Humans ; Infant, Newborn ; Intestinal Perforation ; complications ; diagnosis ; Mycoses ; complications ; diagnosis

[Objective]To explore the clinical indication and effectiveness of anterolateral mini-incision for the total hip replacement (THR).[Method]A retrospective analysis of the 34 cases of anterolateral mini-incision was conducted from May 2002 to March 2005,among the patients 23 suffered from displaced femoral neck fractures and 11 suffered from femoral head aseptic necrosis.[Result]All the patients were followed up for 12～36 months with an average of 18 months.The obvious advantages of anterolateral mini-incision for the total hip replacement were as following:less blood loss in operation,less post-operative pain and complications,and early rehabilitation training,without cinch and subsidence in X-ray.Harris score was 92.1 point.[Conclusion]Anterolateral mini-incision for the total hip replacement can be used as an effective method to treat the patients who were extenuation,without abnormalities of hip joint,deossification and osteoporis.Appropriate incision combined with precise procedure can reduce the operative trauma and speed up functional recovery.

[Objective]To explore the clinical effects of titanium plate and morselized hone grafting for the treatment of severe acetabular hone defect.[Method]A total of 27 patients with acetabular defects were treated with this procedure.According to AAOS,the acetabular defects were classified into various types:type Ⅰ in 6 cases,type Ⅱc in 4 and type Ⅲ in 17.The average preoperation Harris score were 37.The postoperative effect should be evaluated by clinical and X-ray manifestations.[Result]All patients were adopted this method to reconstruct the acetabular bone defects.The prosthetic dislocation was found in one case after operation,which was resulted from over-anteverted titanium plate impacted the greater trochanter.The part of trochanteric bone and impact factors were removed to healing.No complications were found in other patients.The average following up was 3 years and average Harris score was 87.The X-ray showed that none of the patients was presented the radiolucent lines in the acetabular mattress,bone transplantation,reconstructive titanium plate and interface of polyethylene liner.[Conclusion]The titanium plate and morselized bone grafting can repair the acetabular bone defects effectively and provide a solid initial fixation for prosthesis and restore the role of rotational center of hip.

Objective To investigate the clinical application and therapeutic effect of reservation cortical expand resection and reconstruction for extremities bone tumor. Method Twelve cases with extremities invasion bone tumor were reviewed,including 6 male and 6 female.The average age was 37.1 years old.According to the MRI,TypeⅠtumor located in metaphysic and growth eccentricity,and was treated with outside tumor osteotomy with reservation of one side as integumentale,the cut line was shape of "匚".Type Ⅱ tumor was with invasion part articular surface,and was operated with part joint osteotomy with reservation of one side as integumentale,the cut line was shape of"L".Type Ⅲ was with invasion total joint surface and as integmentale,all tumor segment including joint could be cut,but the shape of cut close to the diaphysis was echelonment. Result The operation time was 1~3 h,the operative bleeding quantity were 150~400 ml,all incisions were obtained primary healing.Twelve cases were followed up from 6 months to 8 years.The average extremity functional score according to the system of ISOLS(International Society of Limb Salvage):upper extremity was 22.3 and the lower was 25.3 The average bone healing time of returned deactivation bone graft and bone allograft healing with the osteotomy plane was 3 months,original tumor recurrence in local was 1,the recurrence rate was 7.69%,no malignant change and metabasis was found. Conclusion The reservation cortical expand resection and reconstruction could increase the treatment effect of extremities bone tumor,it is key to decrease the recurrence with strict indication,non-neoplasma and aseptic technique.Tumor shell and osteotomy plane should be deactivated thoroughly.

