To investigate the therapeutic effect of electroacupuncture on shoulder-hand syndrome in apoplectic hemiplegia. Methods:One hundred and sixty patients were randomly divided into two groups. 80 cases in the control group was treated by conventional acupuncture by filiform needles and 80 cases in the treatment group were treated by electroacupuncture. The therapeutic effects were evaluated after two courses of treatment.Results:After two courses of treatment,the therapeutic effect for edema on back of the hand and hand pain in digital flexion and the total effective rate were better in the treatment group than in the control group (P＜0.05). Conclusion:Electroacupuncture is of significant importance for relieving pain on back of hand,preventing the muscular atrophy of hand and promoting recovery from apoplexy.

Objective To discuss the etiology,clinical findings,anatomical characters,diagnosis and treatment of the painful flexion deformity of the hallux after open reduction and internal fixation of the fibular fractures.Methods From October 1996 to March 2004,we treated 33 cases with flexion deformity of the hallux after fibular fracture,including 19 males,14 females,with a mean age of 33.2 years old(ranged from 22 to 49 years).24 cases were ankle fractures,according to Lauge-Hansen clssification,pronation-external rotation for 18 cases;supination-exteral rotation for 4 cases;pronation-eversion for 2 cases.9 cases were distal third tibial and fibular fractures.19 cases were simple hallux flexion deformity,8 cases were combined with the second and third toes deformity,6 cases were combined with not only the second and third toes but also the fourth and fifth toes deformity.The deformities were corrected by flexor hallucis longus tendolysis or lengthening alone or flexor digitorum longus lengthening in combination.Results 19 cases were simple hallux flexion deformity,the deformities were corrected simply by flexor hallucis longus tendolysis(7 cases)and lengthening(12 cases).14 cases were combined with the lesser toes deformity,the flexor hallucis longus tendon were lengthened alone in 6 cases,and both the flexor hallucis longus and the flexor digitorum longus were lengthened in 8 cases.During an average duration of follow-up of 6 months(2 to 10 months),there were no postoperative complications.All patients had full correction of all deformed toes and reported relief from pain,ease of shoe-fitting and subjective improvement of gait.There was no recurrence of the deformity.Conclusion Adhesions of the flexor hallucis longus tendon to the fibular fracture site should be considered when a flexion deformity of the hallux occurs after open reduction and internal fixation of the fibular fractures.Variations in the interconnections between flexor hallucis longus and flexor digitorum longus in the region of the knot of Henry also have special clinical significance.

ObjectiveTo observer the effect of autograft of semitendinosus and interference screws for reconstruction of lateral ankle ligaments. MethodsA total of 12 cases of injured lateral ankle ligaments were selected, including 7 males and 5 females with an average age was 29.4 years, with a course of disease from 3 to 6 months. All lateral ligaments were reconstructed by autograft of semitendinosus & bio-interference screws. A 4.5 mm diameter tunnel was drilled on the lateral ankle, where the tendon of semitendinosus was permeated through, both ends of semitendinosus tendons were fixed with bio-interference screws on talus of at the end of anterior talofibular ligament and calcaneus of at the end of calcaneofibular ligament, maintaining ankle neutral and moderate valgus position. Following operation, the ankle was fixed in neutral position and slightly valgus position with plaster cast. The wound healing, the outcomes of American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and stress radiographic evaluation were assessed at the follow-up. ResultsAll 12 patients showed no infection and the wound healed well at the primary stage. At 3, 6, 12, 24 months after operation, all patients were followed-up. According to AOFAS and FAOS of preoperation and final follow-up postoperation, function of ankle in all patients was significantly improved (P＜0.01), the scores of Chrisman-Snook group were more lower than this approach. No patients complained of instability of the ankle, and stress radiograph confirmed this improvement. ConclusionReconstruction of lateral ligaments of the ankle with autograft of semilendinosus & biointerference screws is a practical and reliable treatment, which restores stability and function of the ankle.

