Objective To discuss the treatment of tibial plateau posterior column fractures via the posteromedial approach which dissects the medial head of the gastrocnemius muscle.Methods From July 2013 to September 2016,7 patients were treated at Department of Orthopaedics and Trauma,The First Affiliated Hospital to Dalian Medical University by surgery via the posteromedial approach dissecting the medial head of the gastrocnemius muscle for tibial plateau posterior column fractures.They were 6 men and one woman,aged from 38 to 61 years (49.3 years on average).According to AO/OTA classification,4 cases belonged to type 41-B3.3,one to type 41-B3.1,one to type 41-C3.3 and one to type 41-C3.1.According to the three-column classification,3 cases were categorized into three-column fracture,2 cases into fracture of both medial and posterior columns,and 2 cases into simple posterior column fracture.Of the posterior column fractures,5 had the medial posterior column split and the lateral column collapsed,and 2 had the medial posterior column split.According to Schatzker classification,5 cases were categorized into type Ⅳ,one into type Ⅴ and one into type Ⅵ.Fracture reduction was assessed according to the Rasmussen criteria postoperation.The knee function was assessed at final follow-ups using The Hospital for Special Surgery (HSS) scoring system.The postoperative complications were documented.Results Insertion rupture of the posterior cruciate ligament was found in one case,lateral meniscus injury in 2 cases,and tibial external dislocation combined with bone fragment incarceration into the lateral femoral condyle in one case.All the lesions were repaired.All the incisions were healed at the first stage.No major neurovascular injuries were found.The 7 patients were followed up for 8 to 12 months (mean,11.4 months).Bony union was achieved in all after 12 to 16 weeks (mean,14.3 weeks).The postoperative Rasmussen reduction scores averaged 17.7 points.The average tibial plateau tilt angle was 9.5°postoperatively and 10.8° at final follow-ups;the average tibial plateau varus angle was 86.7° postoperatively and 87.3° at final follow-ups.The HSS knee scores at final follow-ups averaged 91.4 points.No significant reduction loss,implants loosening,infection or malunion was observed at final follow-ups.Conclusion The posterior medial approach which dissects the medial head of the gastrocnemius muscle is a safe and practical one for treatment of tibial plateau posterior column fractures,because it can well expose the posterior column of the entire tibial plateau so that is beneficial to the anatomical reduction of the fracture and placement of implants,leading to fine short-term curative effect.

Objective To investigate the morbidity of cholecystic disease in renal transplant candidates and study the indications of prophylactic laparoscopic cholecystectomy(LC) for renal transplant candidates with cholecystic disease. Methods The incidence of cholecystic disease in 286 renal transplant candidates in our institution in recent four years was retrospectively reviewed.All the candidates had received one or more ultrasonographic examinations. Results Cholecystic disease was found in 32 of 286 candidates ((11.1)%), including cholelithiasis in twenty(62.4%, 20/32), sludge in six(18.8%, 6/32)and polypoid lesion in six(18.8%, 6/32). Cholecystectomy had been performed in twenty candidates with symptomatic chronic cholecystitis before transplantation, including LC in fourteen and open cholecystectomy with small incision in six .Five of twelve candidates without symptoms received prophylactic LC electively .In three of the other 7 candidates acute cholecystitis occured within six month after transplantation.There was no death of the (candidates) and no grafts function loss occurred in this series. Conclusions Cholelithiasis is the major cause of cholecystic disease in renal transplant candidates. Electively prophylactic LC is recommended for the (candidates) with or without symptomatic cholecystitis before transplantation or before acute cholecystitis has (occured).

Objective To explore the features, diagnosis and treatment of pulmonary infection after kidney transplantation. Methods The clinical data of 31 pulmonary infection cases among 150 patients underwent kidney transplantation were analyzed retrospectively. Results The 31 patients with pulmonary infection after kidney transplantation included 9 cases of simple bacterial infection, 3 cases of fungus infection, 5 cases of CMV infection, 1 case of TB, 10 cases of mixed infection, and 3 cases of infection with unclear pathogen. 27 cases of the patients(27/31,87.1%) were cured, while 4 cases died of pulmonary infection. Conclusion Pulmonary infection is a common and severe complication after kidney transplantation. Early etiological diagnosis, the prompt treatment of antibacterium,antivirus and antifungus, adjustment of immunosuppression regime, and strengthening the support therapy would improve the curative rate.

0.05). PBF was still increased more then normal values 1 years after OLT(P

Objective To summarize the clinical experience of standard piggyback liver transplantation(SPBLT) and modified piggy-back liver transplantation(MPBLT) in the treatment of Wilson′s disease(WD).Methods The clinical records of 29 cases of WD who underwent piggyback liver transplantation over the recent 12 years were analyzed retrospestively.Among them,there were 22 male and 7 female patients,with 6cases aged 8-14y and 23 cases aged 24-37y,who underwent liver transplantation because of chronic advanced liver disease(18cases),fulminant hepatic failure(2 cases),or with normal liver function(9 case),and among them,24 cases showed neurological dysfunction.The modes of operation included SPBLT(13 cases) and MPBLT(16 cases).Results The patients were followed up for 1 month-12 years with the median follow-up time of 47 months.Four patients died in the perioperative period,of which 2 died of hepatic failure due to obstruction of hepatic venous return after SPBLT,and 2 died of hepatic artery thrombosis and bile leakage combined with severe infection.The recipient survival rate at 1 year and 3 years was 86% and 79% respectively.One patient has survived for 12 years.All the levels of serum copper and copper-protein recovered to normal in four weeks post-operatively.Neurological symptoms improved in varying degrees after operation.Conclusions WD patients who undergo PBLT can expect a satisfactory clinical outcome and a good quality of life,and MPBLT can effectively reduce the complications of operation and improve the operation survival rate.

Objective To study the diagnosis and prophylaxis of postoperative infections within 1 month after orthotopic liver transplantation(OLT). Methods Clinical date of 38 consecutive patients who underwent OLT at our institution from 2001 to 2003 were retrospectively reviewed. Result Eighteen patients( 47.4% ) developed twenty-nine times infection after operation .Respiratory tract and peritoneum were the common infectious sites(37.9% and 24.1%). Enterobacter cloacae(8 of 29, 27.6%) , Escherichia coli(7 of 29, 24.1%),staphylococcus aureus(6 of 29, 20.7%) were the commonest bacterial.The mortality of infection was 38.9%(7/18). Identified risk factors for infection including: previous transplantation ; duration of operation; transfusion requirements during surgery; type of biliary anastomosis; delayed restoration of gastrointestinal function and persistent postoperative hyperglucocemia . Perioperative decontamination of the digestive tract had a protective effect. Conclusions Infections are a major cause of death among liver transplant recipients. Reducing risk factors of infection and perioperative decontamination of the digestive tract may decrease the occurrence of postoperative infection.

Objective To investigate the renal hemodynamic changes after orthotopic liver transplantation(OLT)and the correlative parameters. Methods In 20 patients undergoing OLT for cirrhosis,the following renal arterial resistance index(RI) was measured before surgery and 7days,30days, 6 months and 1 year after operation by using color Doppler flow imaging(CDFI) and serum creatinine detection.Meanwhile the same parameters were measured in 10 healthy as controls. Results Both RI and serum Cr rised after OLT ( P 0.05). Conclusions Most alteration of renal hemodynamic parameters in cirrhosis are restored to normal after OLT in 1 year. Preoperative renal abnormalities and intraopterative alteration of hemodynamic may contribute to postoperative renal dysfunction. Cyclosporine (CsA) is the most likely etiologic agent of postoperative renal dysfunction.