Objective To explore the intraoperative fluoroscopy in percutaneous sacroiliac screw fixation based on anatomic measurement and digital reconstructed CT data. Methods The CT data of the pelvis at prostration were collected for 3D reconstruction of the pelvic models from 30 patients with injury to the pelvis or acetabulum.Then the anatomical boundaries of thesafe zone of sacroiliac screw insertion were marked on the 3D models,including the upper,front and back cortex boundaries of S1 vertebra,the front and bottom cortex boundaries of sacral foramen area,and the sacral alar slope. The angles between these anatomical boundaries and the pelvic baseline were measured on the sagittal plane.The digital reconstructed radiology (DRR) was applied to form the inlet,outlet and lateral images of fluoroscopy.The standard protocol to acquire accurate intraoperative images was analyzed by characterization of important anatomic landmarks.Results The angles between the upper,front and back cortex boundaries of S1 vertebra and the baseline (αl,α2,α3) were respectively 37.7°± 8.6°(from 23.2°to 50.8°),22.9° ± 6.7° (from 13.1° to 32.0°),41.9°± 6.8° (from 33.0°to 54.8°).The angles between the front and bottom cortex boundaries of sacral foramen area and the baseline (α4,α5) were 37.0°± 12.0° (from 19.9° to 63.1°) and 38.8°± 8.0° (from 25.7°to 54.6°).The angle between the alar slope and the baseline (α6) was 82.4°± 13.0°(from 70.3°to117.3°).The characteristic manifestations of important anatomic landmarks were observed in the simulated fluoroscopy images. Conclusions It is recommended that the projecting angles in the inlet and outlet views should be decided according to the specific data of each patient.Because the alar slope can not be clearly identified in the outlet view due to its large inclination,the position of screw insertion should be verified in the lateral view to prevent the screw from penetrating the slope to hurt the L5 nerve and iliac vessels.

Objective To assess effects and security of the insertion of sacroiliac screws by the bi-planar navigation robot system. Methods In a simulated surgical setup, 12 AO cannulated screws were placed into the S1 vertebral bodies of 4 human pelvic bone under the guidance of the bi-planar navigation robot system which was developed jointly by Beijing Aeronautics and Space University and our hospital. To compare this new technique with the conventional technique, another 12 cannulated screws were placed into 4 Synbone pelvic models under fluoroscopic control. The fluoroscopic times, the radiation exposure time and operation time between image acquisition and guide-wire insertion were recorded. Results With the guidance of the bi-planar navigation robot system, the average fluoroscopic times were 2.5, the average radiation exposure time was 1.5 seconds, and the average operation time was 253 seconds. All the screws were in the safe area. Under the fluoroscopic control, the average fluoroscopic times were 20.3, the average radiation exposure time was 13.7 seconds, and the average operation time was 246 seconds. Two screws (16.7%) were misplaced. The fluoroscopic times and the radiation exposure time were reduced significantly when the bi-planar navigation robot system was used (P0.05). Conclusions The bi-planar navigation robot system can provide precise navigation for insertion of sacroiliac screws within several minutes, and reduce the radiation exposure to the patient and the staff significantly. The results of this prospectively controlled experimental study are encouraging for further clinical trials.

Objective To study the distribution characteristics of intraperitoneal free gas and the location value of the site of gastrointestinal perforation using multi-slice CT (MSCT).Methods 60 cases of gastrointestinal perforation were retrospectively collected.The distribution of the intraperitoneal free gas in CT image was analyzed and observed.The digestive tract were divided to the upper digestive tract and the lower digestive tract by Treitz ligament.The distribution of the intraperitoneal free gas was analyzed using χ2 test.The distribution of the intraperitoneal free gas between each different perforational site was analyzed.Results 38 cases of the site of gastrointestinal perforation located in upper gastrointestinal tract and 22 cases located in lower gastrointestinal tract,there was statistically significant difference between the upper digestive tract and the lower digestive tract about the distribution of the intraperitoneal free gas(χ2=22.33,P<0.001).In the cases of upper gastrointestinal tract perforation,13 cases of the site located in stomach and 25 cases located in doudenum,there was no statistically significant difference between stomach and duodenum(χ2=1.97,P>0.05).In the cases of lower gastrointestinal tract perforation,11 cases of the site located in bowel and 11 cases located in colon,there was statistically significant difference between bowel and colon(χ2=8.98,P<0.05).Conclusion The MSCT distribution of the intraperitoneal free gas has important value in localization diagnosis of gastrointestinal perforation.

This paper presents the components and the principles of an internal electrohydraulic lithotripter.Cooperating with the cystoscope,the lithotripter introduces the high-pressure discharge pulse into the bladder through the microelectrode.Then the little,easily-moved stone is targeted,and the re-discharge of the lithotripter 5mm away from the stone results in the shock wave to perform lithotritization.

ObjectiveTo explore the clinical effects of cold therapy in treatment of inflammatory hemorrhoids.MethodsSixty patients were separated into two groups according to the visiting sequence with 30 cases each.The treatment group accepted cold therapy,meanwhile the control group took the tablets diosmin and accepted hot compress with 50％ magnesium sulfate.ResultsThe symptoms evaluation score was ( 10.5 ± 1.3 ) scores and (6.4 ± 1.2) scores before and after treatment in treatment group,while ( 10.3 ±1.4) scores and(9.4 ± 1.3) scores in control group,there was no significant difference before treatment between two groups (P＞ 0.05 ),but there was significant difference after treatment between two groups (P＜0.05).After 3 days treatment,cure rate was 60.0％(18/30),eifficient rate was 90.0％(27/30) in treatment group,while 10.0％ (3/30),53.3％ ( 16/30 ) in control group,there were significant differences between two groups(P＜ 0.05).ConclusionCold therapy is good for inflammatory hemorrhoids.

