Objective To discuss the clinical features in the diagnosis and treatment of Maisonneuve fracture.Methods Twenty-three patients(16 males and 7 females)with Maisonneuve fractures were surgically treated in our hospital from August 2005 to August 2009.Mean patient age was 35.3 years(range,25-43 years).The causes of injuries were fall down injury(10 patients),sports related injury(8 patients),traffic injury(4 patients),and high falling injury(1 patient).All of the fractures were closed.The surgical procedures include ORIF of the medial malleolus or repair of the medial deltoid ligament and percutaneous screw fixation of the disrupted distal tibiofibular syndesmosis.The ankle function was evaluated by Baird-Jackson criteria.Results In all the 23 patients,9(39.13%)were misdiagnosed at the time of admission or emergency.Twenty-two patients were followed up and the average follow up time was 16.8 months(range,12-25months).No patient complained of pain,tenderness and obvious swelling of the ankle,and range of motion of the injured ankle was similar to that of the contralateral side.At the latest follow up,19 patients had resumed their preinjury activity level.Radiographs of all 22 patients showed union of all the fractures and normal mortises.And there was no traumatic arthritis and breakage of the syndesmotic screws.Baird-Jackson ankle functional score was from 85 to 100.In all the 22 patients,11 were rated as excellent,8 as good,and 3 as fair.The excellent and good rate was 86.4%(19/22).Conclusion Maisonneuve fracture is easy to be misdiagnosed.The lack of knowledge of this fracture and only initially focus on the local condition are the main reasons for the misdiagnosis.Surgical treatments include ORIF of the medial malleolus or repair of the medial deltoid ligament and percutaneous screw fixation of the disrupted distal tibiofibular syndesmosis.

ObjectiveTo explore the application and outcome of locking compression plate in the treatment of unstable distal radius fracture.Methods From January 2006 to December 2008,eighty-two patients with consecutive unstable distal radius fractures were preformed with open reduction and locking compression plate fixation by volar, dorsal or bilateral approaches. There were 31 males (bilateral fractures in two patients) and 49 females with an average age of 51 years (range, 17-74 years).According to AO/OTA criterion, there were seven patientswith type A3 fractures, four with type B 1, 12with type B2, 10 with type B3, 16 with type C1, 21 with type C2 and 12 with type C3. The locking plate fixations through simple volar approach was performed in 61 patients, fixations through dorsal approach in 12, volar 1/3 radius cylindrical steel plate fixation through volar and dorsal approach in five, bilateral fixations through volar and dorsal approaches in four. Furthermore, the external fixator was used in 19 patients, fixation of the ulna fractures in seven, and bone graft in 39. ResultsThe patients were followed up for average 20.7 months ( range, 1-4 years), which showed postoperative complications including bubble appearing around the incision in three patients, infection in one, median nerve injury in three, screws penetrating into extensor compartment in four, threads penetrating into radiocarpal joint because of reduction loss in two, rejection in one and traumatic arthritis in seven. According to the Cooney criterion, the result was excellent in 56 pateints, good in 19, fair in six and poor in one, with excellence rate of 91％. Conclusions The locking compression plate can provide firm fixation and allow early functional exercise and hence is suitable for unstable distal radius fracture especially the osteoporosis patients with comminuted compression fracture.

Objective To discuss the clinical features of Traumatic Spinopelvic Dissociation(TSD) and to evaluate the clinical results treated by lumbopelvic fixation by retrospective case study.Methods From July 2008 to December 2012,twelve patients of Traumatic Spinopelvic Dissociations were surgically treated at our department in Tianjin Hospital.There were 8 males and 4 females with a mean age of 34.6±9.2 years(range,18-50 years).The causes of injuries were fall or jump from height (11 patients) and traffic injury (1 patient).All the fractures were closed injuries and associated injuries in different degrees were noted in all the patients.The sacral fractures were classified according to fracture shape,with 4 cases of U shape,6 cases of H shape and 2 cases of Y shape.The transverse part of the sacral fractures were classified by Roy-Camille classification,and there were 6 cases of type Ⅱ and 6 cases of type Ⅲ.All the 12 patients were surgically treated by lumbopelvic fixation of a posterior approach,and 6 patients with significant neurological impairments were performed with sacral decompression via the same approach.The clinical results were evaluated by Majeed functional evaluation and the neurological impairments were evaluated by Gibbons score.Results All the patients were followed up on an average of 15.5±6.3 months (range,12-36 months).The diagnosis of the TSD were missed or delayed in 9 of the 12 patients.There were different neurological impairments in all the 12 patients.All the fractures healed in a mean time of 4.8±2.8 months(range,4-8 months).Clinical outcome was rated excellent in 4 patients,good in 4 patients,fair in 2 patients,and poor in 2 patients,according to the Majeed functional evaluation,and the excellent and good rate was 66.7％ (8/12).The neurological injuries were recovered completely or partially in sensation and motion in 11 of all 12 patients (91.7％).For the neural decompression patients,the neurological injuries were recovered completely or partially in sensation and motion in 5 of all 6 patients (83.3％).At last follow up,the average Gibbons score improved from 3.25 preoperatively to 1.67 postoperatively,with significant difference.Conclusion TSD is a rare high-energy injury pattern.It has a high rate of associated injuries and neurological impairments.The correct diagnosis of the injury pattern is easy to be missed or delayed.Surgical procedure of lumbopelvic fixation via post approach should be considered as the method of choice.Early neural decompression for the patients with obvious indications could be helpful in overall neurological and functional recoveries.

