Objective To evaluate clinical application of the gastrocnemius blood vessles as recevier ones to anastomose with free flaps. Methods From June 2005 to July 2011,twenty adult lower limbs were infused with red glue to observe the origin,streching,branches and communication with other blood vessles of the gastrocnemius blood vessles and to measure their outer diameters and pedicle length. Operations were also simulated on these specimens to make the above chacracters of the vessles clear further.CT images of 16 fresh adult lower limbs were got to observe the effects of obstruction of one side of the gastrocnemius blood vessels to the blood supply of the gastrocnemius muscles. Fifty-two free flaps were transplanted to legs with large defects of skin and soft tissues where the gastrocnemius blood vessles were anastomosed with the flaps to supply artery blood and receive vein blood. Results The main blood vessles of the gastrocnemius muscles were medial and lateral gastrocnemius blood vessles. They both origined from the popliteal arteries and communicated with other blood vessles. The pedicles of the medial gastrocnemius blood vessles were 8.0 -13.8 cm in length which averaged 11.1 cm and their outer diameters were (1.8 ± 0.3) mm when they entered the muscles. The pedicles of the medial gastrocnemius blood vessles were 5.4 - 12.3 cm in length which averaged 8.8 cm.The outer diameters of the two accompanying veins were (1.8 ± 0.3)mm when they entered the muscles.When one gastrocnemius blood vessle were obstructed,the gastrocnemius muscles could got enough blood supply by co mmunicating branches between the obstructed vessle and other blood vessles.All the 52 free flaps survived. Through one to two-years follow-up, the defects cured with no infection and the knees' motions were normal. Conclusions With a long pedicle and wide diameter,the medial or lateral gastrocnemius blood vessle can be a reliable alternative used in free flap transplautation for repairing large defects of skin and soft tissues of seriously injured legs with no other choice of blood vessles, which causes unobvious effects to the blood supply of the legs and can simplify the free flap transplantation.

BACKGROUND: At present, more and more scholars pay attention to the influence of spine and pelvis sagittal balance on the quality of life of patients. Postoperative changes in spine imaging parameters fol owing corrective osteotomy for lumbar degenerative kyphosis have not been reported. OBJECTIVE: To evaluate postoperative changes in sagittal balance fol owing corrective osteotomy for lumbar degenerative kyphosis. METHODS: We retrospectively analyzed 35 consecutive lumbar degenerative kyphosis patients treated with posterior osteotomy fixation in the First Affiliated Hospital of Xinjiang Medical University from February 2012 to December 2014. Imaging parameters were measured before fixation, immediately after fixation and during final fol ow-up. RESULTS AND CONCLUSION: (1) There were significant differences between preoperative and postoperative parameters except for pelvic incidence angle (P < 0.05). (2) There were significant differences between postoperative and last fol ow-up parameters except for Cobb angle, pelvic incidence angle, thoracic kyphosis angle and the thoracolumbar kyphosis (P < 0.05). (3) Pelvic tilt angle was negatively correlated with lumbar lordosis after fixation (r=-0.610, P < 0.001). Thoracic kyphosis was positively correlated with lumbar lordosis (r=0.598, P < 0.001). (4) Results suggested that lumbar sagittal contour can be significantly improved by corrective osteotomy for lumbar degenerative kyphosis. Simultaneously, reciprocal changes in the adjacent areas such as thoracic spine and pelvis occur to adapt to the new sagittal balance.