[Objective]To investigate the restoration of the axial alignment of the lower extremity during operation for fracture of tibia plateau and to assess the curative effect.[Method]A retrospective analysis of 45 cases of fracture of tibial plateau were conducted from May 2000 to June 2005,25 male cases and 20 female,mean age were 45.3.The type of fracture:3 cases were Schatzker I,10 were type Ⅰ,19 were type Ⅲ,6 were type Ⅳ,5 were type Ⅴ,2 were type Ⅵ.All cases were treated with open reduction,bone graft and internal-fixation with plate and screw under arthroscopy-assisted,and the normal axial alignment of the lower extremity was restored.The restoration standard was in accordance with the uninjured side limb.The way of measurement:the axial line from anterior superior iliac to interdigit of the first and second toe was done,then,the perpendicular distance from the center of patella to this line was calculated,and compared the data with uninjured side limb's.[Result]Forty cases were followed up,from 6 months to 24 months,average 15 months,according to the Rasmussen knee score standard,24 were excellent,11 were good,3 were fair and 2 were poor.The satisfactory rate was 87.5%,the restoration of knee function were close correlated with whether the line normal or not,there were abnormal lines recurrence in some cases,the main causes were:(1)Meniscus to be cut excessive to the loading redistribution in joint;(2)The reduced articular surface collapsed,again due to the affected limb weight loading too early;(3)Fractures were too complicated to be compress fixed with common buttress plate,resulted in displace fracture.[Conclusion]It is very important that the axial alignment of the lower extremity to be corrected during operation to the injured knee function restoration after operation,and the causes result in the axial line abnormal above-mentioned should be considered thoroughly,at the same time,the corresponding measures should be taken.

[Objective]To explore the treatment of intertrochanteric fracture with expandable proximal femoral nail and prevention and cure of some related complications.[Method]Fifty-eight cases of closed intertrochanteric fracture,including 28 male cases and 30 female,average 73.2 years old(range from 42 to 88)accepted treatment.The type of fracture according to Evans classification:5 cases were type Ⅰ,7 were type Ⅱ,28 were type Ⅲ,13 were type Ⅳ,and 5 were type Ⅴ.All cases were treated with expandable proximal femoral intramedullary nail after close reduction.[Result]Thirty-eight cases were followed up,from 12 to 36 months,average 18.5 months,all of the cases got clinical healing after 8-10 weeks postoperatively.Hip Harris score average was 91.8.Some complications occurred in 6 cases:1 case had secondary fracture nearby the greater trochanter needling insertion point,1 case femoral head peg was outside of the lock hole,and 1 case femoral head peg tip was broken during operation.And after operation,1 case had coxa vara deformation,1 case had femoral middle and superior segment fracture,and 1 case femoral head peg was exited.[Conclusion]Expandable proximal femoral intramedullary nail has some advantages as:minimal invasive,manipulation convenient,fixation reliability,remove easily,but surgeons must be familiar with the construction and fixation principle of the nail in the primary stage,and perform the operating instruction strictly,to reduce or avoid the complications occurrence because of mis-manipulation.

Objective To discuss the opportunity of transurethral resection of prostate (TURP) after transrectal prostate biopsy.Methods We analyzed 60 cases of benign prostatic hyperplasia(BPH) who underwent TURP after transrectal prostate biopsy from September 2013 to September 2015.All the patients were divided into either group A or group B in chronological order, with 30 cases in each group.There were no significant differences in age, prostate specific antigen (PSA), prostate volume, hemoglobin level, and international prostate symptom score (IPSS) between the two groups.The group A and group B were treated by TURP at 1 week and 4 weeks after transrectal prostate biopsy, respectively.The parameters including operation time, excised prostate weight, intraoperative total blood loss, bladder irrigation time, and IPSS at 3 months after operation were recorded.Results The operation time, intraoperative total blood loss, bladder irrigation time, and IPSS in the group B were significantly lower than those in the group A [(58.3±6.0) min vs.(62.0±3.3) min, t=2.952, P=0.005;(154.1±15.8) ml vs.(167.4±29.5) ml, t=2.181, P=0.035;(19.2±0.8) h vs.(20.6±2.3) h, t=3.034, P=0.004;(18.3±2.5) points vs.(20.3±2.0) points, t=3.419, P=0.001].The excised prostate weight in the group B was significantly higher than that in the group A [(37.1±4.0) g vs.(33.3±7.8) g, t=-2.341, P=0.024].Conclusions TURP performed at 4 weeks after transrectal prostate biopsy can significantly increase the excised prostate weight, reduce intraoperative total blood loss volume, shorten the operation time and postoperative bladder irrigation time, and improve urinary symptoms.In brief, we recommend that TURP be executed at 4 weeks after transrectal prostate biopsy.

