Objective To explore the surgical result of unilateral half-pin external fixation in the treatment of distal tibial fracture. Methods For type A fracture, two pins were inserted into the proximal fragment of tibia fracture and another two pins into the distal fragment; for type B and C fracture, distal pins were inserted into the talus and calcaneus. The fracture reduction was performed by distraction of external fixators. A limited open reduction was required in some difficult cases to restore the joint surface, with bone grafting and small fragments fixed with wires or screws. Meanwhile, fracture of fibula was fixed with plate and screws. Results The duration of external fixation was 3.5~8 months (mean, 5 months) in 22 patients. Bone union was achieved in all patients, without serious deep infection, osteomyelitis, or non-union. The patients were followed for 10~32 months (mean, 20 months). Functional exercise was carried out for more than 6 months after the removal of the external fixator. According to the Tornetta’s evaluation standard, excellent results were obtained in 11 patients, good in 7 patients, fair in 3, and poor in 1. Conclusions Unilateral half-pin external fixation combined with limited open reduction and internal fixation is a simple and effective minimally invasive method for the treatment of distal tibial fracture.

Objective To investigate the clinical results, indications and choices of surgical treatment of minimally invasive internal fixation by cannulated compression screws in the treatment of femoral neck fractures. Methods The authors retrospectively analyzed clinical data of 83 patients with femoral neck fractures treated by minimally invasive internal fixation by AO cannulated screws. Results According to the Garden classification, the patients comprised 12 cases of type I, 39 cases of type II, 23 type III and 9 type IV. The mean time from injury to surgery was 63.4 hours, the mean operation time was 65.7 min, the mean intraoperative blood loss was 64 ml and the mean hospital stay was 7.7 days. No wound infection, deep venous thrombosis of leg, pulmonary embolism or breakage of internal fixation occurred. No patients died. Follow-up observation ranged 12～48 months, with a mean of 31.3 months. Normal bone union was obtained in all the cases. Postoperatively, shortening of femoral neck took place in 4 patients (4/83, 4.8%) and different degrees of osteonecrosis happened in 7 patients (7/83, 8.4%). The mean postoperative Harris hip score was 94.6. Conclusions Minimally invasive internal fixation by cannulated compression screws for femoral neck fractures may be an effective alternative. This method is indicated for Garden I/II fractures without displacement in patients above 65 years old, or any types of femoral neck fractures in patients below 65 years old.

Objective To investigate the clinical results of minimally invasive plate fixation for tibial plateau fractures. Methods Minimally invasive plate fixation was adopted in 26 cases of tibial plateau fractures from January 2000 to June 2003. Results Follow-up for 6 months ～ 4 years (mean, 2 1 years) showed bone union in all the patients. The results of therapy were assessed according to the Merchant criteria as follows: excellent in 20, good in 5 and fair in 1. Conclusions Minimally invasive plate fixation in the management of tibial plateau fractures has advantages of minimal trauma, reliable fixation, early movement and fewer complications, being a valuable clinical alternative.

Objective To discuss the feasibility,indications,surgical techniques,and outcome con- cerning the application of less invasive stabilization system (LISS) for complex proximal femoral fractures.Methods We treated 12 complex proximal femoral fractures using femoral LISS reversely from June 2005 to May 2006. They were five complex intertrochanteric fractures and seven subtrochanteric ones.By AO classification,two were type 31-A2.2,two type 31-A2.3,one type 31-A3.3,one type 32-A3.1,three type 32-B1.1,one type 32-B2.1, and two type 32-B3.I.The patients were treated with closed or indirect reduction and fixation with percutaneous LISS plate reversely.Results There were no major postoperative complications in this study.The mean operation time was 65 minutes (range,50 to 90 minutes),the mean intra-operative blood loss was 142 milliliters (range,50 to 400 milliliters),and the mean postoperative hospital stay was 9.3 days (range,6 to 15 days).All patients had a clinical follow-up;the mean follow-up time was 7.2 months (range,3 to 14 months).Ten cases healed clinically three months postoperatively,one periprosthetic fracture healed four months and one pathological fracture healed six months after operation.At the final radiographic follow-up,no collapse,varus deformity,cutting-out,hardware failure,or avascular necrosis was found.Conclusions Femoral LISS used reversely can provide secure fixation for proximal femoral fractures biomechanically and anatomically.It is also easy and safe.It is particularly suitable for old patients with intertrochanteric fractures complicated with disorders of internal organs and severe osteoporosis or patients with complex proximal femoral fractures.It is important to be skillful in indirect reduction and positioning of guide wire into hole A,and to avoid immediate weight-bearing postoperatively.

