Objective To investigate the clinical results, indications and choices of surgical treatment of minimally invasive internal fixation by cannulated compression screws in the treatment of femoral neck fractures. Methods The authors retrospectively analyzed clinical data of 83 patients with femoral neck fractures treated by minimally invasive internal fixation by AO cannulated screws. Results According to the Garden classification, the patients comprised 12 cases of type I, 39 cases of type II, 23 type III and 9 type IV. The mean time from injury to surgery was 63.4 hours, the mean operation time was 65.7 min, the mean intraoperative blood loss was 64 ml and the mean hospital stay was 7.7 days. No wound infection, deep venous thrombosis of leg, pulmonary embolism or breakage of internal fixation occurred. No patients died. Follow-up observation ranged 12～48 months, with a mean of 31.3 months. Normal bone union was obtained in all the cases. Postoperatively, shortening of femoral neck took place in 4 patients (4/83, 4.8%) and different degrees of osteonecrosis happened in 7 patients (7/83, 8.4%). The mean postoperative Harris hip score was 94.6. Conclusions Minimally invasive internal fixation by cannulated compression screws for femoral neck fractures may be an effective alternative. This method is indicated for Garden I/II fractures without displacement in patients above 65 years old, or any types of femoral neck fractures in patients below 65 years old.

Objective To investigate the clinical results of minimally invasive plate fixation for tibial plateau fractures. Methods Minimally invasive plate fixation was adopted in 26 cases of tibial plateau fractures from January 2000 to June 2003. Results Follow-up for 6 months ～ 4 years (mean, 2 1 years) showed bone union in all the patients. The results of therapy were assessed according to the Merchant criteria as follows: excellent in 20, good in 5 and fair in 1. Conclusions Minimally invasive plate fixation in the management of tibial plateau fractures has advantages of minimal trauma, reliable fixation, early movement and fewer complications, being a valuable clinical alternative.

Objective To explore the surgical result of unilateral half-pin external fixation in the treatment of distal tibial fracture. Methods For type A fracture, two pins were inserted into the proximal fragment of tibia fracture and another two pins into the distal fragment; for type B and C fracture, distal pins were inserted into the talus and calcaneus. The fracture reduction was performed by distraction of external fixators. A limited open reduction was required in some difficult cases to restore the joint surface, with bone grafting and small fragments fixed with wires or screws. Meanwhile, fracture of fibula was fixed with plate and screws. Results The duration of external fixation was 3.5~8 months (mean, 5 months) in 22 patients. Bone union was achieved in all patients, without serious deep infection, osteomyelitis, or non-union. The patients were followed for 10~32 months (mean, 20 months). Functional exercise was carried out for more than 6 months after the removal of the external fixator. According to the Tornetta’s evaluation standard, excellent results were obtained in 11 patients, good in 7 patients, fair in 3, and poor in 1. Conclusions Unilateral half-pin external fixation combined with limited open reduction and internal fixation is a simple and effective minimally invasive method for the treatment of distal tibial fracture.

Objective To investigate the clinical results of limited exposure and indirect reduction in treatment of tibial plateau fractures. Methods 41 cases of tibial plateau fractures were treated with limited exposure and indirect reduction. According to Schatzker classification, there were 6 cases of type Ⅰ, 13 type Ⅱ, 11 type Ⅲ, 6 type Ⅳ, 3 type Ⅴand 2 type Ⅵ. Type I fractures were reduced in the close manner by applying large reduction forceps and fixed with percutaneous lag screws. Type Ⅱ, type Ⅲand Type Ⅳfractures were reduced by applying large reduction forceps and fixed by percutaneous plating after restoring joint surface and bone grafting. Type Ⅴand Type Ⅵfractures were reduced by applying fracture distracter and large reduction forceps before they were fixed with percutaneous plating. The clinical outcomes were assessed according to Rasmussens system. Results 36 patients were followed up from 6 to 60 months, with an average of 30.2 months. No deep vein thrombosis, infection, or compartment syndrome was found postoperatively. All the 36 fractures united. Overall, 25 (69%) patients were rated as excellent, 8 (22%) good, and 3 (9%) fair. Conclusion In treatment of tibial plateau fracture, limited exposure and indirect reduction has advantages of less dissection, stable fixation, early movement, better joint function and fewer complications.

