrepancy and/or angular deformity.Methods A retrospective study was conducted involving 12 patients who had been referred to Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from December 2009 to November 2016 for limb length discrepancy and/or angular deformity.They were 3 males and 9 females,with an average age of 23 years (from 14 to 32 years).Altogether 4 left and 8 right sides were involved.Of them,11 got their length discrepancy and/or angular deformity secondary to injury to distal femoral epiphyseal plate caused by trauma in their childhood and one had length discrepancy and angular deformity following unsuccessful conservative treatment of superior condylar fracture of the femur.The femoral shortening ranged from 3 to 11 cm (average,6.7 cm),and the varus or valgus deformity of the knee ranged from 8° to 18° (average,12°).First,a monolateral fixator was installed on the lateral femur.The limb was lengthened from 7 to 14 days after diaphysis osteotomy.Femoral supracondylar osteotomy was conducted again in patients with knee angular deformity after the lengthening reached the expected length and the deformity was corrected with the aid of external fixator.After medial submuscular plating via the femoral lateral approach using minimally invasive techniques,the external frames were removed.The time for plate removal,limb lengthening and correction of the varus or valgus deformity were documented.Results The mean follow-up was 31 months (from 23 to 43 months) for the 9 patients who had their plates still in situ,and 6.5 months (from 2 to 14 months) for the 3 patients who had subsequently their plates removed.None had blood transfusion.All underwent distraction osteogenesis of the femur to their preoperatively expected length,ranging from 3 to 9 cm (mean,6.2 cm).Both varus and valgus deformities were corrected.None developed a deep infection.The range of motion of the knee joint was similar to that before operation in all but one patient who had a range of motion 40° less than the pre-operative one.The time for external fixation averaged 91 days (from 46 to 113 days),with an external index of 22 d/cm.All patients were satisfied with their outcomes.Conclusion Medial femoral submuscular plating after limb lengthening and angular deformity correction with the external fixator on the lateral side is a useful technique for patients with femoral limb length discrepancy and/or angular deformity,significantly shortening the time for external fixation.

Objective To introduce the technique we invented to treat hypertrophic and oligotrophic nonunion of femoral shaft fracture after dynamization of intramedullary nail (IMN) and to report its preliminary results.Methods The data of 2 cases with hypertrophic nonunions of femoral shaft fracture and 1 case with oligotrophic nonunion following IMN dynamization who had been treated by the technique from March 2006 to July 2017 in Beijing Jishuitan hospital were retrospectively studied.There were 2 females and 1 male,aged 50,66 and 24 years old.2 parallel half pins were inserted from anterior to posterior at the trochanteric and condylar zones of the femur for antegrade intramedullary nailing patients,and from lateral to medial sides for retrograde intramedullary nailing patient respectively,then the pins were connected with monolateral limb reconstruction fixator.The fracture nonunion site was compressed by the fixator up to 10-15 mm.The holes at the end of intramedullary nail where their screws were removed for dynamization were locked again with 2 locking screws,and then the frame was removed.The patients are allowed to start their rehabilitation and fully bear their body weight 1 day after the operation.Results The three patients were followed up for 25,22,and 7 months after the surgery,respectively.The X-ray films showed the fracture healed at 7 months in two case,and at 12 months in one.One patient got her nail removed 25 months after the operation,feeling good 37 months after the removal.Conclusion This technique is an option to manage the hypertrophic and oligotrophic fracture nonunion of the femur after dynamization of IMN.It is mini-invasive to the nonunion site,easy to practice and allows early rehabilitation.