[Summary] With the increasing global aging population, osteoporosis vertebral compression fracture ( OVCF) is getting more attention as a big challenge for orthopedic surgeons.Current therapeutic options include conservative treatment, traditional open reduction and internal fixation, percutaneous vertebroplasty (PVP), and percutaneous kyphoplasty (PKP).Due to excellent clinical results on pain relief and function improvement, PVP and PKP, as minimally invasive surgical techniques, now increasingly become more popular for painful OVCF.The review focused on a brief introduction of the current status of the two procedures and a discussion of the future trends of the two techniques.

Objective To investigate the clinical results of limited exposure and indirect reduction in treatment of tibial plateau fractures. Methods 41 cases of tibial plateau fractures were treated with limited exposure and indirect reduction. According to Schatzker classification, there were 6 cases of type Ⅰ, 13 type Ⅱ, 11 type Ⅲ, 6 type Ⅳ, 3 type Ⅴand 2 type Ⅵ. Type I fractures were reduced in the close manner by applying large reduction forceps and fixed with percutaneous lag screws. Type Ⅱ, type Ⅲand Type Ⅳfractures were reduced by applying large reduction forceps and fixed by percutaneous plating after restoring joint surface and bone grafting. Type Ⅴand Type Ⅵfractures were reduced by applying fracture distracter and large reduction forceps before they were fixed with percutaneous plating. The clinical outcomes were assessed according to Rasmussens system. Results 36 patients were followed up from 6 to 60 months, with an average of 30.2 months. No deep vein thrombosis, infection, or compartment syndrome was found postoperatively. All the 36 fractures united. Overall, 25 (69%) patients were rated as excellent, 8 (22%) good, and 3 (9%) fair. Conclusion In treatment of tibial plateau fracture, limited exposure and indirect reduction has advantages of less dissection, stable fixation, early movement, better joint function and fewer complications.

Some phytoestrogen-containing Chinese herbs have both estrogenic and antiestrogenic activity. With the development of phgtoestrogen study and the application of herbs in breast cancer, phytoestrogen-containing herbs become the hot researches, but consensus is hampered by conflicting data from various in vitro and in vivo experiments. This article will address the effects of some kinds of herbs on breast cancer cell proliferation, the mechanism and their biological activity. The review will focus on 3 popular botanical herb: Angelica sinensis (dong quai) , Salvia miltiorrhiza (dan-shen root) and ginseng.

