Micro-invasive thoracic surgery has become new trends of thoracic surgery,and video-assisted thoracic surgery (VATS),which has the advantage of less trauma,rapid recovery and fewer postoperative complications,has become the mainstream of lung cancer resection.With the development of technology and surgical instruments,VATS has taken the place of open procedure,and the postoperatively follow-up also showed that both the two procedures have similar results in long-term survival rate and so on.With years of rapid develop,now the traditional VATS has nearly been perfect,the thoracic doctors eagerly try to find a new kind of micro-invasive surgery.It is in this background that Uniportal video-assisted thoracic surgery is born and it has been received by more and more operators.Uniportal VATS is not only inferior than multiportal VATS in Postoperative survival,but also has the advantage in reliving post thoracotomy chest pain as it only has one incision.In this paper,the author would like to summarize up the newest development of uniportal VATS in recently years.

The anterior cruciate ligament (ACL) injury in sports is a common knee joint injury.It is widely accepted to reconstruct ACL under arthroscopy with autologous patellar ligament or popliteal ligament fixed in tibial or femoral tunnel with interference screws.Interference screws are widely used as intra-articular fixation devices in ACL reconstruction.The ideal materials for interference screw provide rigid fixation of graft with high mechanical strength,long-lasting stiffness and the bioactivity to stimulate osteointegration and tendon-bone healing.Current interference screws are made of metals and bio-absorbable polymers.Metallic interference screws provide high mechanical strength and stiffness for tendon graft fixation,but require a second surgery for removal.Bioabsorbable interference screws made of polymers avoid second surgery for removal,but have lower mechanical strength and might cause aseprtic inflammation during its degradation as well as screw slip,tunnel enlargement and many other complications.Magnesium (Mg) has been investigated as a novel and potential biomaterials for biodegradable interference screws.Mg is essential nutrient element and has good biocompatibility.Its mechanical strength and related stiffness are much higher than that of biodegradable polymers and are close to cortical bone.Furthermore,the degradation rate of Mg in vivo could be modulated via techniques such as alloying.In previous studies,the relationship between screw design and its pull-out force has been investigated,based on which the design of interference screw is optimized.The mechanical properties (the ultimate load to failure and the related stiffness) of interference screws proved to be higher than that of bioabsorbable interference screws sharing the same design both in vitro and in vivo.Furthermore,Mg performs good biocompatibility without severe intra-articular inflammatory reactions,as well as unique bioactivities to promote osteointegration,mineral deposition and the regeneration of fibrocartilaginous entheses.The present study reviews the researches of Mg interference screws both in vitro and in vivo,gives reference for further research and has great importance for the application of Mg interference screws in ACL reconstruction.

Objective To evaluate the clinical outcomes of open reduction and locking plate fixation with or without auto-iliac graft for humeral shaft nonunion.Methods Between January 2008 and May 2012,65 cases of humeral shaft nonunion were treated in our department.They were 48 men and 17 women,24 to 54 years of age (39.8 years).Of them,43 were atrophic and 22 hypertrophic.The radial nerve was exposed and protected during operation.After the nonunion portion was debrided,the humeral length was recovered.Next the fracture sites were fixated by a locking plate.The defected area was filled with auto-iliac graft if necessary.The visual analogue scale (VAS) scores and The Short Form-36 (SF-36) scores were documented after operation; the functional recovery was evaluated using Constant scoring at the last follow-up.Results The patients obtained a mean follow-up of 13.8 months (from 10 to 32 months).Of them,50 achieved clinical bone union after an average of 3.8 months (from 3 to 7 months).The remaining 6 cases showed no sign of union 9 months postoperatively.Of the 50 patients with union,the mean VAS score was decreased significantly from the preoperative 5.1 ± 3.2 points to the postoperative 1.4 ± 0.8 points,and the mean SF-36 score was increased significantly from the preoperative 45.7 ± 16.9 points to the postoperative 72.9 ± 18.5 points (P ＜ 0.05).The function was scored at the last follow-up as excellent in 34 cases,good in 12,fair in 2 and poor in 2,giving an excellent to good rate of 92.0％.The radical nerve injury was repaired within 3 months postoperation in 3 patients.Rotation deformity occurred in 3 cases without obvious functional limitation.No implant complications such as plate breakage and screw loosening were observed.Conclusion Open reduction and locking plate fixation with or without auto-iliac graft is one effective treatment of humeral shaft nonunion,but damage to the radial nerve should be avoided and fixation of 6 layers of cortex should be maintained at both fracture ends during operation

Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg.Methods Sixteen patients were identified from a retrospective review from July,2008 to July,2013,who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method.There were 12 males and 4 females aged from 22 to 62 years old (average 42.6 years old).The size of soft tissue defect ranged from 8 cm×9 cm to 30 cm×20 cm.The length of the bone discrepancy ranged from 2 to 14 cm.According to the local condition of the lower leg and the size of the composite tissue defects,10 patients received the free flap covering,6 patients repaired by the saphenous neurocutaneous perforator flap (3 cases) and sural nerve neurocutaneous flap (3 cases).Daily monitoring the skin temperature postoperative.Distraction was commenced on postoperative day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments.Results The follow-up time ranged from 18 to 36 months.Sixteen flaps survived completed,only 1 flap was observed the venous congestion in postoperative day 2.The duration of ilizarov application ranged from 3.5 to 18.0 months.All patients achieved final union.All patients were satisfied with the outcome of the surgery.Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg.Significantly reduce patient treatment time,improving traction osteogenesis of long bones and the ability of resistance to infection.

