Objective To investigate the intervention of low molecular weight heparin on lung function and coagulation function of patients experiencing acute exacerbation of chronic obstructive pulmonary disease (COPD).Methods Senventy patients,hospitalized in our department from 2009 -2010,with acute exacerbation of COPD,were randomly divided into control group ( 32 patients) and anticoagulation group ( 38 patients).The control group was treated with oxygen inhalation,antibiotics,antispasmodic asthma,relieving cough and phlegm.The anticoagulation group received low molecular weight heparin 4100 IU AXa/times by abdominal subcutaneous injection at 12 h intervals addition to that of control group.Ten days were considered as a course of treatment in both groups.All patients received pulmonary function and blood coagulation testing before and after treatment.Results After treatment,lung function and arterial blood gas indices were significantly improved in both groups ( the anticoagulation group:t =8.2064,6.9207,9.4351,7.5845,7.5241 ; the control group t =5.5588,3.0795,3.9374,2.8488,2.7726,all P ＜ 0.01 ),but the patients in anticoagulation group were improved more significantly than the control group( t =3.2732 4.0167,7.3392,2.2528,3.0008,Pall ＜ 0.01 ) ;anticoagulation treatment greatly improved the plasma D-dimer ( D-dimer,DD) content and the coagulation parameters in anticoagulation group ( comparing with that before treatment,t =5.721,23.235,25.318,23.841,11.354,Pall ＜ 0.01 ; comparing with that of control,t =7.738,19.365,23.373,21.008,9.712,Pall ＜ 0.01 ),while the control group did not produce significant improvement after treatment (t =1.9409,8.0000,1.1592,1.6562,1.2726,P all ＞ 0.05 ).There were had no serious adverse reactions in the anticoagulation treatment group.Conclusion Although the conventional treatment can improve the symptoms of the patients with COPD,but it can't effectively improve the patient's blood hypercoagulability.Conventional therapy combined with low molecular weight heparin anticoagulant therapy is able to improve the blood coagulation hence the lung function in COPD patients.

Epilepsy is the common neurological disease, and antiepileptic drugs are the main means for the treatment of epilepsy. However, there is no conclusion on the timing of drug withdrawal in patients with epilepsy. In recent years, some large-scale prospective studies have provided some guidance on anti-epileptic drugs withdrawal. This article focused on the factors affecting the prognosis and timing of drug withdrawal, hoping to further the understanding of anti-epileptic drugs withdrawal and instruct clinical practise.

ObjectiveTo study the technique and therapeutic effect of percutaneous cannulate screw fixation to treat the traumatic diastasis of the pubic symphysis.MethodsFrom February 2003 to December 2010,46 patients (27 men and 19 women,mean age of 34.6 years) with unstable pelvic fractures and diastasis of the pubic symphysis were admitted.All the patients were treated by closed reduction and percutaneous cannulate screw fixation of the symphysis pubis.Then to complete the fixation of posterior ring,by percutaneous screw inserted through the sacroiliac joint or posterior iliac wing.According to Tile's classification,the patients were classified into type B1.1 in 4 cases,B1.2 in 7,B2 in 2,B3 in 2,C1.1 in 7,C1.2 in 7,C1.3 in 10,C2 in 5 and C3 in 2.All patients were performed posterior ring fixation except 4 cases of type B1.1.Anteroposterior,inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities,and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws.ResultsThe average operative time was 45 min (range,15-65 min),and the average intraoperative blood loss was 25 ml (range,15-50 ml).Each patient was inserted one screw in the symphysis pubis.Thirty-five patients underwent postoperative pelvic CT scan and 3screws of them penetrated the wall of symphysis pubis.The average follow-up period was 23.5 months (range,5-48 months).In the follow-up period,no infection and displacement were found.The last follow-up result:according to Matta and Tornetta's standard,the result was excellent in 43 cases and good in 3.Among all patients,31 cases (67.39％) had returned to their original works,6 were to give up their original works as complicating injuries; 28 cases had no pain,13 cases had slight pain of the symphysis pubis while to make an effort,5 cases had pain of sacroiliac joint.There were no iatrogenic injury of nerve.ConclusionClosed reduction and percutaneous cannulate screw fixation of the traumatic diastasis of the pubic symphysis is a safe,feasible and easy manipulated method.The operative injuries is small and the clinical outcome is satisfactory.

