[Objective]To evaluate the incidence and predictors of stiff knees after primary TKA.[Method]A retrospective review was given to the data from 1216 patients undergoing primary total knee arthroplasty between October 1996 and October 2006.Forty-five stiff TKA patients with a 1-year postoperative flexion range of less than 90?was taken as treatment group.Forty-five TKA patients with greater than 90? flexion at 1 year postoperative as control group.The age,sex,body mass index,American Society of Anesthesiologists(ASA) rating,surgeon,implant type,and fixation of the control group were matched to those of the treatment group.A case-control study was conducted to determine predictive factors of stiff TKA.[Result]No significant differences were found with regard to the mean age,ratio of sex and preoperative medical comorbidities.Preoperative flexion and intraoperative flexion were predictive of ultimate postoperative flexion(P=0.001 and P=0.039,respectively).Preoperative and postoperative relatively decreased patellar heightwere significantly correlated with postoperative stiffness(P=0.001).[Conclusion]Stiffness post-TKA is multifactorial,careful attention to surgical exposure,restoring gap kinematics,minimizing surgical trauma to the patellar ligament/extensor mechanism,appropriate implant selection,and physiotherapy may all serve to reduce the incidence of post-TKA stiffness.

Understanding and learning the up-date clinical information of evidence-based medicine are the important part of knowledge for clinical postgraduates and are the basic ability required in their future clinical work.The necessity and role of literature retrieval course were studied with meta analysis of literature retrieval course teaching as the core content,and with meta analysis of literature retrieval course teaching as the writing objective.The literature retrieval course teaching process was displayed by demonstrating the case design and analysis,retrieval methods and their implementation in different stages of literature retrieval course teaching.

Objective To explore the pathogenesis of Hirayama disease from juvenile cervical curvature and growth rate.Methods Totally 60 patients diagnosed with Hirayama disease (HD) from 2009 to 2011 in our hospital were included in the present study.Patient's height and growth rate 1-2 years prior to the onset of disease were recalled by patients and family members.Lateral cervical X-ray was examined,and cervical curvature was measured by Borden's method.Results All the patients were adolescents with onset age at 12-25 (17.0 ± 2.4) years old and peak age of onset at 15-18 [45 cases (75.0％)].Fifty-seven cases were male and 3 cases were female.Cervical MRI examination of the 60 cases showed that the spinal cord atrophy involving C4-C8 vertebral level.The C line values for cervical curvature by Borden's method of the patients was 2.6 (1.2,4.2) mm.Among 60 patients,57 of them were with abnormal cervical curvature.The average height growth rate 1 year prior to the onset was (7.1 ± 1.8) cm.Conclusions The clinical manifestations that featured in overgrowth in the first two years and abnormal cervical vertebra curvature are possible related with pathogenesis of HD.HD is possibly a cervical spinal cord compression disease,which is associated with cervical spinal dysplasia during juvenile growth.

Objective To explore the clinical and radiological features of bilateral thalamus venous infarction.Methods The cases definitely diagnosed as thalamus venous infarction were collected and the corresponding clinical and radiological data were retrospectively analyzed.Results Four cases confirmed as thalamus venous infarction by digital substraction angiography (DSA) were collected.Bilateral thalamus lesions were detected in all cases by brain MRI scans which mainly presented as thalamus edema with high T1 and T2 signals with partial enhancement.Mild hemorrage was also shown in one case.Acute or subacute onset with clinical manifestations of headache,hypomnesia and hypersomnia were reported in all cases.The neurological examination showed conscious disturbance,memory impairment and positive Babinski sign.The venous thrombi were formed mainly in the transverse and the straight sinuses in 3 cases with the deep cerebral venous involved in 2 cases.All patients were improved after the anticoagulation therapy.Dural arteriovenous fistula was found in the other case drained by the Rosenthal's vein,and the symptoms were ameliorated after the embolotherapy.Conclusions As the thalamus is drained by the thalamostriate vein and the lateral thalamic vein towards the internal cerebral vein with the caudate portion drained particularly by the Rosenthal's vein,venous thrombosis or fistula drainage into these veins would probably disturb the normal drainage of the thalamus and result in further edema and infarction.Thus,the venous infarction should be taken into consideration whenever bilateral thalamus lesions are encountered in clinical practice and DSA is necessary to confirm the diagnosis.

