Objective To evaluate the short-term outcomes of minimally invasive percutaneous plate osteosynthesis(MIPPO) combined with locking compression plate(LCP) in the treatment of distal tibial fractures.Methods From June 2004 to March 2006,16 patients with distal tibial fractures were treated using MIPPO combined with LCP in our department.According to the AO classification,there were 7 cases of type 43A1,5 type 43A3,2 type 43B1 and 2 type 43C3.After reduction of tibial fracture with three methods,LCP was inserted and fixed with locking screw.All the cases were followed up periodically after the operation.Results All the cases were followed up for 5 to 20 months(mean,11.5 months).Primary wound healing was achieved in 16 patients.No complications,such as non-union,abnormal union and breakage of the plate,occurred in the cases.Callus formation was seen on X-rays at 7.6 weeks(4 to 12 weeks) after the surgery,when the patients began part weight-bearing exercises.The bone union was detected at 16 weeks(8 to 20 weeks),when the patients began full weight bearing.3 patients felt uncomfortable at the distal tibia around the implant.According to the AOFAS Ankle-Hindfoot Scale,14 cases(87.5%) were excellent and 2(12.5%) were good.Conclusions MIPPO combined with LCP technique is an effective treatment for the fractures of the distal tibia.This minimally invasive method can achieve stable fixation,promote bone healing,and permit early functional rehabilitation.

Objecitve To observe the diffusion and distribution of imported Oncomdania snails in non-endemic areas of schistosomiasis.so as to provide scientific basis for developing the scheme of snail surveillance.Methods Oncomelania snails from the msrshland of Dongting Lake were imported in a waste land in March,2008,Qingxin County,which belonged to non-endemic areas of schistosomiasis.and their diffusion and distribution condition were observed from May to December in the same year.Resuits A total of 1 600 Oncomelania snails were imported.The occurrence rate of frame with snails in sunny days and cloudy rainy days were22.88%and 29.24%,respectively,and there was a statistically significant difference between them(χ~2=4.113,P=0.043).Those in waste Land and the sides/bottoms of the ditches were 9.38%and 35.99%,respectively,and the difference between them also showed a statistical significance(χ~2=67.246,P<0.001).The average density of living snails in sunny days and cloudy rainy days were 0.79 and 1.11 No./0.1 m~2,respectively,and those in waste land and the sides/bottoms of the ditches were0.11 and 1.34 No./0.1 m~2.The furthest diffusion distance of snailswas 4.5 m.Conclusions The detective opportunity of imported snails is relatively high in cloudy rainy days,which mainly distribute at the sides/bottoms of ditches and diffuse along the ditches.

Objective To discuss the indications, surgical techniques and outcome of less invasive stabilization system (LISS) in treatment of special proximal femoral fractures. Methods Twenty-eight patients with special proximal femoral fractures were treated with LISS from June 2005 to December 2007. All fractures could not be reduced by close reduction with traction table. There were eight patients with in-tertrochanterie fractures ( including type 31-A2.2 fractures in three, type 31-A2.3 in two, type 31-A3.1 in three and type 31-A3.3 in two according to AO classification), 19 with subtrochanteric fractures (including type ⅡA fractures in three, type ⅢB in one and type Ⅴ in 15 according to Seinsheimer classification) and one with peripheral fractures ( type Vancouver B1 fracture) of the femoral prosthesis. The data about opera-tion duration, intraoperative blood loss, postoperative complications, fracture healing time and postoperative hip function score were recorded. Results The operation lasted for mean 88 minutes (45-120 minutes), with intra-operative blood loss of average 320 ml (50 -700 ml). There occurred deep vein thrombosis of lower limb in two patients, myocardial infarction in one and lower digestive tract bleeding in one after oper-ation, with no incision complications. One patient with breast cancer was died of brain metastasis after op-eration and three lost follow-up. Other 24 patients were followed up for mean 18 months (6-33 months), which showed that 23 patients got fracture healing 2-5 months ( average 3 months) postoperatively but that one patient with type Seinsheimer V fracture had breakage of proximal locking screws six months postopera-tively because of nonunion of subtrochanteric fracture. The Harris score of the hip was 70-99 points ( aver-age 84 points). Conclusions Reverse femoral LISS has advantages of minimal invasion, easy opera-tion, stable fixation, high degree of safety and minor complications for treatment of special proximal femoral fractures. Skillful reduction, correct positioning of guide wire into hole A and avoidance of immediate weight bearing are key to success of the operation.

