Objective To explore the isometric attachment site of the posterolateral structure in the femoral lateral condyle and introduce the method of knee posterolateral complex(PLC) reconstruction with the semitendinosus tendon. Methods Isometric reconstruction of the chronic PLC injury of knee joint in 18 cases, were performed with the semitendinosus tendon from February 2001 to February 2005. Of all patients, there were 12 males and 6 females, average age was 39 years old(range, 19-52 years old). All cases were chronic injuries, with duration of 1.5-14 months. 3 cases were simple PLC injury, 10 cases were PLC injury with posterior cruciate ligament(PCL) injury, 2 of which had undergone PCL reconstruction about 6.5 months. 3 cases combined with anterior cruciate ligament(ACL) injury, 2 cases combined with ACL and PCL injury. To put in the double semitendinosus tendon from the bony tunnel of anatomical insertion of the fibular collateral ligment in caput fibulae and put out from the bony tunnel of anatomical insertion of the popliterofibular ligment in the caput fibulae, then fix them respectively in the isometic bony tunnel of the femoral lateral condyle. The posterolateral stability of the knee was evaluated mainly through examination varus instability of knee and external rotation range of leg. Results It was relatively isometric from the femoral attachment site of the popliteal tendon to the anatomical insertion of the popliterofibular ligment in the caput fibulae. The better isometric attachment site was from the anatomical caput fibulae attachment site to 8-10 mm in front of the anatomical femoral attachment site of the lateral collateral ligament. The average follow-up period was 14 months(12-24 months). There was no varus knee instability in full extension. At 30? flexion, one-grade varus instability was found in 2. At 30? and 90? flexion, external rotation range increased by 6? in 3 cases, remained the same in 14 cases, and decreased in 1 case, all compared with the healthy side. Conclusion The method provided good stability for the knee and acquired satisfactory clinical results.

Objective To analyze the effect of traditional Chinese combined with Western medicine on the treatment of supracondylar fracture of humerus, and provide reference for clinical treatment.Methods122 patients with supracondylar fracture of humerus in hospital the affiliated hospital of traditional Chinese and western medicine;Zhejiang Chinese Medicine University from January 2015 to March 2016 were randomly divided into the observation group and the control group.The control group were given conventional fracture reduction, the observation group were given a new therapy of integrated traditional and western.Treatment outcome, quality of life changes and prognosis in the two groups were compared.ResultsThe excellent rate in the observation group (91.8%) was significantly higher than that in the control group (72.1%) (P<0.05).The fracture healing time in the observation group (4.1±1.1)months was significantly shorter than that in the control group (6.6±2.3) months (P<0.05).Before treatment, there was no significant difference in quality of life scores between the two groups;after treatment the overall health in the observation group (75.69±4.61), physiological function (77.62±4.19), pain (74.63±4.96), social function (76.84±4.28), mental health (76.12±4.18) scores were significantly higher than those overall health(62.74±4.36) in the control group, physiological function (64.51±4.12), pain (67.26±4.25), social function(68.72±4.13), mental health (65.97±4.23) (P<0.05).There were 2 cases with cubitus varus in the observation group, while 3 cases with elbow inversion in the control group.All patients were followed up for more than 6 months.There was no serious infection and abnormal bone development in the two groups.ConclusionIt can improve the treatment effect, reduce the pain of patients, promote the rapid recovery of the disease, improve the quality of life and prognosis, which traditional Chinese medicine combined with Western medicine was used in the treatment of humeral supracondylar fracture, it has the value of use.

Objective To design an arthroscopic universal aiming device for cruciate ligament repairing and evaluate its clinical efficacy. Methods The aiming device was designed on the principle of “a line crossing any point on a spherical surface and perpendicular to it must cross the sphere center”, which enables the surgeon to locate the ligamentous attachment of cruciate ligament precisely for reconstruction. Twelve cases of PCL injuries have been treated with this method. Results The average follow up period was 12.1 months (5-19 months). According to Lysholm scoring system, the average score was improved from 59.2 points to 92.7 points, increased by 33.5 points. Lachman test turned negative in all patients, the average range of motion was 120?. Conclusion The instrument was reasonably designed for easy handling and precise orientation. It is particularly preferable to locate the tibial attachment of cruciate ligament for endoscopic reconstruction on the posteromedial approach.