Objective To investigate the effectiveness of ultrasound in evaluating the degree of xerostomia in the patients with nasopharyngeal carcinoma ( NPC) receiving intensity?modulated radiotherapy (IMRT). Methods A total of 30 NPC patients who were admitted to our hospital from May 2013 to December 2014 were enrolled in this study. The degree of xerostomia in these NPC patients was scored according to the Radiation Therapy Oncology Group scoring criteria. Color Doppler ultrasound was used to measure the peak systolic blood flow velocity of the parotid gland and submandibular gland and the changes in vascular diameter of the parotid gland in the NPC patients before, during, and after IMRT. The correlation between each parameter and the degree of xerostomia was determined by analysis of variance. Results In the 28 NPC patients included in the statistical analysis, the degree of xerostomia during IMRT was significantly higher than that before IMRT ( P=0024 ) , and the degree of xerostomia at 3 months after IMRT was significantly lower than that during IMRT ( P=0035) . The peak systolic blood flow velocity of the parotid gland and submandibular gland and the proportion of patients with decreases in vascular diameter of the parotid gland during IMRT were significantly higher than those before IMRT ( P=0001 and 0003;P=0001);the above parameters at 3 months after IMRT were significantly lower than those during IMRT ( P=0008 and 0012;P=0001) . During IMRT and after IMRT, the degree of xerostomia was significantly correlated with the peak systolic blood flow velocity of the parotid gland ( r=0563, P=0026;r=0409, P=0031) . Conclusions Ultrasound can be used as a noninvasive detection for the hemodynamic changes in the parotid gland, and it has a certain clinical reference value for evaluating the degree of xerostomia in NPC patients during and after IMRT.

Objective To observe the curative effect of repairing the distal foot skin and soft tissue defect by using flap.Methods We used nutrient artery flap and low external ankle to repair the foot distal skin soft tissue defect in 16 cases.Results The flap survived,necrosis happened in small skin edge part and distal skin flap of sural nerve nutrient artery flap in two cases,and the skin graft healing with dots after removed the necrotic tissue and changed dressing.16 cases were followed up for 3-16 months,2 cases of flap slightly bloated,1 case back to the hospital got thin skin flap repairing technique;14 cases of walking were as usual,2 lame cases,related to some tissue defect in patients with forefoot injury.The use of flap to repair the foot injury,could maximially recover the limb function,reduce the rate of the sick.Conclusion Skin flap is a kind of operation which is simple,with smaller cost for skin area,beautiful and effective to repair skin and soft tissue defect of foot.

Objective:To study the clinical manifestations and treatments of closed injuries of the cervical trachea.Method:We carried out a retrospective study of the clinical manifestations, diagnosis and treatment of patients with closed injuries of the cervical trachea that have been treated in our hospital over the last ten years. We analyzed commonly occurring clinical problems, key points of surgical treatment, and postoperative recovery. Fourty-one patients with acute closed injuries of the cervical trachea underwent emergency tracheotomy or anesthesia orotracheal intubation and surgical repair of the trachea within 24 to 48 hours. Twenty six patients had their tracheotomy tubes extubated after surgery and had their anesthesia orotracheal tubes extubated within 48 hours postoperatively; tracheotomy tubes remained in the airway in 15 patients postoperatively, and of them, 12 had extubation successfully in 2 weeks postoperatively, while the remaining 3 were left intubated due to laryngotracheal stenosis. Among the 3, 2 underwent further surgical repair and recovery, and 1 had a stent inserted.Result:Twenty-eight patients fully recovered postoperatively. Ten patients mostly recovered postoperatively exception for hoarseness, and their fundamental phonation function recovered within 2 to 3 months but with poor movement of the vocal cords. The breathing and swallowing function of the other 3 patients recovered after the surgery, but they suffer from hoarseness.Conclusion:In the treatment of closed disruption of the cervical trachea, prompt diagnosis and timely surgical repair of the structure and function of the trachea are key to saving the patients' lives and avoiding tracheal stenoses.