Objective:To investigate the correlation between hematopoietic cell kinase (HCK) and the expression level of the mitochondrial ribosomal protein L13 (MRPL13) and hematopoietic multimode ultrasound.Methods:204 female breast cancer patients treated by surgery in Quzhou people’s Hospital from Jan. 2017 to Sep. 2020 were selected as study subjects. Breast cancer tissues and adjacent normal tissues were extracted intraoperatively. Preoperative conventional ultrasound, shear wave elastography (SWE) and contrast-enhanced Ultrasonography (CEUS) were used to detect HCK and MRPL13 expression levels. Univariate analysis and binary Logistic regression were used to analyze the correlation between multi-mode ultrasonic features and HCK and MRPL13.Results:The positive expression ratios of HCK and MRPL 13 in breast cancer tissues were significantly higher than those in adjacent tissues ( χ2 was 5.625, 7.197; P was 0.018, 0.007) . In conventional ultrasound features, the proportions of HCK-positive breast cancer patients with irregular mass edges, microcalcifications, and grade II to III blood flow classification were significantly higher than those of HCK-negative patients ( χ2 was 7.437, 16.684, 23.262; P was 0.006, <0.001, <0.001) ; The proportion of MRPL13-positive breast cancer patients with a maximum diameter of ≥2 cm, irregular edges of the tumor, and grade II-III blood flow classification was significantly higher than that of MRPL13-negative patients ( χ2 was 4.676, 11.118, 8.389; P was 0.031, 0.001, 0.004) . For SWE signs, the proportion of HCK positive breast cancer patients with hard ring sign was significantly higher than that of HCK negative patients ( χ2=11.220, P=0.001) ; the proportion of MRPL13 positive breast cancer patients with hard ring sign and black hole sign was significantly higher than that of MRPL13. Those who were negative ( χ2 was 4.482, 8.775; P was 0.034, 0.003) . Among CEUS characteristics, the proportion of HCK-positive patients with high enhancement was significantly higher than that of HCK-negative patients ( χ2=7.356, P=0.007) ; the proportion of MRPL13-positive patients with high enhancement and late regression was significantly higher than that of MRPL13-negative patients ( χ2 was 9.165, 7.631; P was 0.002, 0.006) . The results of binary logistic analysis showed that there was microcalcification ( OR=4.619, 95% CI=2.657-8.119, P=0.009) , blood flow classification II to III ( OR=4.150, 95% CI=2.547-7.954, P=0.015) and high enhancement of CEUS ( OR=4.150, 95% CI=2.547-7.954, P=0.015) are independent risk factors for positive expression of HCK; blood flow grade II to grade III ( OR=4.213, 95% CI=3.145-8.557, P=0.012) , appearance of black hole sign ( OR=5.246, 95% CI=2.864-10.378, P<0.001) and high enhancement of CEUS ( OR=3.872, 95% CI=1.887~6.438, P=0.026) were the independent risk factors for the positive expression of MRPL13. Conclusion:The multimodal ultrasonographic features of breast cancer are helpful to predict the expression levels of HCK and MRPL13, so as to provide new imaging ideas for early diagnosis of breast cancer, the designation of treatment options and the preoperative non-invasive assessment of breast cancer prognosis.

Objective To discuss the selections of surgical treatment for lower cervical spine fracture and dislocation and the treatment outcome.Methods Clinical data of 50 cases of lower cervical spine fracture and dislocation were analyzed retrospectively.There were 37 males and 13 females at mean age of 41 years (range,20-80 years).Forty-four cases underwent anterior fusion,but 4 with ankylosing spondylitis and 2 with extremely unstable cervical spine were treated with combined posterior fusion.Two cases sustaining ankylosing spondylitis and being unable to be operated via the anterior approach due to the maximum neck flexion limits were treated with posterior decompression and fusion.Two cases developed delayed fracture and underwent posterior release prior to the anterior fixation and fusion.Two cases underwent a second surgery with the posterior release,anterior fusion and posterior fusion performed successively.Neurological performance was evaluated using the American Spinal Injury Association (ASIA)scale.Results All the patients were followed up for mean 28 months (range,12-48 months).Implant loosening and redislocation occurred in one ankylosing spondylitis case 2 months after anterior fusion.Other 49 cases achieved bony fusion in 6 months.Neurological function showed no recovery in complete spinal cord injury cases,but improved for average ASIA 1-2 grades for incomplete spinal cord injury cases.Conclusions Anterior surgery provides good reduction and neurological improvement in treatment of lower cervical spine fracture and dislocation.For extremely unstable cases or difficult anterior reduction cases,posterior surgery or combined anterior/posterior surgery should be considered.

Objective To evaluate the curative effects of surgical treatment of unstable clavicular fractures. Methods From August 2000 to April 2005, 50 cases of clavicular fracture in our department underwent open reduction and internal fixation with reconstruction plate or clavicular hook plate or 1/3 tubiform titanium plate. According to Robinson’s classification, 12 of them were identified as type-2B1, 24 as type-2B2, 1 as type-3A1 and 13 as type-3B2. 13 cases of them had other injuries. 37 patients were fixated with a reconstruction plate. Clavicular hook plates were applied in 12 cases. One patient was fixated with the 1/3 tubiform titanium plate. The curative effects were evaluated on the basis of healing time, quality of healing and function of the shoulder. Results All the 50 patients were followed up. The mean follow-up was 19 months (2 to 57). All the clavicular fractures achieved bony union. The mean healing time was 2.5 months (2 to 4). 3 patients experienced malunion. The functions of the shoulder were excellent in 32 cases, good in the other 18 patients. The total clinical efficacy was evaluated as excellent in 22 patients, good in 23 and fair in 5. Conclusions The type-2B and type-3B fractures in Robinson’s classification belong to unstable clavicular fractures. The patients treated by operation can recover normal functions soon without considerable complications.