Objective To evaluate CT characteristics of pulmonary sclerosing hemangioma(PSH) so that to improve the knowledgeof this disease.Methods CT characteristics of PSH pathologically verified were retrospectively analysed.Conventional scan andcontrast-enhanced scan were performed in all the patients.Results 14 lesions were in right lung,while 10 were in left,Diameters of these lesions ranged from 0.8 to 10 cm,and the average diameter was 3.08 cm.3 lesions were located in hilum of lung,while the rest(87.5%)were located in peripheral lung tissue.20 lesions were oval,and 4 were lobulated in morphology.21 lesions were smooth in edge.45.8% of the cases had calcification.All the lesions enhanced obviously on contrast-enhanced scan,and average CT value of(46.62?9.47) HU was increased.The dilated and distorted blood vessels could be detected in 2 large lesions.Conclusion On the basis of general benign tumor features, obvious enhancement and calcification are the characteristics of PSH on CT.

To evaluate the treatment effect of the late avascular necrosis of femoral head with concentrated autologous bone marrow and impaction autologous bone graft. The clinical data of 35 patients with late avascular necrosis of femoral head treated with the above methods was analyzed retrospectively with the University of Pennsylvania staging system, and evaluated with Harris hip score system. Among the 35 patients, there were 8 at stage Ⅲ, 23 at stage Ⅳ and 4 at stage Ⅴ. The preoperative Harris hip scores ranged from 43-72 with the average scores of 49. The patients were followed up for at least one year with the mean time of 2 years and 3 months. Two patients (preoperative at stage Ⅴ) had received total hip replacement duo to severe pain and ostarthritis. The imageology in 5 patients showed that the femoral head appearance collapsed little compared with that before operation, but their subjective feelings were well. All the femoral heads of left patients remained the shape after operation, complains of pain disappeared or lessened. The overall successful rate was 94% (33/35). In Harris scale, there was 1 patient with 92 scores, 17 with 80-89 scores, 3 with 70-79 scores and 2 patients

Objective To investigate the application value of CT venography(CTV) in the diagnosis and treatment of Budd‐Chiari syndrome(BCS) .Methods 58 patients with BBCS in our hospital from January 2012 to January 2014 were performed the CTV examination .The inferior vena cava ,hepatic vein ,portal vein and collateral vessels were performed the reconstruction analysis . Results All the patients were definitely diagnosed as BCS after completing CTV examination ,including :19 cases of inferior vena cava(IVC) diaphragm type ,15 cases of short IVC segment occlusion ,8 cases of long IVC segment occlusion ,9 cases of hepatic vein stenosis or occlusion ,7 cases complicated by fresh thrombosis .In addition ,the different degrees of compensatory expansion of col‐lateral vesse ,intuition and comprehensiveness ,can display the position ,character and length of lesion vessel ,also observes the de‐grees of collateral vessels expansion and liver cirrhosis .

Objective To compare the safety and efficacy of the 2μm laser and the bipolar electrotome used in transurethral re-section of bladder tumor(TURBT)for treating non-muscle invasive bladder cancer(NMIBC).Methods The clinical data in the pa-tients with NMIBC treated by TURBT in our hospital from March 2009 to May 2013 were retrospectively analyzed.All patients were divided into the 2μum laser group(n=89)and the bipolar electrotome group(n=82).The operation time,complications,post-operative hospital stay and recurrence rate were compared between the two groups.Results There were no statistically significant differences in the operation time,postoperative hospital stay and recurrence rate between the two groups(P>0.05).Compared with the 2 μm laser group,the bipolar electrotome group showed significantly higher occurrence rate of the obturator nerve reflex (20.7%vs.0,P<0.05)and the bladder perforation(7.3% vs.0,P<0.05)and longer postoperative bladder irrigation time [(3.1±0.9)d vs.(2.2±1.0)d,P<0.05],the differences between the two groups had statistical significance.Conclusion Com-pared with bipolar electrotome,the 2μm laser used in TURBT is safe and effective with few complications for treating NMIBC.