Objective To study the anatomical characteristics of sural blood vessel, and to explore the clinical effect of sural blood vessel combined with free skin flap in repairing large tissue defect of calf. Methods 10 fresh adult cadavers were col-lected for experimental studies. Chose 8 cadavers randomly and ligate the sural medial vessel (4 cases) or sural lateral vessel (4 cases) of one limb, leaving the contralateral limb un-ligated as control. Angiography was performed to observe the blood supply of the gastrocnemius muscle after the ligation of the sural medial vessel or sural lateral vessel. For the remaining 2 cadavers, the ori-gin, diameter, and location of the communicating branch of the gastrocnemius muscle were observed by macroscopic anatomy and vascular cast. The data of 19 patients with large tissue defect of calf from October 2006 to September 2013 were analyzed retro-spectively for clinical research. There were 11 males and 8 females aged from 10-40 years (mean, 32 years). 12 patients took sural medial blood vessels as recipient vessels, and 7 patients took sural lateral blood vessels. 6 patients were grafted with free chest na-vel flaps, 8 with anterolateral thigh flap, 2 with lateral thoracic flap, and 3 with latissimus dorsi flap. The areas of wound surface were ranging from 5 cm×10 cm-8 cm×37 cm. The areas of the flap dissected were ranging from 7 cm×10 cm-10 cm×30 cm. Re-sults The study found that the blood supply of gastrocnemius muscle of the calf was multifocal, and was mainly by sural artery. When the blood supply of sural artery was cut off from one side, the gastrocnemius muscle could be supplied by the communicat-ing branches between medial and lateral head of gastrocnemius muscle and the communicating branches of soleus muscle. The communicating branches were at constant anatomical locations, with larger diameter and rich branches. All the 19 cases of free skin flip transplantation were survived. Healing time of wound was ranging from 13-29 d, among which 11 cases were primary healing, and 8 were secondary healing. The follow-up duration was ranging from 12-24 months. The flaps could endure friction of certain degree. No sensory dysfunction was reported. For the cases that split thick skin graft or split-thickness thin skin flap taken from abdomen or huckle were autografted to cover the donor site, primary healing was all gained. Conclusion The sural blood vessels are deeply located in the gastrocnemius muscle at constant anatomical locations, with a long pedicle and a large diameter, and are easy to be dissected, thus they are suited for anastomosis. Sural vessel combined with free skin flip provides a new treat-ment option for the repair of large tissue defect of calf.

Objective To investigate the epidemiological characteristics of outpatients exposed to rabies and to analyze the post-exposure prophylaxis in Weinan City in 2017 in order to provide a scientific basis for the prevention of rabies. Methods Clinical data of all outpatients with exposure to rabies in Wei-nan were collected. Ecxcel 2007 was used for data entry and SPSS13. 0 for Chi-square test. Results A total of 32 094 cases were reported with an annual exposure rate of 625. 64/100 000 in Weinan in 2017. Animal bites mainly occurred in spring and summer,accounting for 47. 47% of the total cases in 2017. There were statistically differences in exposure rate among different age groups (χ2=15. 858,P=0. 003). Farmers ac-counted for the largest proportion of the outpatients exposed to rabies (52. 34% ). Among 31 435 outpatients, 28 181(89. 65% ) received wound care and rabies vaccination. The vaccination rate of rabies immunoglobu-lin for patients with gradeⅢ exposure was 46. 93%. Conclusion Comprehensive measures with focuses on compulsory vaccination for domestic dogs and adoption of stray dogs should be implemented to prevent human rabies. Meanwhile,health education rabieson prevention and control should also be strengthened.

Objective:To evaluated the indications, methods, outcomes and prognosis of surgical treatment for post-traumatic epiphyseolisthesis at odontoid process in children.Methods:Retrospective analysis was performed on 5 cases of children with delayed epiphyseolisthesis of odontoid process in our institution from July 2009 to October 2016, including 1 male and 4 females. Initial surgery age were at1.7~5.4 years old, averaged (39.6±19.4) months and were 0.67-8 months, averaged (87.0±95.1) days. Disease duration ranged from 23 days to 8 months, with an average of 88 days. X-ray, CT and MRI examinations of the occipital-cervical area were taken to evaluate the type of the fracture and the severity of spinal cord compression. Children were treated with anterior loosening combined with posterior fixation fusion or posterior loosening reduction and internal fixation respectively.The function of spinal cord was evaluated by Frankel scale at pre- and post- operation. During the follow-up, X-ray and CT were performed to assess the fusion condition of the grafted bone.Results:The duration of operation was ranged from 75-145 months, with an average of (101.0±20.7) months; Blood loss ranged from 50-100 ml, with an average of (70.0±21.2) ml; follow-up duration ranged from 6 to 48 months, with an average of (23.5±17.6) months. Two cases preoperatively evaluated as Frankel C and D recovered to postoperative Frankel E. Among the five cases, two received satisfactory reduction, two cases received incomplete reduction, and one experienced failure reduction. The epiphyseolisthesis and bone grafted sites achieved solid fusion at 6-15 months after surgery, with an average of (9.5±3.4) months. The physiological curvature of cervical remained well without bone resorption, nonunion, pseudoarthrosis, as well as screw loosening or broken. Internal fixation of 2 cases were removed.Conclusion:Children with post-traumatic epiphyseolisthesis at odontoid process are not common in clinical practice. The detailed diagnosis of medical history, physical examination and comprehensive imaging evaluation. The posterior approach technique of C1-2 was feasible and effective, which could obtain decompression, reconstruction andstability all together.