BACKGROUND: Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE: To investigate the outcome of autologous iliac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN, TIME AND SETTING: The own control study was performed at the Department of Orthopaedics, Sixth People’s Hospital, Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS: Of 21 cases of the ununited distal ulnar fracture with osseous defects, 13 cases were induced by ulnar and radial fracture, and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fractureof first onset. Bone defects were 1.5 cm-5.0 cm, averagely 3.1 cm. METHODS: Bone defects were filled with intercalary iliac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate, reconstruction plate or locking compression plate. At least two screws were used at the distaend, and 3 or 4 screws were fixed in the proximal end. Follow-up was conducted once per month to observe clinical appearanceand radiograph in each patient. MAIN OUTCOME MEASURES: Fracture nonunion, dorsal extension and palmer flexion of wrist joint, pronation and supination othe forearm were measured. RESULTS: All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union, and a mean timof 4.6 months (ranged 3 to 7 months). The distal ulnar healed with

Objective To report the anatomical study and clinical application of the medial sural artery pertorator flaps. Methods The anatomical study involved 12 fresh adult cadaver lower legs, the arteries of which were perfused with suspensions of lead oxide and gelatine. The bifurcation, location, length, diameter and blood territories of the medial sural artery and its perforating vessels were recorded by dissection, angiography and photography. The integument of the leg was dissected and ridiographed. The tendency of the vessels was analyzed, the surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. With the aid of anatomic study, a series of five clinical cases was reported, including five free medial sural flaps for ipsilateral hand reconstruction. Results There was at least one perforating vessel in the medial sural areas of the specimen. A mean of 2.1 perforators was noted over the medial gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease, 1 to 5 cm from the posterior medial line. Their diameter was (1.03±0.22)mm at the deep fascial level. The average vascular territory on the sural area was (107.5±23.9)cm2, and the average supplying area of single perforator was (58.3±17.0)cm2. All the transferred free flaps taken in the 5 clinical cases survived uneventfully. All the patients were followed-up from 6 months to 12 months. The appearance of flaps and the function of the limbs were satisfied. Conclusion The standard method for the study of perforator flap is the lead oxide-gelatin technique. It is the anatomic basis that there are perforating musculocutaneous vessels on the medial gastrocnemius muscles constantly. The free medial sural perforator flap has the advantage of good appearance. It is the safe and suitable choice in the cases when a medium or small-sized flap is required for resurfacing hand injuries.

Objective: To investigate the effects of enamel matrix pr ot eins(EMPs) and purified EMPs(EMD) on the proliferation and protein synthesis act ivity of rat ectomesenchymal stem cells in vitro. Methods: C ell culture technique and 3H-leucine label assay were used to measure the pr oliferation and protein synthesis activity of rat ectomesenchymal stem cells exp osed to the EMPs- or EMD-conditioned culture media with different concentratio n. Results: Both EMPs and EMD at 50～200 mg/ml increased the pro l iferation and protein synthesis of the cells in 10-day-culture. EMPs and EMD a t 150 mg/ml showed the strongest effects(P

BACKGROUND:Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE:To investigate the outcome of autologous lilac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN,TIME AND SETTING:The own control study was performed at the Department of Orthopaedics,Sixth People's Hospital,Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS:Of 21 cases of the ununited distal ulnar fracture with osseous defects,13 cases were induced by ulnar and radial fracture,and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fracture of first onset. Bone defects were 1.5 cm-5.0 cm,averagely 3.1 cm. METHODS:Bone defects were filled with intercalary lilac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate,reconstruction plate or locking compression plate. At least two screws were used at the distal end,and 3 or 4 screws were fixed in the proximal end,FoUow-up was conducted once per month to observe clinical appearances and radiograph in each patient. MAIN OUTCOME MEASURES:Fracture nonunion,dorsal extension and palmer flexion of wrist joint,pronation and supination of the forearm were measured. RESULTS:All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union,and a mean time of 4.6 months (ranged 3 to 7 months). The distal ulnar healed with < 10° of angular deformity in a coronal plane in one patient and with 15° of angulation in a sagittal plane in another one,while others (19 patients) obtained satisfactory alignment. The excellent and good rate was 90.5％. CONCLUSION:Intercalary bone-grafting with autologous lilac and secure fixation for treating the ununited distal ulnar fracture with osseous defects can reconstruct ulnar length,correct deformities,and obtain good bone healing and functional recovery.

Objective:To report the results of neurocutaneous axial island flaps in the forearm in clinical application.Methods:12 patients with soft tissue defects around the elbow and the wrist were treated with proximally or distally based island flaps based on the lateral and medial forearm cutaneous nerves.The flaps measured 9cm?8cm to 4cm?3cm.Results:The flaps totally survived in 11 pa- tients,the other was patially survived.The color and texture of the flaps were good.Their appearance and function were satisfactory after 12～18 months follow—up.Conclusions:On the basis of the vascu- larization of the lateral and medial cutaneous nerves of the forearm,some reliable island flaps were raised successfully.These flaps are easy to dissection and have a large arc of rotaion.They were satisfac- tory in repairing the soft tissue defects around the elbow,the distalone of third of the forearm and the wrist.