BACKGROUND:Epidural scar after laminectomy is one important reason for the secondary spinal stenosis, and local application ofSanqi sodium hyaluronate gel can prevent epidural scar adhesion after laminectomy. OBJECTIVE: To study the effects ofSanqisodium hyaluronate gel on α-smooth muscle actin expression in the process of rabbit's epidural scar formation. METHODS: In this study, there were ninety-six rabbits which were randomized into four groups and given 0.5 mL normal saline, 0.5 mLSanqi concentrated solution, 0.5 mL sodium hyaluronate and 0.5 mLSanqisodium hyaluronate gel around the dura. At 1, 2, 4, 8 weeks after treatment, immunohistochemistry staining was employed for analysis of α-smooth muscle actin expression. RESULTS AND CONCLUSION:At the end of weeks 1 and 2, the expression of α-smooth muscle actin antibody in the normal saline group was significantly higher than that in the other three groups (P < 0.01 orP < 0.05), but there were no significant differences among the Sanqi, sodium hyaluronate andSanqisodium hyaluronate gel groups (P> 0.05). At weeks 4 and 8, the expression of α-smooth muscle actin antibody in theSanqi sodium hyaluronate gel group was significantly lower than that in the other three groups (P < 0.01 orP < 0.05), and there was no significant difference among the latter three groups (P > 0.05). These findings suggest thatSanqi sodium hyaluronate gel can inhibit the expression of α-smooth muscle actin, and thus ease scar contracture.

Objective To investigate the effects of the two major conjugated linoleic acid(CLA) isomers on serum lipoprotein composition in fatty rats.Method Eighteen male OLETF rats were randomly divided into three groups.The control group fed with AIN76 diets,CLA groups were fed with 1% 9c,11t-CLA (9ct group) or 1%10t,12c-CLA (10tc group) containted AIN76 diets.After two weeks,serum triglyceride (TG),total cholesterol (TC),and high density lipoprotein cholesterol (HDL-c) were determined by commercial kits.On the other hand,serum lipoprotein were separated into chylomicron(CM),very low density lipoprotein(VLDL),low density lipoprotein(LDL) and HDL by HPLC according to the different particle sizes,and the TC and TG levels were measured in each lipoprotein.Results 10t,12c-CLA feeding reduced the concentrations of rat serum TG significantly,and increased the concentration of serum TC (26.1%) by increasing TC levels of the small particle size LDL and the big particle size HDL.While 9c,11t-CLA feeding increased the serum TG by 22.6%,and had no effect on the serum TC.Conclusion 10t,12c-CLA can reduce the concentration of serum TG and increase the concentration of HDL-c,but the effect on the improvement of atherosclerosis still need further investigation.

Objective: To study the main pharmacodynamics of Zengguang Tablets. Methods: Mice were given Zengguang Tablets orally in dosages of 0.75g/kg and 1.50 g/kg. The celiac macrophage phagocytic function and antibody formation of serum hemolysin (IgM) of mice were determined. The mouse blood vacuity model was established by injecting cyclophosphamide intraperitoneally in the dosage of 80mg/kg. Results: Zengguang Tablets could raise the celiac macrophage phagocytic function of mice and promote the antibody formation of serum hemolysin. Conclusion: Zengguang Tablets has the enhancement on organism immune function.