Objective To discuss the selection of short- or long-segment posterior fixation for treatment of unstable thoracolumbar fractures. Methods A total 134 patients with thoracolumbar fractures treated with pedicle instrument fixation from January 2005 to December 2008 were studied retrospectively. According to AO fracture classification, there were 70 patients with type A fractures, 37 with type B and 27 with type C. The patients were divided into two groups according to the number of instrumented levels; short-segment posterior fixation (SSPF) group (four screws; one vertebral body above or below the fractured vertebrae) and long-segment posterior fixation (LSPF) group (eight screws; two vertebral bodies above or below the fractured vertebrae). Clinical outcomes and radiological parameters (superior-inferior endplate angle, vertebral body angle, displacement of vertebral body) were compared according to AO fracture classification. Results All type A fractures were treated with SSPF, mean superior-inferior endplate angle changed from preoperative 21.3° to postoperative 8.5° and 11.1° at final follow up. There was no statistical difference in the correction of Cobb angle for type B fractures in SSPF group (26 patients) and LSPF group (11 patients), while the correction loss of vertebral body angle was 3. 64° in SSPF group and 1.09° in LSPF group, with statistical difference (P < 0. 05). There was no statistical difference in the correction of Cobb angle for type C fractures in SSPF group (7 patients) and in LSPF group (20 patients), but the correction loss of vertebral body angle was 3.6° in SSPF group and 0. 8° in LSPF group, with statistical difference (P < 0. 05). There was no statistical difference in vertebral displacement correction. Conclusions Most types A and Bl fractures should be treated with SSPF; most types B2, B3 and C fractures should be treated with LSPF.

Objective:To observe and compare the therapeutic effect of metoprolol by routine increasing dose method and rapid titration method on acute myocardial infarction (AMI).Methods:A total of 60 inpatients,who were di-agnosed with AMI within 24h and without contraindications for metoprolol,were randomly divided into two groups:routine therapy group (received metoprolol using routine methods,the dose was added in seven days)and rapid ti-tration group (metoprolol was added in three days using titration).The dosage maintained with 190 mg/d after both groups reaching the target dose of 190mg/d;then therapeutic effects were observed in both groups.Results: ①There were no re-myocardial infarction,rehospitalization caused by heart failure and sudden death etc.in both groups;② Patients received echocardiography in outpatients after three months.Compared with routine increasing dose group,there was significant reduction in left ventricular end-diastolic diameter [LVEDd,(55.00±7.56)mm vs.(50.00± 5.81)mm]and significant rise in left ventricular ejection fraction [LVEF,(49.13 ± 10.18)% vs. (57.84±10.34)%]in rapid titration group,P <0.01 both.Conclusion:Rapid titration method could make the pa-tients rapidly reach the targeted dose of metoprolol and inhibit renin release earlier,block the renin-angiotensin sys-tem,and improve myocardial remodeling and cardiac function.