Objective To probe the effects of the size and location of cranial defect on the neurological symptoms of patients with skull bone defect.Methods The patients were classified into the following groups according to the influence to symptoms by changes in body position and changes of symptoms before and after craniectomy: True syndrome of the trephined(ST,Ⅰ), partial ST patients(Ⅱ), other patients or symptom-free patients (Ⅲ).Results The group I consisted of 33 cases, their defects were located in the parieto-occipital region in 23 cases, frontoparietal in 10 cases. All these patients had flaccid skin flaps that became concave while in the upright position. The group Ⅱ was composed of seven cases, their defects were located in frontoparietal and parieto-occipital region in three respectively. All these patients had flaccied skinflap in defects pars.Group Ⅲ included twelve patients, flat and rigid skin flaps were usually demonstrated , predominantly in the tempora and parietal regions.Conclusions The size and location of the cranial could play an important role in the development of the neurological symptoms.

Objective To study the therapeutic efficacy and the application value of microsurgical shunt in varicocele (VC) with oligospermia. Methods Funicular vein elevatus ligation and microsurgical shunt were applied in 66 patients. Improvements of the symptom, sign,semen quality and the couple's pregnant rate in prognosis visiting were observed. Results in 71 sides by microsurgical shunt,symptom disappeared in 51 cases and obviously improved in 20 cases after 7 days. Half and one year later,symptom and sign were disappeared in 69 cases (97% );semen quality was improved in 52 cases (78% ). In 37 cases (56. 3% ),sperm density was ≥20 ? 109/L, progress sperm was ≥50% and morphologically normal sperm was ≥30 %. In 11 cases (16. 7% ),sperm density was increased from 5 ? 10,/L- 15 ? 109/L before operation to 10 ? 109/L- 19 ? 109/L after operation,and both of the sperm motility and viability were increased. In 4 cases (5% ),sperm density was increased from less than 5 ? 10s/L before operation to more than 5 ? 10,/L after operation. In 26 cases,the couple was pregnant;the pregnant rate was 39. 4%' Conclusion Vein elevatus ligation and microsurgical shunt blocked the vein blood reflux,established the new vein circuit and improved the blood supply of testis in the mean time. It was approved that the method was effective in diminishing the local symptom and sign, improving semen quality and preventing recurrence' It was especially suitable for classⅢ exudative VC patients

Objective To evaluate the levels of neutrophil gelatinase associated lipocalin (NGAL) in prediction of acute kidney injury (AKI) in children with burn. Methods Forty seven children with burn were selected in this study and thirty healthy children were enrolled as a control group. Levels of blood routine, urine routine, serum creatinine (Scr), serum NGAL (SNGAL), urine NGAL (UNGAL), blood urea nitrogen (BUN) and C-reactive protein (CRP) were measured. Receiver operating characteristic (ROC) curve were used to estimate the AKI diagnostic value of serum NGAL, urine NGAL and Scr. Results On the day of admission, serum NGAL and urine NGAL were significantly increased in patients with AKI , while Scr did not change significantly as compared with those in non-AKI patients and the healthy controls. In AKI group, serum NGAL and urine NGAL were positively correlated with WBC and CRP on the day of admission , and positively related with Scr on the seventh day. ROC analysis showed the AUC of serum NGAL, urine NGAL and Scr on admission were 0.737(95%CI: 0.653 ~ 0.779, P < 0.05), 0.772(95%CI: 0.632 ~ 0.793, P < 0.05), and 0.508(95%CI: 0.454~0.618, P < 0.05) respectively. The cut-off value of serum NGAL and urine NGAL were 318 μg/L (sensitivity of 72.8% and specificity of 81.6%) and 105 μg/L (sensitivity of 75.6% and specificity of 83.7%). Conclusions Elevation in levels of serum NGAL and urine NGAL occurs earlier than that in Scr level in children with burn. Both serum and urine NGAL level can be used as a biomarker for early prediction of AKI.