Anemia, Aplastic ; genetics ; metabolism ; Bone Marrow Cells ; metabolism ; Case-Control Studies ; Cell Line ; Child ; Child, Preschool ; Female ; Fibroblast Growth Factor 2 ; metabolism ; Gene Expression Profiling ; Humans ; Male ; Mesenchymal Stromal Cells ; metabolism

Objective To investigate outcomes of different operations in treatment of cervical spinal fracture in patients with ankylosing spondylitis and summarize experiences and bases in selection of operation.Methods A retrospective study was done on 19 patients with cervical spinal fracture following ankylosing spondylitis treated between 2005 and 2011 and received complete follow-up.Among them,nine patients were treated with combined anterior and posterior surgical approach (combined treatment group),seven with single posterior surgical approach (posterior approach group) and three with single anterior surgical approach (anterior approach group).Clinical data,follow-up data and image outcome of the patients were collected and compared.Results All patients received average 14 months of follow-up (range,12-20 months).In combined treatment group,the fracture was healed at postoperative 4-6 months.One patient had palsy of recurrent laryngal nerve but was recovered at postoperative three months.Seven patients with incomplete spinal cord injury had at least one level improvement in neurological function according to American Spinal Injury Association (ASIA) classification.No implant loosening or shifting were found in internal fixation.In posterior approach group,fracture was healed at postoperative 4-6 months,with no surgical complications,loosening or shifting of implants.Five patients with incomplete spinal cord injury had at least one level improvement in neurological function according to ASIA classification.In anterior approach group,an additional operation for implant loosening was performed in one patient at postoperative four weeks.The other two patients obtained fracture healing at postoperative four and five months respectively,without implant loosening.Condusions Combined anterior and posterior approaches can not only be the first choice for treatment of cervical spinal fracture following ankylosing spondylitis,but also be used for patients with bone defect at fracture site or separation at fracture end,with no necessity of postoperative external fixation.Single posterior reduction and fixation can be considered in patients with transvertebral fracture in the absence of bone defect,separation at fracture end,displacement or slight displacement,with necessary postoperative external fixation.However,single anterior fixation takes risk of implant failure and needs postoperative external fixation.

Objective To discuss the selection of short- or long-segment posterior fixation for treatment of unstable thoracolumbar fractures. Methods A total 134 patients with thoracolumbar fractures treated with pedicle instrument fixation from January 2005 to December 2008 were studied retrospectively. According to AO fracture classification, there were 70 patients with type A fractures, 37 with type B and 27 with type C. The patients were divided into two groups according to the number of instrumented levels; short-segment posterior fixation (SSPF) group (four screws; one vertebral body above or below the fractured vertebrae) and long-segment posterior fixation (LSPF) group (eight screws; two vertebral bodies above or below the fractured vertebrae). Clinical outcomes and radiological parameters (superior-inferior endplate angle, vertebral body angle, displacement of vertebral body) were compared according to AO fracture classification. Results All type A fractures were treated with SSPF, mean superior-inferior endplate angle changed from preoperative 21.3° to postoperative 8.5° and 11.1° at final follow up. There was no statistical difference in the correction of Cobb angle for type B fractures in SSPF group (26 patients) and LSPF group (11 patients), while the correction loss of vertebral body angle was 3. 64° in SSPF group and 1.09° in LSPF group, with statistical difference (P < 0. 05). There was no statistical difference in the correction of Cobb angle for type C fractures in SSPF group (7 patients) and in LSPF group (20 patients), but the correction loss of vertebral body angle was 3.6° in SSPF group and 0. 8° in LSPF group, with statistical difference (P < 0. 05). There was no statistical difference in vertebral displacement correction. Conclusions Most types A and Bl fractures should be treated with SSPF; most types B2, B3 and C fractures should be treated with LSPF.

