Objective To evaluate the short term results of repairing osteonecrosis of the femoral head by modified free vascularized fibular grafting through Smith-Peterson approach without cutting the rectus femoris.Methods Between January,2009 and September,2012,14 osteonecrotic hips of 14 patients who underwent free vascularized fibular grafting were retrospectively studied including 10 male and 4 female.The follow up period was 24 months.The preoperative and postoperative symptoms relief,recovery of hip function (Harris score),radiographic assessment (X-ray).Results All patients got postoperative ipsilateral hip pain relief.Average Harris hip score improved significantly (68.47 ± 5.33,86.80 ± 4.72 points in preoperation and postoperation,respectively; paired t test,t =18.724,P ＜ 0.01).Postoperative X-ray results showed there were no progresses of osteonecrosis and no collapse in the operative side within 2 years follow-up.Conclusion The short term treatment results of femoral head avascular necrosis were satisfactory by using free vascularized fibular graft through Smith-Peterson approach without cutting off the rectus femoris and it may be a relatively practical option of surgical approach.

Objective To explore the treatment and efficiency of high blood flow vascular malformations of oral maxillofacial region with super-selective arterial embolization. Methods 18 cases underwent angiography of the head and neck before treatment and then followed by super-selective catheterization with microcatheter to embolize the feeding vessels of the vascular malformations with PVA. 8 cases underwent surgical excision within 72 hours after the embolization and the other 10 cases passed through the arterial radical emboliztion treatment. Results Technical success ratio reached 100% with no complications causing skin necrosis or incorrect arterial embolization else where in the skull. All 8 cases undergone preoperative embolization showed obviously less bleeding, easier removal of the mass and reduction of operation time. 10 cases with radical arterial embolization manifested reduction of swelling and improvement of organ function within 1 to 24 months after the procedure. 5 patients were cured with only once operation, 4 cases with twice operation and 1 with the thrice. Conclusions Aterial embolization is a safe and effective method in the treatment of high blood flow vascular malformations of oral maxillofacial region.

Objective To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions.Methods A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed.All the patients underwent embolization from October 1998 to June 2010,including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years.Only lesions were occlued in 12 cases without involving the internal carotid artery,while occlusions of internal carotid artery were performed in the rest 25 cases.Results Thirty-six patients were cured without recurrent hemorrhage after embolization.Only 1 patient with carotid artery occlusion died 48 hours after operation.Conclusion For patients with carotid arterial intractable epistaxis,if the elimanation of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation,the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives.

Objective To explore the predictive value of CT image texture analysis for early enlargement of hypertensive intracerebral hemorrhage.Methods One hundred and eight patients with hypertensive intracerebral hemorrhage were divided into enlarged hematoma group (positive group)and non-enlarged hematoma group (negative group),according to whether the volume of hematoma on 24 h follow up CT scan was more than 30% or 6 mL of the baseline CT.Phillis Radiomics Tool V93 software was used to segment the hematoma on CT plain scan images of two groups,four features of first-order and three of gray-level co-occurrence matrix (GLCM),thirteen of gray-level size zone matricx (GLSZM)and eleven of gray-level run-length matricx (GLRLM)were obtained.The differences of thirty-one texture features between the two groups were compared.The ROC curves of the features with statistical differences were analyzed.The independent predictors of early enlargement of intracerebral hemorrhage were screened by Logistic multivariate regression model.Results Among the one hundred and eight patients,twenty-eight were positive group and eighty were negative group.Skewness and long run low gray-level emphasis (LRLGE)in positive group were significantly higher than those in negative group (P＜0.05).There was no significant difference in the remaining twenty-nine features between the two groups (P＞0.05).ROC curve analysis showed that the AUC of Skewness,LRLGE and their combined diagnosis were 0.634,0.814 and 0.828,respectively.The independent variables were screened by stepwise regression analysis.The LRLGE (OR＝1.238,95%CI＝1.009－1.51 9,P＜0.05)was selected as the regression model, suggesting that LRLGE was an independent predictor of the early enlargement of intracerebral hemorrhage.Conclusion Texture analysis of CT images is helpful to predict the early enlargement of hypertensive intracerebral hemorrhage,and LRLGE based on GLRLM algorithm can be used as an independent predictor.