Objective:To evaluate the long-term outcomes of posterior release, reduction, fixation, and fusion for irreducible atlantoaxial dislocation (AAD).Methods:Between January 2005 and June 2016, a total of 31 patients with irreducible AAD who had received posterior approach surgery were included. Among them, there were 13 males and 18 females, the average age was 39.1±13.5 years (range 9-72 years). The clinical data of the eligible individuals were collected and analyzed. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) scores were recorded to evaluate the recovery of neck and neurological functions. The atlantodental interval (ADI), clivus-canal angle (CCA), and cervico-medullary angle (CMA) were measured to evaluate the reduction of AAD. C 0-C 2 angle and C 2-C 7 angle were measured to evaluate the recovery of cervical alignment. For individuals with basilar invagination, the distances from the tip of odontoid process to Chamberlain line and Wackenheim line were measured to assess the reduction in the vertical direction. The duration of bony fusion and complications were also analyzed. Results:The mean follow-up period was 82.7±26.4 months (range 61-170 months). In terms of functional scores, the NDI dropped from 43.41%±11.60% before surgery to 12.19%±6.97% at the six months follow-up, and 9.45%±7.51% at the last follow-up ( F=89.56, P<0.001). The JOA increased from 9.48±2.41 points before surgery to 14.71±1.42 points at the six months follow-up, and 14.97±1.47 points at the last follow-up ( F=52.89, P<0.001). Regarding the horizontal and vertical dislocations, the ADI decreased from 9.16±2.32 mm before surgery to 1.39±1.04 mm at the six months follow-up, and 1.29±1.08 mm at the last follow-up ( F=189.61, P<0.001). The distance from the tip of odontoid process to Chamberlain line decreased from 11.15±4.35 mm before surgery to 2.03±2.83 mm at the six months follow-up, and 2.15±3.02 mm at the last follow-up ( F=37.58, P<0.001). The distance from the tip of odontoid process to Wackenheim line reduced from 6.81±2.57 mm before surgery to -2.23±1.58 mm at the six months follow-up, and -2.27±1.58 mm at the last follow-up ( F=122.16, P<0.001). For the amelioration of the compression on medulla and spinal cord, the CCA increased from 113.68°±12.67° before surgery to 143.39°±7.38° at the six months follow-up, and 142.39°±7.13° at the last follow-up ( F=67.13, P<0.001). The CMA increased from 115.71°±13.69° before operation to 145.58°±10.78° at the last follow-up ( F=41.44, P<0.001). Regarding the curvature of the cervical spine, the C 0-C 2 angle recovered from 1.94°±15.82° before surgery to 14.84°±6.45° at the last follow-up ( F=11.97, P<0.001), and the C 2-C 7 angle ameliorated from 27.26°±8.49° before operation to 19.26°±5.44° at the last follow-up ( F=11.13, P<0.001). Bony fusion was achieved in all cases, the fusion time was 9.71±2.55 months (range 5-15 months). A total of five complications occurred in the cases (two cerebrospinal fluid leakages, one deep infection, one transient neurologic deficit, and one dysphagia). They were all cured with corresponding treatments. In the last follow-up, none of the cases developed failure of internal fixation or re-dislocation. Conclusion:Posterior approach release, reduction, fixation and fusion technique is a safe and efficient surgical strategy with favorable long-term follow-up outcomes for irreducible AAD.

Aiming at the medical practice problems of the surgical steel medical instruments, such as the crevice corrosion, the poor mechanical compatibility and the Ni, Cr plasma exudation, the laser deposition of Ti-6Al-4V alloy cladding layer at the local functional area as alternative coating was proposed and realized as a new process method. The accurate element content and good formability Ti-6Al-4V cladding powder was chosen, the low power and high duty cycle optimized laser process was adopt, the alternative coating of good fusion and low dilution was prepared. Through the elemental line scanning, the interface microstructure analysis and the experiments of basic mechanical properties, the basic properties of the cladding were characterized and verified. The experiments results showed that, the Ti, Al and V contents of the top coating were respectively about 88%, 4.9% and 3.9%, no sensitizing ions such as Cr and Ni were detected. Initial equiaxed α phase, flake β phase dist were distributed in the coating and interface, the α' martensite was precipitated at the boundary of the flake β phase, some refined granular β phase dispersion pinned to the grain boundary of basket structure. The microhardness of cladding layer was 352.08~312.76 HV_0.1. The friction coefficient of the cladding layer was about 0.22~0.65. A new technology and method reference for improving and upgrading the performance of surgical medical devices is provided by this research.
Alloys ; Corrosion ; Materials Testing ; Steel ; Titanium