Objective To discuss the indications, surgical techniques and outcome of less invasive stabilization system (LISS) in treatment of special proximal femoral fractures. Methods Twenty-eight patients with special proximal femoral fractures were treated with LISS from June 2005 to December 2007. All fractures could not be reduced by close reduction with traction table. There were eight patients with in-tertrochanterie fractures ( including type 31-A2.2 fractures in three, type 31-A2.3 in two, type 31-A3.1 in three and type 31-A3.3 in two according to AO classification), 19 with subtrochanteric fractures (including type ⅡA fractures in three, type ⅢB in one and type Ⅴ in 15 according to Seinsheimer classification) and one with peripheral fractures ( type Vancouver B1 fracture) of the femoral prosthesis. The data about opera-tion duration, intraoperative blood loss, postoperative complications, fracture healing time and postoperative hip function score were recorded. Results The operation lasted for mean 88 minutes (45-120 minutes), with intra-operative blood loss of average 320 ml (50 -700 ml). There occurred deep vein thrombosis of lower limb in two patients, myocardial infarction in one and lower digestive tract bleeding in one after oper-ation, with no incision complications. One patient with breast cancer was died of brain metastasis after op-eration and three lost follow-up. Other 24 patients were followed up for mean 18 months (6-33 months), which showed that 23 patients got fracture healing 2-5 months ( average 3 months) postoperatively but that one patient with type Seinsheimer V fracture had breakage of proximal locking screws six months postopera-tively because of nonunion of subtrochanteric fracture. The Harris score of the hip was 70-99 points ( aver-age 84 points). Conclusions Reverse femoral LISS has advantages of minimal invasion, easy opera-tion, stable fixation, high degree of safety and minor complications for treatment of special proximal femoral fractures. Skillful reduction, correct positioning of guide wire into hole A and avoidance of immediate weight bearing are key to success of the operation.

Objective To discuss the selections of surgical treatment for lower cervical spine fracture and dislocation and the treatment outcome.Methods Clinical data of 50 cases of lower cervical spine fracture and dislocation were analyzed retrospectively.There were 37 males and 13 females at mean age of 41 years (range,20-80 years).Forty-four cases underwent anterior fusion,but 4 with ankylosing spondylitis and 2 with extremely unstable cervical spine were treated with combined posterior fusion.Two cases sustaining ankylosing spondylitis and being unable to be operated via the anterior approach due to the maximum neck flexion limits were treated with posterior decompression and fusion.Two cases developed delayed fracture and underwent posterior release prior to the anterior fixation and fusion.Two cases underwent a second surgery with the posterior release,anterior fusion and posterior fusion performed successively.Neurological performance was evaluated using the American Spinal Injury Association (ASIA)scale.Results All the patients were followed up for mean 28 months (range,12-48 months).Implant loosening and redislocation occurred in one ankylosing spondylitis case 2 months after anterior fusion.Other 49 cases achieved bony fusion in 6 months.Neurological function showed no recovery in complete spinal cord injury cases,but improved for average ASIA 1-2 grades for incomplete spinal cord injury cases.Conclusions Anterior surgery provides good reduction and neurological improvement in treatment of lower cervical spine fracture and dislocation.For extremely unstable cases or difficult anterior reduction cases,posterior surgery or combined anterior/posterior surgery should be considered.

Objective To confirm the performance of rate method for detecting ALT in blood donors to verify that it meets the requirements of ISO15189 .Methods according to the requirements of CNSA‐CL02 :2012 the Medical Laboratory Quality and Abili‐ty Recognized Standards and the Blood Station Technical Operation Regulations(edition 2012) ,the precision ,accuracy ,sensitivity , reportable range ,biology reference interval and measurement uncertainty of the detection system were verified .Results The intra‐batch imprecision for the ALT quality control serum and 2 concentrations of blood donor sample detected for 20 times and 20 d was<5 .0% and the inter‐batch imprecision was <6 .7% ;the correct estimates passed the external quality assessment results of the original Ministry of Public Health in 2014 and calibration results analysis .The relative bias was less than 1/2 of CLIA′88 permissi‐ble error;the regression equation of reportable range obtained by the linear regression was Y =0 .995 1X -5 .618 4 ,r=0 .999 7 (R2 =0 .999 4) ,the results within the detection range were correct ;the biological reference interval was 0 .0 -32 .7 U/L and the measurement uncertainty was (74 .90 ± 3 .32)U/L .Conclusion The performance indexes of ALT detection method conform to the expected requirements of ISO15189 .This method can be used as a blood screening test method in laboratory .