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 compare the efficacy of reversed less invasive stabilization system (LISS) and intramedullary fixation devices for treatment of femoral trochanteric fractures.Methods Data of 362 consecutive patients with femoral trochanteric fractures who were treated with reversed LISS or intramedullary fixation devices at our institution between March 2004 and May 2011 were retrospectively analyzed.There were 32 males and 38 females treated with reversed LISS.The mean age at injury was 73.4 years.There were 125 males and 167 females treated with intramedullary fixation.The mean age at injury was 74.7 years.The operation time,intraoperation blood loss and length of hospitalization were compared.The patients were asked to fill in a questionnaire of Harris hip score,and radiographs were used to evaluate the bone healing situation.Results The mean operation time was 120 min in reversed LISS group and 80 min in intramedullary group.The length of hospitalization was 12 days in reversed LISS group and 10 days in intramedullary group.More operation time and longer length of hospitalization were needed in reversed LISS group.The intraoperation blood loss was 100 ml in reversed LISS group and 100 ml in intramedullary group.There were 3 DVT in reversed LISS group,10 DVT and 3 PE in intramedullary group.No difference was found in the aspect of intraoperation blood loss,postoperative deep venous thrombosis and pulmonary embolism rate.A total of 320 patients were successfully followed-up,including 63 in LISS group and 257 in intramedullary group.The median Harris score was 75 in LISS group and 77 in intramedullary fixation group respectively.There was no difference of hip function score between two groups.The implant-related complication rate was 11.1％ in reversed LISS group,including 7 implant breakages.In intramedullary fixation group,there were neck screw exiting in 2 patients and cutout in 9 patients.So the implant-related complication rate was 4.3％ in intramedullary fixation group,which is statistically lower.Conclusion Both reversed LISS and intramedullary are effective for the treatment of proximal femoral fractures.There were no major difference in functional outcome between LISS and intramedullary nail.Intramedullary nail is still the choice of priority in most unstable proximal femoral fractures.The implants related complications in reversed LISS group are higher than Intramedullary nail group.However,for the unstable fractures proximal femoral fractures with lateral wall fracture,in which nailing may be difficult,reversely using LISS may be a good alternative.

OBJECTIVE To investigate nosocomial infection and drug-resistance of Pseudomonas aeruginosa(PAE) in our hospital to provide the evidence for clinical monitoring and control of nosocomial infection.METHODS The microbiological system MicroScan WalkAway-40 was used to identify PAE and the drug-resistance in vitro was determined by K-B methods.RESULTS Among 325 strains of PAE in two years,imipenem-resistant P.aeruginosa(IRPA) accounted for 14.8%.The highest isolating rates occurred in the intensive care unit(ICU),accounted for 20.9%.The following was senile disease department,accounted for 19.4%.The respiratory department rated the third,accounted for 16.9%.The resistance of IRPA to 11 kinds of common antibiotics was significantly higher than imipenem-sensitive P.aeruginosa(ISPA).Except the drug-resistance of IRPA to ceftazidime,cefepime and aztreonam was below 50.0%,that to the other eight antibiotics was all over 50.0%.CONCLUSIONS The drug-resistance of PAE is very serious in our hosptial.We should perform rigorous monitoring and prevent the outbreak of nosocomial infection with PAE.

Background Neointima formation plays an important role in the pathogenesis of atherosclerosis and restenosis after angioplasty.We hypothesized if atorvastatin inhibits neointima formation mediating decreases in cathepsin S (Cat S) and nuclear factor-?B(NF-?B) expression.Objective The study was aimed to explore the effect of atorvastatin on the neointima formation,Cat S and NF-?B expression in rats after balloon-injured carotid artery.Methods Twenty-four male Sprague-Dawley rats were randomly one of three arms:control group(n=8),surgery group(n=8) and atorvastatin group[10 mg/(kg?d),n=8] for 4 weeks.Surgery and atorvastatin group were performed with balloon angioplasty to the left common carotid artery.The serum levels of IL-1? were measured using enzyme-link-immunosorbent assay(ELISA).Carotid arteries were excised and examined with pathomorphology.The expression of Cat S and NF-?B was measured using using the RT-PCR and immunohistochemistry techniques.Results Compared with surgery group,atorvastatin decreased intima area and intima media ratio(I/M)[intima area:(148.6?8.8)?103 vs (64.8?5.1)?103 ?m2;I/M:(2.1?0.2) vs (0.9?0.1),all P

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.