Objective To explore serratus anterior muscle transplantation for the repair of soft tissue defects in foot and ankle. Methods Seventeen patients consisted of 11 males and 6 females aging from 13 to 58 years with the mean age of 35.2 years. The anatomical parameters of serratus anterior of 17 cases were measured, the thickness of the muscle was (1.24?0.65) cm, and the diameter of origin point of the nutrient artery to the muscle was (1.4?0.6) mm. There were two veins arising from the muscle, the diameter of larger one was (2.5?0.8) mm. The length of vascular pedicle was (8.31?1.48) cm. 17 patients with soft tissue defect of foot and ankle were treated with free serratus anterior muscle transfer and split skin graft overlying the muscle. The primary lesions were soft tissue defect around the ankle and Pilon fracture in 5 cases, non-union of distal tibial fracture in 3, Achilles tendon and soft tissue defect in 3, metatarsal fracture and soft tissue defect in 4, and calcaneal fracture with soft tissue defect in 2. All of the patients suffered from infection or exposure of bone or applied plate, the area of soft tissue defect ranged from 4.5 cm?6 cm to 11 cm?13 cm. Results The average operative time was (6.5?1.2) hours. The complications included local hematoma in 2 cases, superficial infection in 2, winged scapula without function loss in 1,scar pain in 2, and numbness of lateral thoracic wall in 1. Furthermore, weakness and decreased shoulder mobility were noted in 3 patients comparing with the contralateral side, but the condition improved half year following the operation. The transferred muscle flap appeared thinner and less bulky , and healed intimately with the adjacent foot tissue, the patients resumed good function in walking. Conclusion The serratus anterior muscle flap is a good choice for treatment of soft tissue defects in foot and ankle.

30 sexually mature, virgin female SD rats, weighed 200-270 g were mated and used for the study of the teratogenic effect of N, N-methylene-bis (2-amino-1,3,4-thiadiazole) (Bis-A-TDA) on fetal neural tube formation and to explore the possible morphological mechanism of neural tube defects (NTD). In the morning of day 10 of gestation, the experimental group was administered with 10mg/kg body weight Bis-A-TDA mixed in peanut oil, and the control group with the same amount of peanut oil only. The results Showed that the incidence of NTD was 52.9% and the majority of NTD were excencephaly and encephalocele in the experimental group. In the early stage of NTD formation, some neuroepithelial cells showed vacuolated degeneration and necrosis, and the mitochondria became swollen and with indistinct or even disappeared crista. The intercellular spaces widened, and some cells escaped into the lumen of neural tube. The mitotic index of neuroepitbelial cells were sharply decreased. In the closure region of the telencephalon, similar changes of the neuroepithelium were present also, and decreased migration of mesodermal cells was noted. We consider the failure of cranial neural folds to approximate and closure was caused mainly by the damage of neuroepithelial cells, inhibition of cell proliferation, alteration of intercellular junctions and the changes of topographical arrangement of the neuroepithelium. The damage and delayed migration of mesodermal cells might also be involved in this event.

Objective To introduce the technique.indication and outcome of treatment of degenerative Achilles'rupture with transfer of flexor hallucis longus tendon and V-Y tendinous flap. Methods From October 2003 to May 2006,21 cases of degenerative Achilles'tendon rupture were treated in our department using transfer of flexor hallucis longus tendon and V-Y tendinous flap.Rivets were used in 17 cases and surface screws in 4.They were followed up for 12 to 18 months(average,14). Results According to the Arner-Lindholm criteria for curative results,19 of the 21 cases were excellent and 2 good.Follow-ups revealed no Achilles'tendon re-rupture,infection,skin necrosis,stiff ankle,or injury to nerves and vessels.Walking gaits nearly recovered to normal.The repair strength allowed early functional exercise of the Achilles'tendon. Conclusion Transfer of flexor hallucis longus tendon combined with V-Y tendinous flap can cure the degenerative Achilles'tendon ruptures and defects of Achilles'tendon within 3 cm.

