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.

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 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.

Objective To investigate the alleviative effects of lidocaine postconditioning on pulmonary injury following ischemia reperfusion. Methods Seventy-two adult SD rats were randomized to 4 groups; sham group, ischemia-reperfusion (I-R) group, ischemic postconditioning(IPC) group and lidocaine postconditioning group. The pulmonary ischemia-reperfusion model was established by occlusion of the left hilum of lung for 45 min and the reperfusion was taken by removing the clamp for 2 h. At the moment of reperfusion, lidocaine 4 mg/kg was injected as a priming dose following a continuous rate of 4 mg/(kg · h). PaO_2, TNF-α, W/D of left lung, the level of MDA of left lung tissue were measured. At the end of reperfusion left lung was removed for microscopy. Results After reperfusion PaO_2 of lidocaine group was much higher than that of I-R group (P<0.05). Lidocaine postconditioning induced a significant decrease in the level of MDA of lung tissue[(7. 03±1.17) μmol/L] compared with ischemia reperfusion group [(8.77±1.42) μmol/L] (P<0.05). Lidocaine postconditioning resulted in a lower level of TNF-α [(1. 69±0.34) μg/L] than that of I-R group [(2. 52±0. 54) μg/L] (P < 0. 05). Microscopic examination showed that lidocaine postconditioning could decrease the level of edema of left lung and accumulation of neutro-phils. Conclusion Lidocaine postconditioning exerts a protective effect on pulmonary ischemia-reperfusion injury administered in the beginning of reperfusion. The effect may be explained by to the antioxidant effect and the suppression of expression of TNF-α.

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 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.

Objective To discuss the issue of the limb salvage versus the amputation of serious lower limb injury. Methods The history, the age, the clinical presentation, the treatment time and method of the 72 severe open fractures of the lower limb were studied. Following the patients admission, they were examined completely in emergency room and were sent to radiological department for taking X ray films. According to Gustilo and Andserson classification, there were 48 limbs of type ⅢB and 24 limbs of type ⅢC.16 limbs had multiple trauma as well as severe lower extremity injury. Among them, there were 7 (9.7%) limbs with head or spine injury, 5(6.9%) limbs had abdominal trauma, 4(5.6%)limbs had thoracic trauma. Results 16 limbs in 72 limbs were amputated, in which 7 limbs were type ⅢB and 9 limbs were ⅢC. 4 limbs in 8 limbs of more than 50 years old were amputated. The ratio of amputation was 50.0 %. 12 limbs in 64 limbs younger than 50 years old were amputated. The ratio of amputation was 18.8%.Their comparison has statistically significance(?2=4.018, P

ve To explore the effective methods for removing the nitrogen oxides in tobacco smoke main stream. Methods Porphyrin and ferriporphyrin were added into cigarette filter with doses of 2.0, 4.0 and 8.0 ?g per cigarette. The effectiveness of removal of nitrogen oxides in tobacco smoke main stream by porphyrin and ferripor-phyrin were determined by muriatic acid naphthaline-ethylene diamine spectrophotometry. Results The contents of nitrogen oxides in tobacco smoke main stream decreased with the increases of the contents of porphyrin and ferripor-phyrin added into the cigarette filters (porphyrin: r= -0.9943, P

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.