The cause of hospice care in modern sense has been applied in China for 30 years. Ever since the term "hospice care" was introduced, its interpretation and meaning were different. The development of hospice care in mainland China has experienced ups and downs, but not smoothly. On the one hand, it is influenced by traditional Chinese thought. The practice of sending family members to hospice care institutions often leads to unfilial and unjust accusations. On the other hand, it is due to the imperfection of relevant national policies and the lack of death education in China, which makes it difficult for people to really understand the good death. With the concept of "healthy China" put forward in 2016, the concept of hospice care has attracted people's attention again. However, the cause of hospice care in China is still facing various difficulties. Legislature, administrative departments, hospice care institutions and families must cooperate effectively in order to find countermeasures to meet the needs of hospice care and achieve considerable development.

Objective:To evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Methods: In the study,12 patients with pelvic and acetabular fractures who were treated in Beijing Jishuitan Hospital from January to April in 2016 were involved in this research.The research subjects were randomly divided into two groups: the experimental group and the control group.Robotic-assisted percutaneous sacroiliac screw internal fixations were performed under the guidance of fluoroscopy navigation in the experimental group;in the control group,doctors operated manually guided by fluoroscopy.Statistical analysis was performed on the total operation time,the intraoperative fluoroscopy time,the adjustment numbers of intraoperative guide wires,the excellent rate of screw placement and the incidence of adverse events in order to evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Results: Eleven screws were placed in 7 patients from the experimental group,while 7 screws were placed in 5 patients from the control group in total.All the screw placement positions were satisfactory according to postoperative CT images.The excellent rates of screw placement position were 100％ in both groups.However,the P value was 0.016 based on the comparison between the screws' distribution in the two groups which meant that the screw distribution of the experimental group was better than that of the control group.The average fluoroscopy time needed for screw insertion was (7.36±2.63) s in the experimental group while (41.80±13.99) s in the control group (P<0.001).This suggested that the difference between the two groups had statistical significances.Intra-operative fluoroscopy time of the experimental group was significantly smaller than that of the control group.The number of the average screw adjustment was (0.36±0.48) times in the experimental group while (9.00±3.06) times in the control group (P=0.003).This suggested that the difference of the number of the guide needle adjustment between the two groups had statistical significances,and the number of the experimental group was smaller than that of the control group.The average operation time was (43.86±49.06) min in the experimental group while only (29.00±12.14) min were needed in the control group (P=0.528).This suggested that the difference between the two groups had no statistical significance.That is,the total operation time of the two groups was equal.All the screws were in satisfactory positions according to validation results of CT scans.No complications such as screw breaking out the bone cortex and entering into the knee joint cavity,wound infection occurred.Conclusion: Surgical robots are suitable for robot-assisted percutaneous screw fixation in pelvic and acetabular fractures.Robot-assisted treatment of pelvic and acetabular fractures has significant advantages over manual operations including high accuracy,small perspective radiation,safety and efficiency.

As lactate is elevated due to lactate metabolic disorder in liver failure, recent studies have shown that blood lactate has a high value in predicting the prognosis of liver failure. With reference to the research findings in recent years, this article introduces the prediction model of LiFe score and reviews the advances in the clinical application of blood lactate level in patients with liver failure in China and foreign countries. It is believed that a high lactate level is an independent risk factor for poor prognosis of liver failure patients, and it is proposed that lactate can be used as an important indicator to evaluate the severity and prognosis of liver failure and further optimize the scoring system for the prognosis of related liver diseases.

Objective To investigate the feasibility and curative effect of botulinum toxin type A(BTX-A)point injection under the guidance of type-B ultrasonic on upper limb spasticity after stroke.Methods 18 cases were divided into two groups:9 cases for treatment group were treated with point injection BTX-A in 5 points with the guidance of type-B ultrasonic diagnosis,other 9 cases for control were only injected experientially.They were evaluated with the modified Ashworth scale(MAS)and the time taking effect were recorded.Results Compared with the control,the scores of MAS in the treatment group improved,and they came into effect more quickly(P<0.05).Conclusion The point injection of BTX-A under the guidance of type-B ultrasonic was practicable for and effective on upper limb spasticity after stroke.

A medical robot that is used for closed reduction and the internal fixation of intramedullary locking nailing in treatment of tibial fracture is designed.The system is primarily composed of stereotaxic frame and computer system.Using C-shaped arm-taken X-ray images containing various marked points and keyhole-two-end-center of intramedullary nail,the system calculates the actual position of keyhole in the coordinate system of stereotaxic frame according to space mapping relation and locates the pilot hole on the reference coordinate according to computation.Electric-traction system can realize the precise reduction and remote control operation by network transmission of operation data.In the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture in 17 patients,robot reducing fracture and computer-assisted localization of distal keyhole were used.Remote control operation was applied in 4 of them.All operations were performed according to the preset procedure and planning of robot and navigation system.All distal lock nails were successfully implanted at one time.Results demonstrated that both medical robot and computer-assisted localization and navigation system can satisfy fracture reduction and distal Iock nail implantation in the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture and shorten intraoperative fluoroscopy time;in addition,remote control operation is reliable and easily mastered due to its simple systemic structure.