Objective To analyze the imaging features of congenital spinal deformity (CSD) associated with split cord malformation (SCM) and other intraspinal abnormalities, and to investigate the relationship to neurological symptoms. Methods 105 cases CSD with SCM were retrospectively studied. Analysis the imaging features of SCM (including type of SCM, location of SCM, location and apical vertebrae, symmetry of divided cord) and other intraspinal abnormalities. To investigate the relationship of the factors and neurological symptoms using Chi?square test of one factor and multiple factors logistic regression analysis. Re?sults 28 cases (26.7%) were formation failure, 33 cases (31.4%) were segmentation failure, and 44 cases (41.9%) were combina?tion of 2 disorders. 41 cases had neurological symptoms, 64 cases were asymptomatic. The distribution of SCM combined with spi?nal deformities:thoracic (11 cases), thoracolumbar (18 cases) and lumbar (20 cases) in type I SCM, thoracic (31 cases), thoracolum?bar (20 cases) and lumbar (5 cases) in type II, none was in cervical. The location of SCM upper than apical vertebrae 29 cases, on apical vertebrae 25 cases, lower than apical vertebrae 51 cases. Spinal cord was splitted symmetric 27 cases and asymmetric 78 cases. 66 cases combined with other intraspinal abnormalities, lower conus 42 cases, syringomyelia 38 cases, meningocele 10 cas?es and sakrale zyste 5 cases. Associated with intraspinal abnormalities, the rate of neural symptoms was different. According to Chi?square test of one factor and multiple factors logistic regression analysis, lumbar SCM, spinal cord asymmetric and lower conus were related with neurological symptoms. Conclusion The predilection spinal deformity of type I is combination, type II SCM is segmentation failure. When SCM patients associated with other intraspinal abnormalities, the incidence of neurologic symptoms is increased. The lumbar SCM, hemicords asymmetry and lower lying conus have significant relationship with neurologic symptoms.

Objective To report the effect of expanded neck and mastoid region flap in the reparation of facial scars.Methods Total 8 patients were included from January 2007 to May 2011.Tissue expanders were implanted in the neck and mastoid region after we selected suitable expander on the basis of an area of facial scars.Three to six months later,the expanded neck and mastoid region flap was used to repair large area of facial scars.Results From January 2007 to May 2011,we used expanded neck and mastoid region flap to resurface the facial scars in 8 patients.One patient appeared small size of necrosis (0.3 cm× 2.0 cm to 0.5 cm× 2.0 cm) in the distal area and healed after dressing changes.All the other patients healed completely.The period of follow-up was 6 months to 2 years.The flaps matched well to the surrounding skin in terms of color and good texture.Conclusions The method of combined expander neck and mastoid region skin flaps to repair facial scars is suitable.We believe this is a good option of repairing large area of facial scars.

Objective To observe cerebral hippocampus glucose metabolism using 18F-FDG micro-PET as an imaging technique in a normal group of mice, and model and electroacupuncture groups of SAMP8 mice with senile dementia (rapid aging mice). Method Four 6-month-old SAMR1 mice were picked at random out of the normal group and every four 6-month-old SAMP8 mice, out of the model and electroacupuncture groups respectively. Each of them was anesthetized by inhalation of 2% isoflurane and then given a bolus injection of radioactive tracer 18F-FDG 14.8~16.5 MBq through the tail vein. After one hour of the uptake, a PET scan was performed for 10 min. Hippocampus 18F-FDG uptake rate per gram of brain was calculated in every group of mice and the uptake rates were compared between the groups.Result The 18F-FDG uptake rate per gram of brain tissue was higher in the electroacupuncture group of mice than in the normal and model groups.Conclusion Electroacupuncture can markedly increase cerebral 18F-FDG uptake and the uptake rate per gram of brain tissue in SAMP8 mice. It may play a neuroprotective role through its influence on cerebral glucose metabolism.