Objective To investigate the methods of X-ray diagnosis of various displacement of unstable pelvic fracture in three-dimensional space and its instructive significance in closed reduction.Methods A normal adult pelvic specimen was selected and fixed in a wood-frame at supine position after soft tissue rejection and ligament preservation.With the breakage at the unilateral anterior-posterior ring,models of hemipelvic rotation in the transverse and sagittal planes and hemipelvic vertically upward displacement were induced.Anteroposterior radiographs of the pelvic specimen were made and picture archiving and communication system (PACS) was used to measure width of iliac wing,suprainferior diameter of hemipelvis,vertical displacement of iliac crest,acetabulum roof,pubic tubercle and sciatic tuber and area of obturator foramen.Methods of X-ray diagnosis of various displacements of hemipelvis were concluded and applied in treatment of 43 patients with unstable pelvic fractures.Operation time and intraoperative blood loss were recorded.Postoperative images were evaluated by Matta standard.Results Hemipelvic rotation in transverse plane included eversion and inversion.Width of iliac crest was enlarged and area of obturator foramen was shrunk while extroversion ; on the contrary,an opposite result was observed while inversion.Sagittal rotation included pronation and supination.Pubic tubercle had obvious downward shift,iliac crest presented no change or slight upward shift,suprainferior diameter of hemipelvis was lengthened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was shrunk while pronation; on the contrary,pubic tubercle had obvious upward shift,iliac crest presented no change or slight downward shift,suprainferior diameter of hemipelvis was shortened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was enlarged while supination; iliac crest,acetabular roof,pubic tubercle and sciatic tuber presented equidistant upward shift while the hemipelvis displaced upward vertically.Average operation time was 55 minutes (range,15-85 minutes) and intraoperative blood loss was 26 ml (range,10-50 ml).According to Matta standard,pelvic radiography evaluation at postoperative 3 days was excellent in 31 cases and good in 12 cases,with excellent and good rate of 100％.Conclusion Pelvis X-ray films are able to diagnose various three-dimensional displacement of unstable pelvic fractures and guide closed reduction timely and rapidly to achieve satisfactory result.

Objective To investigate the anatomical features, operative method and efficacy of internal fixation in the treatment of iutra-articular fractures of caleaneum via the sinus tarsi approach. Methods The pathway, branches distribution and anastomosis of perforating descending branch of peroneal artery were observed on 18 adult cadaveric lower limbs. A sinus tarsi approach was designed. From July 2001 to January 2008, 71 intra-articular calcaneal fractures in 68 patients were treated with open reduction and internal fixation via sinus tarsi approach at lateral sides of calcaneus. According to the Sanders classification, there were 26 type Ⅱ fractures, 32 type Ⅲ fractures and 13 type Ⅳ fractures. Results All patients were followed up for a mean period of 39.3 months (13-85 months), and the fractures were completely healed. There was a significant difference in the length, width and height of the calcaneus, Bohler angle and Gissane angle before and after operation (P < 0.01). According to Maryland Foot Score, the operative effect was excellent in 33 feet, good in 29 feet, fair in 6 feet and poor in 3 feet. Conclusion Open reduction and internal fixation via sinus tarsi approach is an effective method for minimally invasive treatment of intraarticular fractures of the calcaneus, with the advantages of good clinical results and causing minimal damage to soft tissues.

Objective To introduce the methods and key points for the external fixation combinel with limited percutaneous internal fixation plus colostomy in the treatment of open pelvic fracture concomitant with perineal laceration.Methods Nine patients with open pelvic fractures concomitant with perineallaceration were treated by external fixator combined with limited percutaneous internal fixer plus colostomy. Data including injury details, management and outcomes were collected for comparison.Results All the patients survived and attained bony union except for two patients with local infection that was healed several days after repeated wound debridement and use of wide spectrum antibiotics. All the patients had good extremity function at the latest follow-up. Conclusion External fixation combined with limited percutaneous internal fixation plus colostomy is a reliable, safe and less invasive procedure for the treatment of open pelvic fractures concomitant with perineal open wound.

Objective To study the therapeutic efficacy of the chondroplasty with radiofrequency technique under arthroscope for osteoarthritic knees in the senile patients.Methods Thirty-six patients were divided randomly into control and test groups(in each with 18 patients).The patients suffered from osteoarthritis of knees.The control group confirmed and treated by knee arthroscope,which was subjected to debridement with routine technique.The test group was treated by chondroplasty with radiofrequency technique under arthroscope.Results The patients developed no infection or other complications.Better therapeutic results were obtained after follow up of 6 to 18 months.Conclusions Chondroplasty with radiofrequency technique under arthroscope for the osteoarthritic knees has the advantages of less injury,less bleeding,less complication and quick recovery.

OBJECTIVETo evaluate the clinical effects of percutaneous pedicle screw fixation(PPSF) combined with percutaneous vertebroplasty(PVP) for the treatment of osteoporotic thoracolumbar fractures.

METHODSThe clinical data of 94 patients with osteoporotic thoracolumbar fractures treated from January 2014 to December 2015 were retrospectively analyzed. There were 31 males and 63 females, aged from 65 to 70 years old with an average of 67.2 years. Fracture level was T₁₁ on 15 cases, T₁₂ on 32 cases, L₁ on 29 cases and L₂ on 18 cases. The patients were divided into two groups according to different therapeutic methods. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty were applied in 43 patients(group A) and percutaneous vertebroplasty was applied to 51 patients(group B). Operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time were recorded; preoperatively, 3 d, 1 year after the operation, the ratios of anterior border heights, sagittal Cobb angles, visual analogue scale(VAS) scores were compared between two groups. The condition of postoperative complication in two groups was analyzed.