Pedicle screw fixation is widely used in spine surgery, which allows 3?dimensional fixation with a more rigid construct and permits a shorter fusion length. However, conventional pedicle screw fixation has some drawbacks, including signifi?cant muscle dissection for the exposure of bone marks. Although percutaneous pedicle screw technique can compensate for above defects, it requires an additional approach for decompression and bone graft insertion. Besides, the percutaneous pedicle screw technique depends on intraoperative multiplanar fluoroscopy, which results in high risk of radiation exposure of the surgeons and patients. Screw loosening is a well?known complication, especially in osteoporosis patients. Several methods can enhance screw stability, for example, modifying screw design and augmenting vertebral bodies with reinforcing materials that can improve the structural capacity of the deteriorated tissue, however, they also have some disadvantages. Although we can enhance bone?screw by modifying screw design, it is not useful in severe osteoporosis patients. At the same time, bone cement can increase pedicle screw axial pullout strength and fatigue resistance, however, it is associated with a number of inherent disadvantages such as its high exothermic polymerizing temperature, toxicity of the monomer, and risk of leakage to the spinal canal. Santoni et al. intro?duced cortical bone trajectory (CBT) for lumbar pedicle screw with a new screw design that is shorter and smaller in diameter which has been proposed to maximize the thread contact with this higher density bone surface. In addition, the CBT technique fol?lows a caudocephalad path sagittally and a laterally directed path in the transverse plane, engaging only cortical bone in the pedi?cle without the involvement of the vertebral body trabecular space. Finally, the screw insertion point of this technique locates around lateral pars, enabling less tissue dissection. Therefore, it can be an alternative approach to enhance screw fixation strength, and it may rescue failed pedicle screw and be used in minimally invasive spine surgery.

Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P ＜ O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8％).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis.

Objective:To compare the efficacy and safety of Shikani ( S) optical stylet and Macintosh (M) laryngoscope for double-lumen endotracheal tube intubation .Methods:In the study, 60 patients undergoing elective thoracic surgery were randomly allocated to group S ( n=30 ) and group M ( n=30 ) . After general anesthesia induction , the patients in group S and group M were intubated double-lumen en-dotracheal tube ( DLT) by Shikani optical stylet ( SOS) and macintosh laryngoscope respectively .Intuba-tion time, intubation attempts , cuff broken and oral mucosal or dental injury were recorded;Blood pres-sure and heart rate at baseline ( T0 ) , at the time of intubaiton onset ( T1 ) , 1 minute after intubaiton (T2), 3 minutes after intubation (T3) and 5 minutes after intubation (T3) were also recorded;Hoarse-ness and throat sore of the patients 24 hours after surgery were evaluated .Results:The intubaiton time with the SOS was faster than with the Macintosh [(37.4 ±9.7) s vs.(43.9 ±13.7) s, P=0.039] and the first attempt success rate (87%vs.80%, P=0.488) did not differ between the groups; No tube cuff broke in both the groups;Group S had fewer patients who suffered oral mucosal or dental injury than group M (8 vs.2, P=0.038);The blood pressure and heart rate at T0,T1,T2,T3 and T4 did not differ between the groups;Throat sore(7 vs.10, P=0.390) and hoarseness (5 vs.7, P=0.519) incidence did not differ between the groups .Conclusion:By comparison of the Macintosh laryngoscope , the SOS provides faster DLT intubation and causes less oral Mucosal or dental injury .

PurposeCT myelography (CTM) and gadolinium-enhanced MR myelography (Gd-MRM) are essential methods used for localizing spinal cerebrospinal fluid leaks in patients with spontaneous intracranial hypotension (SIH) and are significant for diagnosis and guided epidural blood patches. This paper analyzes the rate and imaging features of unsuccessful myelography due to misinjection of contrast into epidural space to guide prompt and correct clinical judgment of unsuccessful myelography.Materials and Methods Myelography from 121 patients with SIH was retrospectively reviewed and the image features of the unsuccessful myelography were analyzed.Results A total of 128 myelography examinations were done. Contrast media was accidently injected into the epidural space in 33 examinations. The failure rate was 25.8%. In all 33 failed exams, bilateral spinal nerve roots on both sides of the dural sac passing through contrast media was observed without visualization of anterior and posterior nerve roots. Cauda equina was not seen within contrast media in 29 cases (87.9%); non-diffusion of contrast media into cisterns and ventricles in 26 cases (78.8%). Contrast was not continuous in spinal canal in 16 cases (48.5%), heterogeneous in 10 cases (30.3%). In 4 cases (12.1%) the inner contour of contrast was not smooth.Conclusion The unsuccessful rate of myelography is relatively high in SIH patients. A prompt and correct decision could be made based on the knowledge of contrast misinjection imaging features.