Objective To observe the operation methods and curative effect of sacroiliac joint screw fixation by using traditional imaging monitoring technique in combination with sacral slope position imaging monitoring technique. Methods After bone traction and enema cleansing, 37 patients with pelvic fractures were fixed with sacroiliac joint screws, which was monitored under C-armed X ray machine at slope position, inlet and outlet views. There were 23 males and 14 females, at average age of 30. 8 years (18-63 years). Results All the patients were followed up for 4-23 months (average 9. 8 months) , which showed basic anatomical restoration in 28 patients, coronal section dislocation for 2 mm in seven and dislocation for 5 mm in two. All fractures were healed, with no nerve or blood vessel complications found. According to Majeed scoring, the excellence rate was up to 94. 5%. Conclusions Combined use of traditional imaging monitoring and sacral slope position imaging monitoring can help improve the safety of percutaneous iliosacral screw fixation, simplify operation process and shorten operation time.

Objective To investigate the effects of Sangju Qingjie Decoction on the ventilator-induced lung injury in rats.Methods Thirty-six healthy male SD rats of both sexes,weighing 300-350 g,were randomly divided into 3 groups(n =12 each):control group(group C); mechanical ventilation group(group V)and Sangju Qingjie Decoction group(group SJ).The animals were anesthetized with intraperitoneal 3％ urethane 1.4 g/kg and tracheostomized.The femoral artery and vein were cannulated for blood sampling and drug administration.The animals were mechanically ventilated for 2.5 h(VT =40 ml/kg,RR 40 bpm,I:E =1:1,FiO2 21％).Ingroup SJ,Sangju Qingjie Decoction 300 g was injected into the stomach through a gastric tube once a day for 10 consecutive days,and mechanical ventilation was performed 2 h after the last injection.While in groups V and C,the equal volume of normal saline was given instead of Sangju Qingjie Decoction.Arterial blood samples were collected before ventilation,at the end of ventilation,and at 30 min after ventilation(T0-2)for blood gas analysis.Respiratory index(RI)and oxygenation index(OI)were calculated.The animals were then sacrificed and the lungs were removed for microscopic examination and determination of the content of TNF-α,IL-6 and IL-10 and W/D lung weight ratio.Results Compared with group C,RI at T1,2,the content of TNF-o,IL-6 and IL-10 and W/D ratio were significantly increased,and OI was significantly decreased at T1.2 in groups V and SJ(P ＜ 0.05).Compared with group V,RI at T1,2,the content of TNF-α and IL-6 and W/D ratio were significantly decreased,and OI at T1,2 and the content of IL-10 were significantly increased in group SJ(P ＜ 0.05).The pathological damage was attenuated in group SJ compared with group V.Conclusion Sangju Qingjie Decoction can attenuate the ventilator-induced lung injury through inhibition of inflammatory response in rats.

Objective To analyze the CT features of intestinal tumor obstruction, and explore its CT value.Methods CT manifestation and clinical materials of intestinal tumor obstruction proved by surgical findings or endoscopy biopsy in 35 cases were analyzed restrospectively, and compared with the results of surgery-pathology and endoscopy. Results CT findings were consistence with the results of surgery-pathology and endoscopy in 33 of 35 cases. The CT diagnostic accuracy of intestinal obstruction was 100%. And the accuracy of the cause was 94%, including colon carcinoma in 25, lyphoma in 5, gastrointestinal stromal tumor in 2, and lipoma in 3.Conclusion CT has unique advantage in examining intestinal tumor obstruction, not only for definiting the existence of the obstruction, but also locating the site of obstruction diagnosing the cause and chosing the appropriate treatment.

Objective To investigate the diagnostic Value of multi-slice spiral CT 3-Dimensional reconstruction in intestinal obstruction.Methods 28 Patients with malignant lesions of colon underwent volume scanning using multislice helical CT.Four types of reconstruction included multiple planner reconstruction(MPR),CT virtual colonoscopy(CTVC),shaded surface display(SSD)and raysum.The results were compared with those of colonoscopy and patholog.Results CT diagnostic accurate rate was 100%,and the accurate rate of the cause was 96% in intestinal obstruction,including primary or secondary neoplasms(18/28),abhesions(2/28),bowel torsion(2/28)and external or internal hernias(3/28) and gallstone ileus(3/28).Conclusion There were advantages and disadvantages in diagnosis of mechanical intestinal obstruction with MPR,CTVC,SSD and Raysum respectively.The combined use of the four post-processing technigues can be more helpful to precise localizing and qualitative diagnosis of lesions.MPR should be the optimal post-processing technigues for the diagnosis of intestinal obstruction