RESULTSAll the patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time of group A [(96.2±28.7) min] was longer than that of group B [(31.8±10.6) min]. Intraoperative blood loss of group A[(62.2±25.5) ml] was more than that of group B [(25.4±10.9) ml]. Bone cement volume of group A [(5.5±0.5) ml] was larger than that of group B [(4.9±1.1) ml]. Postoperative in-bed time of group A[(5.1±1.8) d] was longer than that of group B[(1.8±0.7) d]. There were significant differences in operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time between two groups(<0.05). Three days, 12 months after the operation, the ratios of anterior border heights and Cobb angles in two groups were significantly improved. At final follow-up, the ratio of anterior border height and Cobb angle of group A[(85.6±3.5)%, (11.9±5.3)°] were better than of group B[(84.2±4.5)%, (15.3±3.4)°](<0.05). Three cases in group B had re-collapse of cemented vertebral bodies. Postoperative at 3 d, 1 year, VAS score of all patients had significantly decreased(<0.05), and there was no significant difference between two groups(>0.05).

CONCLUSIONSCompared to simple PVP, PPSF combined with PVP in treating osteoporotic thoracolumbar fracture can obtain stronger vertebral strength and stiffness, furthermore to improve vertebral reduced effect, keeping vertebral heights, and preventing vertebral re-collapse.

Aged ; Female ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Osteoporotic Fractures ; surgery ; Pedicle Screws ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Treatment Outcome ; Vertebroplasty

OBJECTIVEThe skeletal Class III malocclusion often occurs in ethnic Asia population, and it is difficult to obtain an ideal results if only treated with protraction headgear (PH). However, the combined rapid palatal expansion (RPE), Edgewise Technique and PH can reach it, so the authors investigated the methods and characteristics of combined RPE, Edgewise Technique and PH in the treatment of skeletal Class III malocclusion.

METHODSFifteen patients, aged 8.5-12 years, including six males and 9 females, with skeletal Class III malocclusion and maxillary retrusion were selected for this study. Radiographs of left hand and wrist showed that all patients were at the pre-pubertal stage. The duration of treatment was nine months on average.

RESULTSThe SNA and A-ptm increased with a mean of cephalometric analysis, which showed significant difference (P < 0.05).

CONCLUSIONObvious skeletal and profile changes can be achieved with combined RPE, Edgewise Technique and PH in the treatment of early skeletal Class III malocclusion.

Child ; Extraoral Traction Appliances ; Female ; Humans ; Male ; Malocclusion, Angle Class III ; therapy ; Orthodontics, Corrective ; instrumentation ; methods ; Palatal Expansion Technique

Objective To evaluate the clinical outcome in the treatment of humerus shaft comminuted fractures using limited open reduction and internal fixation combined with an external fixator.Methods Data of 80 patients with comminuted humerus shaft fractures treated from January 2005 to January 2013 were analysed retrospectively.All the patients underwent limited open reduction and internal fixation combined with an external fixator (treatment group) and open reduction and plate fixation (control group) according to the random number table.In the treatment group,there were 40 patients (28 males,12 females),at mean age of 33.5 years (range,21-54 years),with causes of injury including traffic accidents in five patients,falls in nine,crashes in seven and others in six.There were seven patients with open fractures and 33 with closed fractures.In the control group,there were 40 patients (25 males,15 females),at mean age of 32.9 years (range,19-55 years),with causes of injury including traffic accidents in 16 patients,tumbling in seven,crush in seven and others in ten.There were eight patients with open fractures and 32 with closed fractures.The operation time,intraoperative blood loss,bone union time and complications in both groups were recorded.Clinical efficacy was evaluated using the Stewart and Hundley standard.Results Mean follow-up was 19 months (range,15-24 months).Treatment and control groups showed significant differences in operation time [(55.5 ± 10.3) minutes vs.(120.5 ± 15.3) minutes],intraoperative blood loss [(120.4 ± 20.7) ml vs.(245.4 ± 26.7) ml] and bone union time [(11.6 ± 1.3) weeks vs.(14.9 ± 2.3) weeks] (P ＜ 0.05).Rate of incision infection was 8％ (3/40) in treatment group and 10％ (4/40) in control group (P ＞ 0.05).In treatment group the results were excellent in 31 patients and good in nine.In control group the results were excellent in 27 patients,good in nine,fair in one and poor in three.One patient with radial nerve injury after a second surgery for implant removal and two patients with osteomyelitis or bone nonunion were noted in control group.Conclusion Limited open reduction and internal fixation in combination with an external fixator is associated with small trauma,easy operation,short operation time,few bleeding,rigid fixation,early functional exercises and reduced bone nonunion for treatment of comminuted humerus shaft fractures,which exhibits great clinical value.