Objective To explore the effect of polyethylene terephthalate artificial ligament revascularization on the treatment of distal tibiofibular syndesmosis injury .Methods The data of 18 patients with distal tibiofibular syndesmosis injury in our hospital from March 2013 to March 2014 were retrospectively analyzed .Fourteen patients received the bilateral suspension fixed technology ,and 4 cases were fixed with unilateral suspension fixation by extrusion screw which could be absorbed .The ankle joint mobility was measured during the follow-up,which were evaluated by American orthopedic foot and ankle society ( AOFAS) .Results Eighteen patients with distal tibiofibular syndesmosis in-jury were followed up for 12~17 months,with an average of 13.5 months.Imagings showed that the tibiofibular space was normal on postop-erative X-ray films,and there was no lost in 1 year.The PET of artificial ligaments were taken out ,and the artificial ligament and bone tissue were combined with a good ligament toughness .The pathological examination revealed the fibrous tissue grew in the artificial ligaments .Ac-cording to AOFAS ankle function grading evaluation of curative effect ,11 cases were excellent ,6 cases were good ,and 1 case was not obvious . Conclusion PET artificial ligament revascularization can recover the hinge functions of tibiofibular syndesmosis for patients with early recov -ery of ankle plantar flexion range in a short time .Different ways of fixed ligament had no obvious effect on functional recovery ,however,the extrusion screw technology can shorten the time of surgery .

Objective To discuss the interactive management mode (IMM) of preventive treatment on osteoporosis self-rehabilitation of rural elderly residents.Methods IMM was used to manage osteoporosis patients in the community of Changshu,and general self-efficacy scale was adopted for evaluation.Results Self-efficacy score (34.2) increased comparing with before(23.5 ) the medical management,the difference was statistically significant ( P＜0.05 ).Conclusion IMM of preventive treatment can effectively improve the rural community general self-efficacy level.

SUMMARY Pheochromocytomaisrareinpregn’ancy.Clinicalfeaturesofacaseofpheochromocytoma during pregnancy in the Peking University People’s Hospital was investigated and the literature reviewed to discuss the diagnosis and treatment of this disease.The patient manifested with hypertension and pro-teinuria,who was easily misdiagnosed with gestational hypertension disease.When she was transferred to our hospital,the symptoms such as,paroxysmal palpitation,dizziness,vomiting were noticed,and the possibility of pheochromocytoma was considered due to the accompanying abdominal mass.An emergent cesarean section was performed successfully due to preterm labor during the treatment of the disease.Af-ter the delivery the drug preparation continued.And the laparoscopic resection of pheochromocytoma pro-ceeded when the blood pressure was steady.The patient recovered fully after the surgery.The final diag-nosis of pheochromocytoma was confirmed with the pathology.Its diagnosis and treatment experiences could improve our understanding and treatment of secondary hypertension due to pheochromocytoma in pregnancy.

Objective To analyze the indications and evaluate the efficacy of the needle to 'double reverse' traction reset,inside and outside double column locking plate internal fixation with MiPPO for tibial plateau fractures.Methods From August 2015 to March 2017,a total of 31 patients with tibial plateau fractures in our hospital were divided into treatment group and control group.The treatment group with 12 cases were treated with the needle to be 'double reverse' traction reset,inside and outside double column locking plate MiPPO fixation.The control group with 19 cases received open reduction and internal fixation with locking plate.Results In treatment group,the operation time was (51.3±6.5)minutes,the intraoperative bleeding was (60±8.7)mL.In the control group,the operation time was (68.5±6.6)minutes,the intraoperative bleeding was (230±7.8)mL.The operation time and blood loss of treatment group were less than those of control group,the differences were statistically significant(P<0.05).The postoperative X ray film of fracture showed that the bone plate and screw position were ideal compared with those before operation,no complication occurred.Conclusion The needle 'double inverse' traction and locking plate MiPPO fixation treatment have good clinical effect for patients of Schatzker Ⅴ,Ⅵ tibia platform fracture,with less complication.

Objective To investigate the biomechanical characteristics of the acromioclavicular joint,put forward the treatment of acromioclavicular joint dislocation based on the principle of anchor and apply to clinic.Methods From August 2011 to March 2015,24 patients with the acromioclavicular joint dislocation in department of orthopedics of Chinese Medicine Hospital of Changshu were divided into the treatment group and the control group,with 12 cases in each group.The treatment group were treated by vertical suspension buttons steel cable system based on principle of anchor,while the control group were treated by the hook plate technology.The clinical results of the two groups were evaluated by Karlsson score system.Results All the patients were followed up for 6 to 12 months.In terms of the curative effect in the treatment group,there were 11 cases of excellent and 1 case of good,with the excellent and good rate of 100%,and no complication occured.In the control group,there were 7 cases of excellent and 3 case of good,with the excellent and good rate of 83.3%.And there was 1 case of subacromial osteolysis.Conclusion To treat acromioclavicular joint dislocation above Rockwood Ⅲ with vertical suspension buttons steel cable system based on principle of anchor may be an ideal treatment method.