Objective To evaluate the effect of domestic wire-reinforced epidural catheter on the occurrence of adverse events during epidural block.Methods Three hundred ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 41-78 kg,scheduled for elective operations under combined spinal-epidural anesthesia,were randomly divided into 3 groups (n =100 each):polyvinyl chloride epidural catheter group (group A),imported wire-reinforced epidural catheter group (group B) and domestic wire-reinforced epidural catheter group (group C).Combined spinal-epidural anesthesia was performed routinely.The corresponding epidural catheter was inserted in each group.The catheterization without difficulty,paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,intravascular catheter insertion,injection obstruction,easiness during removal of the catheter,bleeding after removal,postoperative paresthesia and epidural hematoma within 1 week after operation were recorded.Results Compared with A group,the incidences of paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,injection obstruction and postoperative paresthesia were significantly decreased (P ＜ 0.05),and no significant change was found in the other parameters in B and C groups (P ＞ 0.05).There was no significant difference in all the parameters between B group and C group (P ＞ 0.05).Conclusion Domestic wire-reinforced epidural catheter can decrease the occurrence of catheterization-induced damage to the nerve and blood vessels and the efficacy is comparable with that of imported wire-reinforced epidural catheter.

Objective To determine the effect of primary realignment of posterior urethral injury associated with pelvic fracture on length and delayed operative treatment of ensuing urethral stricture.Methods A retrospective review was made on the clinical data of 64 patients with posterior urethral injury after pelvic fracture treated from January 2008 to January 2012.Of those patients,43 underwent primary endoscopic realignment (early realignment group) and 30 received primary suprapubic cystostomy (cystostomy group).All were evaluated postoperatively for the late stricture rate,stricture length,types of delayed repair,and operation frequency.Results Rate of stricture was 53％ (18/34) in early realignment group and 100％ (30/30) in cystostomy group,but all were corrected by delayed urethroplasty.Mean length of the stricture was (1.8±0.6) cm in early realignment group and (2.9±0.7)cm in cystostomy group(t=6.7,P＜0.05).Of the urethrostenosis patients in early realignment group,83％ (15/18) were successfully corrected with a simple endoscopic cold incision and 17％ (3/18) with open surgery.In contrast,only 60％ (18/30) in cystostomy group were successfully corrected by endoscopic cold incision.Patients in cystostomy group underwent (2.8 ± 0.5) procedures for cure compared with (1.6 ± 0.6) procedures in early realignment group (t =9.2,P＜0.05).Conclusion Primary endoscopic realignment for posterior urethral injury pelvic fracture offers the decrease in stricture incidence,stricture length,operation difficulty and operation frequency.

Objective To investigate the effects of long-term glucocorticoid administration on neuromuscular block of cisatracurium in elderly patients undergoing general anesthesia. Methods Forty ASA Ⅱ or Ⅲ patients,aged≥65 yr,with BMI of 18-24 kg/m2 ,scheduled for elec-tive operation were studied.According to the history of using or not long-term glucocorticoid,patients were assigned into two groups (n = 20 each):control group(group C),glucocorticoid group(group J).Midazolam 0.03 mg/kg was injected,mask inhalation of 8% sevoflurane and flow rate of oxygen 8L,every 30 s decline 2%,until the 4%.After the disappearance of eyelash reflex,cisatracurium 0.1 5 mg/kg was injected intravenously.After 1 min intravenous injection of remifentanil 2 g/kg and 30 s after stop of sevoflurane inhalation anesthesia, endotracheal intubation for mechanical ventilation,target controlled infusion of propofol and remifentanil anesthesia,using TOF-Watch SX acceleromyography monitoring of muscle relaxation,and onset time,clinical duration and recovery in-dex(for T1 to return from 25% to 75% of the control twitch)were recorded.Results Compared with group C,the onset time was significantly prolonged,clinical duration and recovery index were short-ened in group J (P <0.05 ).Conclusion Long-term glucocorticoid admininstration could reduce the neuromuscular blocking effect of cisatracurium in elderly patients.

Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury.Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked.The animal model of iatrogenic splenic injury was established by general anesthesia.Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding.The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 rmin if still bleeding.Then hemostatic effect after removing blocking and oppression was observed.Control group was only treated with gelatin sponge compression to stop bleeding.Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group,and before compression and relieving the compression for 2 hours in control group.IL-1 (interleukin),SOD (superoxide disproportionation enzyme),MPO (myeloperoxidase),MDA (malondialdehyde) and caspase-3 (aspartame acid cysteine protease) were detected.Results The control group still had bleeding,while the experimental group had successfully stopped bleeding.Serum markers before and after occlusion in the experinental group were IL-1 (124.4 ± 106.8 vs.121.2 ± 105.1),SOD (4.7 ± 2.7 vs.5.2 ± 1.8) and MDA (8.8 ±6.5 vs10.8 ±7.5).There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 (121.2 ± 105.1 vs.162.8 ± 73.8),SOD (5.2 ± 1.8 vs.4.7 ± 2.8) and MDA (10.8 ±7.5 vs.9.6 ±6.6) (P＞0.05).Histological indicators before and after occlusion in the experimental group included MPO (0.62 ±0.23 vs.0.68 ±0.21) and Caspase-3 (0.90 ±0.29 vs.0.86 ± 0.26),and there was no statistical difference on MPO (0.68 ±0.21 vs.0.86 ±0.23 after two sets of experiments) and Caspase-3 level (0.86 ± 0.26 vs.1.21 ± 0.18) (P ＞ 0.05) in two groups after occlusion/ oppression.Conclusion The therapeutic effect of intermittent splenic artery occlusion combined with gelatin sponge compression hemostasis is safe and effective and without obvious ischemia reperfusion injury.

Objective To evaluate the effects of long?term glucocorticoid administration on cisatra?curium?induced neuromuscular blockade in the patients undergoing laparoscopic operation. Methods Six?ty?four patients of both sexes, aged 40-64 yr, with body mass index of 18-22 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic operation under general anesthesia, were assigned into 4 groups ( n=16 each) according to whether or not glucocorticoid was used for a long?term period: control ( non?hormone and non?laparoscopic operation ) group ( group C ) , hor?mone + laparoscopic operation group ( group HL ) , non?hormone + laparoscopic operation group ( group NHL) and hormone +non?laparoscopic operation group ( group HNL) . Midazolam 0.03 mg∕kg was injected intravenously, 8% sevoflurane was inhaled by mask, and the concentration of sevoflurane was decreased by 2% every 30 s until the concentration of 4% was reached. After loss of eyelash reflex, remifentanil 2μg∕kg was injected intravenously over 1 min, and 30 s later sevoflurane inhalation was stopped. The patients were tracheally intubated and mechanically ventilated. Anesthesia was maintained with propofol and remifentanil given by target?controlled infusion. Neuromuscular blockade was monitored with accelerograph TOF?watch
SX. At 20 min of pneumoperitoneum in NHL and HL groups or 20 min after intubation in C and HNL groups, cisatracurium 0. 15 mg∕kg was injected intravenously. The onset time, maximal degree of N?M block, clinical duration and recovery index of cisatracurium were recorded. Results Compared with group C, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clini?cal duration was shortened, and the recovery index was decreased in HL and HNL groups ( P<0.05) , and the clinical duration was significantly prolonged, the recovery index was increased ( P<0.05) , and no sig?nificant change was found in the onset time in group NHL ( P>0.05) . Compared with group HNL, the clin?ical duration was significantly prolonged, the recovery index was increased (P<0.05), and no significant change was found in the onset time in group HL ( P>0.05) , and the onset time was significantly shortened, the clinical duration was prolonged, and the recovery index was increased in group NHL ( P<0.05) . Com?pared with group NHL, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clinical duration was shortened, and the recovery index was decreased in group HL ( P<0.05) . Conclusion Long?term glucocorticoid administration can weaken cisatracurium?induced neuromus?cular blockade in the patients undergoing laparoscopic operation.

Objective To investigate the feasibility and clinical effect of the posterior single segment anterolateral decompression and anterior column reconstruction in the treatment of thoracolumbar burst fractures. Methods A retrospective study was done on 21 patients with type Denis B thorocalumbar burst fractures who were treated by posterior approach minimal incision pedicle SCreW fixation,single segment anterolateral decompression and titanium mesh and bone graft from August 2007 to August 2009.There were 15 males and six males at mean age of 35.6 years(range,23-50 years).The involved segments included T12 in six patients,L1 in 11,L2 in three,and L3 in one.The preoperative spinal canal enemachment rate was 62.5%and the anterior-middle vertebral compression of all patients was less than 50%.CT scanning showed normal vertebral body and inferior endplate structure.The fracture reduction,graft fusion,neurological function recovery,correction loss,lumbar activities and adjacent lumbar disc degeneration were observed through preoperative,immediate postoperative and final follow up X-ray,CT and neurological examinations. Results The operation duration was 1.5-3.2 hours(average 2.1hours),with the bleeding of 350-1 000 ml(average 580 ml).All the patients were followed up for 4-26months(average 10.3 months),which showed that the vertebral fusion time was 4-6 months,with no loss of the vertebral height,implant breakage,loosening or extrusion.The nerve function was improved for 1-2 grades. Conclusions With correct selection of the indications,the posterior single segment anterolateral decompression and anterior column reconstruction is a reliable fixation,for it takes advantages of simple operation,minor trauma,less fusion segments and fast recovery.