ObjectiveTo study the diagnostic value of double balloon endoscopy (DBE) for gastrointestinal disease.MethodsClinical data of 53 patients with suspected intermediate gastrointestinal diseases who underwent DBE procedures were retrospectively analyzed for detection rate,complications and the incidence of adverse reactions.ResultsAll of 53 patients underwent successful DBE,Procedures were performed via mouth ( n =26),anus ( n =9 ) and the combined routes ( n =18 ).And definite diagnosis was made in 46 cases (86.79％),including upper gastrointestinal (above ligament of Treitz) disease in 3 cases (5.66％),intermediate gastrointestinal disease in 41 cases (77.36％ ) and lower gastrointestinal disease in 2 cases (3.77％).All 53 patients were tolerant to the operation and anesthesia.No severe complications like bleeding,perforation,intestinal torsion,mesenteric tear,pancreatitis or anesthetic accident occured.Several patients showed abdominal flatulence,transient abdominal pain.Some patients in oral route reported slight throat discomfort or slight nasal bleeding.Incarceration occurred in 1 case due to friction of endotracheal intubation and the silicone tube,which was released after deflation and removed out.2 patients showed mild diarrhea with low fever,and the symptoms were self-healing without special treatment in 48 h.ConclusionDBE is of high diagnostic value for gastrointestinal diseases with a high safety.

ObjectiveTo investigate the clinical value of endoscopic esophageal submucosal tunnel resection of gastric fundus-cardiac tumors originating from muscularis propria.Methods Clinical date of 18 patients with gastric fundus-cardiac submucosal tumors originating from muscularis propria who underwent endoscopic esophageal submucosal tunnel resection from January 2011 to December 2011 were retrospectively collected and analyzed.ResultsAll lesions were successfully and completely resected in 18 patients,with sizes ranging from 0.7 cm to 7.2 cm,mean (2.43 ± 1.91 ) cm.Pneumoretroperitoneum,pneumomediastinum and pneumohypoderma occured during the procedure in 2 cases,but spontaneously resolved in 3 days.Fever with increased WBC within 24 h after the procedure occurred in one patient,and was cured in two days with antibiotics.There were no severe complications including bleeding,perforation or death.All patients could have liquid diet 3 days later after the operation.Follow-up endoscopy at 1 week after the operation showed a healing of esophageal incision.ConclusionEndoscopic esophageal submucosal tunnel resection is a safe and effective method for gastric fundus-cardiac submucosal tumors originating from the muscularis propria,lessening the difficulty of traditional endoscopic resection.

Objective To investigate the clinical value of endoscopic biliary stent drainage for obstructive jaundice due to hepatic portal metastatic carcinoma. Methods Patients with obstructive jaundice arising from hepatic portal metastatic carcinoma were selected and treated with consent by plastic endoscopic bile duct stents since 2006. Success rate and survival were evaluated. A total of 38 patients with obstructive jaundice were treated and analyzed. Hepatic portal metastatic carcinoma included 13 cases of liver cancer, 3gallbladder carcinoma, 14 gastric carcinoma, 2 esophageal carcinoma, 1 ileum adenocarcinoma and 5 pancreatic carcinoma. Results Stents were successfully placed in all patients and jaundice rapidly subsided after the endoscopic procedure. Follow-up life span was 92-521 days, mean 264. 42 ± 104. 41 days. During follow-up, biliary stents were replaced in 5 patients in 3-14 months ( mean 8. 6 ± 4. 1 months) because of stent displacment in 1 case, biliary stone obstruction in 2 cases and carcinomatous obstruction in 2 others.Conclusion For patients with obstructive jaundice arising from hepatic portal metastatic carcinoma, endoscopic biliary stent drainage is effective and can prolong life span to some degree.

Objective To evaluate the clinical value of endoscopic palliative stents drainage in patients with unresectable carcinoma at pancreas head.Methods Endoscopic stents placement was Derformed in 197 patients with unresectable pancreas head carcinoma,from August 2003 to August 2007,and the clinieal data was studied retrospectively.Results Bile duct obstruction was present in all patients.in which 126 were accompanied with dilation of distal pancreatic duct,91 with atrophy of pancrea body and tail. Stent placement in pancreatic duct Was performed in 108 patients with a Success rate of 96.4%,and placement in bile duct was performed in all patients with a success rate of 99.0%.In 195 patients with successful stent placement,jaundice dissolved after the procedure.Of 101 patients who had abdominal pain,complete pain alleviation Was achieved in 98,partially alleviation achieved in 3. Serum amylase level increased after the operation in 24 cases,which resumed tO normal value after corresponding managements.All Datients received a lifelong follow-up at mean duration of 373.57±157.35 days,with a longest survival time of 842 days.Conclusion Endoscopic palliative stents drainage is safe and effective in patients with unresectable Dancre.atie carcer,which miight increase survival rate and improve life quality.