Objective To discuss the value of diffusion-weighted MRI (DWI) and 18F-FDG-PET/CT in assessing the early therapeutic effect of radiofrequency ablation (RFA) for VX2 sarcomas in experimental rabbits. Methods VX2 sarcoma was inoculated at bilateral hind limbs in 14 New Zealand white rabbits to establish the animal models. The implanted VX2 tumor on one hind leg was treated with ultrasound-guided percutaneous RFA (study group), while no RFA was given to the VX2 tumor on the contralateral hind leg (control group). DWI-MRI was performed at 2 days after RFA, and 18F-FDG-PET/CT examination was employed at 3 days after RFA. The mean apparent diffusion coefficient (ADC) values and standard uptake value (SUV) of the untreated tumor and the ablated tumor were separately calculated. Taking the pathologic result as the gold standard, the consistency of DWI-MRI, PET/CT as well as the combination of DWI-MRI and PET/CT with the clinical diagnosis was separately evaluated by Kappa test. Results Before RFA, DWI-MRI demonstrated that the VX2 tumor was characterized by hypo-intensity signal on T1 and hyper-intensity signal on T2 with ring-shaped enhancement on T1-weighted image; PET/CT showed that the tumor had nodular or ring-shaped 18F-FDG accumulation. After RFA, DWI-MRI revealed that the VX2 tumor was manifested as hyper-intensity signal on T1 and slight higher density on T1 with slight enhancement on contrast-enhanced T1-weighted image; PET/CT showed lowered accumulation of 18F-FDG. The mean ADC value of the ablated tumor was (1.52 ± 0.24) × 10-3 mm2/s, which was obviously higher than that of the un-ablated tumor, that was (1.09 ± 0.12) × 10-3 mm2/s, the difference was statistically significant(P<0.05). The mean SUV value of the ablated tumor was (0.6 ± 0.3), which was significantly lower than that of the ablated tumor (9.6 ± 3.2, P<0.05). No significant difference in sensitivity, specificity and accuracy existed between DWI-MRI and pathology as well as between PET/CT and pathology, the Kappa value being 0.357 and 0.428 respectively (P>0.05). The Kappa value of the consistency between combination of DWI-MRI with PET/CT and pathology was 0.786, which was significantly different from the result by simple DWI-MRI or simple PET/CT evaluation (P< 0.05). Conclusion Both ADC value of DWI-MRI and SUV value of PET/CT are useful indexes for evaluating the early therapeutic effect of RFA. Both DWI-MRI and PET/CT have their respective advantages, nevertheless, combination use of both can effectively improve the evaluation of curative effect for VX2 tumor after RFA in experimental rabbits.

This paper aims to establish an accurate finite element model of complete lumbar spine with complex lumbar spinal stenosis (LSS), and then to do comparison and analysis of normal model and decompression surgery model. Firstly, we chose some patients with complex LSS and then collected the CT scanned data. Then we generated a complete FE model of Lumbar with complex LSS using a specially designed modeling system, and we also created a normal lumbar model and a decompression treated model. We applied same boundary conditions in all the three models. The results showed that the active movement range of complex LSS was smaller than that of the normal model, but the movement range of the decompression model was larger than that of the normal. There are stress concentration around the endplate and disk at the degenerative intervertebral? disk L4-L5 and adjacent disk L3-L4 for LSS model, and the stress of the decompression model increased more significantly. This simulation demonstrated that the treatment of simple decompression for lumbar spine with complex LSS can release the pain, but may result in unstability and accelerate the degeneration.
Decompression, Surgical ; methods ; Finite Element Analysis ; Humans ; Lumbar Vertebrae ; surgery ; Models, Biological ; Spinal Stenosis ; surgery

OBJECTIVE: To assess clinical value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for differentiation of malignant from benign focal thyroid incidentaloma. MATERIALS AND METHODS: This retrospective study included 99 patients with focal thyroid incidentaloma of 5216 non-thyroid cancer patients that had undergone PET/CT. PET/CT semi-quantitative parameters, volume-based functional parameters, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of thyroid incidentaloma were assessed. Receiver-operating characteristic (ROC) analysis was conducted and areas under the curve (AUC) were compared by Hanley and McNeil test to evaluate usefulness of maximum standardized uptake value (SUVmax), MTV and TLG, as markers for differentiating malignant from benign thyroid incidentalomas. RESULTS: Of 99 thyroid incidentalomas, 64 (64.6%) were malignant and 35 (35.4%) were benign. Malignant thyroid incidentalomas were larger (1.8 cm vs. 1.3 cm, p = 0.006), and had higher SUVmax (11.3 vs. 4.8, p < 0.001), MTV (all p < 0.001) and TLG (all p < 0.001) than benign. TLG 4.0 had the highest performance for differentiation of malignant from benign thyroid incidentaloma in all semi-quantitative parameters with AUC 0.895 by ROC curve analysis. AUC (TLG 4.0) was significantly larger than AUC (SUVmean), AUC (MTV 2.5), AUC (MTV 3.0), AUC (MTV 3.5), AUC (TLG 2.5), and AUC (TLG 3.0), respectively (all, p < 0.05). There was no statistical difference between AUC (TLG 4.0) and AUC (SUVmax) (p > 0.05). A threshold TLG 4.0 of 2.475 had 81.3% sensitivity and 94.3% specificity for identifying malignant thyroid incidentalomas. CONCLUSION: Volume-based PET/CT parameters could potentially have clinical value in differential diagnosis of thyroid incidentaloma along with SUVmax.
Area Under Curve ; Diagnosis, Differential ; Electrons ; Fluorodeoxyglucose F18* ; Glycolysis ; Humans ; Positron-Emission Tomography and Computed Tomography* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms ; Tumor Burden