ObjectiveTo study the effect of TCM diagnostic method flow reconstruction and optimized management in the mass injuries emergency previewing reception.MethodsWorking mode of TCM optimized receiving and dispatching flow were established and enforced.Results27 batch of 216 cases were received by emergency previewing reception in 2009～2010.Compared to 2009,patient dispatching time was shorten by 3.0 min,area dispatching time was shorten by 2.9 min in average.Emergency treatment satisfaction was elevated from 65％ to 95％ and rescue successful rate was increased from 82.3％ to 89.6％.ConclusionTCM diagnostic method flow reconstruction and optimized management improved the level of management of in the mass injuries emergency previewing reception and obtained better results.

Objective To evaluate the clinical effectiveness of early interfering of yellow-water on Deep Venous Thrombosis (DVT) in lower extremities of hip fracture patients after operation. Methods 60 patients with hip fracture were recruited into a control group and a treatment group randomly. The control group was treated with low molecular heparin,while the treatment group was treated additionally with yellow-water on that basis. The status of pain, swelling levels, vascular color doppler ultrasound and safety of medication were reviewed after two weeks. Results There was 23.3% cure rate and 60.0% significant improvement rate in the treatment group, and 13.3% cure rate and 40.0% significant improvement rate in the treatment group. The therapeutic effect in the treatment group was better than the control group, with significant difference (P＜0.05 ) . Conclusion Yellow-water was effective in early interfering in DVT in lower extremity due to its quickness in eliminating swelling and alleviating pains with no stimulus feeling.

Objective To explore the clinical features and causes of misdiagnosis of the patients with acquired deficiency of vitamin K-dependent coagulation factors (ADVKDCF). Methods Retrospective analysis was performed with the data from 62 patients with ADVKDCF for etiological factors, clinical manifestations,laboratory examinations, diagnosis and treatments. Results Among the 62 patients, 51 patients were with unknown causes( subgroup A) and 11 were with clear histories of anticoagulant rodenticide poisoning( subgroup B). The presentations of hemorrhage of the patients varied with hematuria as the most common first symptom,followed by skin, mucosa, muscle, internal organs bleeding (28/62). The most common hemorrhage symptom is hematuria. 35 of the 62 patients had hemoglobin(Hb) levels less than 100 g/L due to blood loss( the lowest level was 32 g/L). Thirty-eight patients were misdiagnosed at the first visit and the median time from hemorrhage manifestation to definite diagnosis was 8 days (range,2 to 192 days). ADVKDCF was mostly misdiagnosed as the urinary system diseases (23/38), followed by hemophilia (8/38). Laboratory examinations showed normal platelet count , throm bin time (TT) and normal fibrinogen(Fg) concentration, but prolonged plasma prothrombin time (PT), activated partial prothrombin time (APTT) and international normalized ration (INR). All of patients received high dose vitamin K ( intravenous vitamin K1 with a initial dose of 20 to 240 mg/d and then oral vitamin K4 maintenance) . The bleeding symptoms disappeared 1 day after treatment and the Hb levels increased dramatically. There were significant differences in PT, APTT and INR of the patients before and after treatment( P ＜0. 01 ). Followed by a median follow - up of 8 months , no patient had severe adverse effects or recurrence. Conclusion The hemorrhage presentations of the patients with ADVKDCF are various. The most common hemorrhage symptom is hematuria. The misdiagnosis rate of ADVKDCF is high with urinary systems disorders as the most common misdiagnosis. Sequential treatment with vitamin K is an effective and safe method to prevent recurrence. Early detection of coagulation function is helpful to reduce misdiagnosis possibility.

Objective:To monitor and evaluate in vivo dose changes of intensity-modulated radiotherapy (IMRT) in patients with cervical cancer in a real-time manner. Methods:Twelve patients with cervical cancer admitted to our hospital were enrolled in this study. The in vivo doses were monitored by PerFRACTION?. Electronic portal imaging device (EPID) were collected in each treatment fraction for two-dimensional in vivo dose verification[γ index and dose difference (DD) index]. Log files were recorded for three-dimensional in vivo dose verification (γ index). The correlation between in vivo dose and treatment duration was analyzed by Pearson correlation analysis. Results:A total of 206 sets of EPID images and corresponding Log files were collected. The three-dimensional in vivo dose verification γ 1%/1mm of all patients was not correlated with treatment fraction ( P>0.05). Among them, the absolute difference of γ 1%/1mm of 94.66% fractions was< 1%. The mean DD 3% of two-dimensional in vivo dose verification of all patients was negatively correlated with treatment fraction ( P<0.05). Among which, the average γ 3%/3mm of 9 patients was>89% in the treatment fractions, and the average γ 3%/3mm of 98.57% fractions of these 9 patients was>93%. The other 3 patients had an average γ 3%/3mm ranged from 38% to 100%. CBCT images showed that the bladder volume of these 3 patients was significantly decreased with the relative changes by 82.08%, 84.41% and 73.59%, respectively, and the target area was retracted significantly with the relative changes by 38.12%, 59.79% and 24.46%, respectively. Conclusion:Combined with γ index and DD index, PerFRACTION? can monitor the mechanical stability of accelerator and MU delivery accuracy during treatment fractions, and monitor the changes of in vivo dose in patients with cervical cancer, which can improve the safety and quality assurance of IMRT for cervical cancer patients and provide guidance for patients with adaptive radiotherapy.