Cases Got Research Articles

Application of the Hering's law in corrective surgery for asymmetric bilateral ptosis

Objective To evaluate the clinical result of Hering's law in the correction of asymmetric bilateral ptosis. Methods From January 2014 to July 2016, 165 cases divided into 2 groups with asymmetric bilateral ptosis in mild and moderate ptosis were corrected with aponeurosis advancement type correction: A group of 15 cases, in which the surgery does not consider the influence of Hering's law, the first correction of mild side, and then corrected the heavier side; B group of 150 cases, in which the Hering's law was applied, the first correction of severe side so that the margin reached the edge of the cornea is tangent or low 0.5-1.0 mm, and then corrected mild side. That the difference of symmetry between the two sides of the palpebral fissure was less than 0.5 mm, and the follow-up was more than 3 months. The Pearson chi square test was used to compare the differences between the two groups. Results In this group, 165 cases were followed up for 3-24 months, 10 cases (66.67%) was satisfactory in group A (15 cases); 145 cases (96.67%) was satisfactory in group B (150 cases); After 3 months, all the failure cases got satisfactory result by using the Hering's law in corrective surgery again. The P value of chi square test between groups was less than 0.05. Conclusions The application of Hering's law in the correction of asymmetry bilateral ptosis is more satisfactory. Key words: Hering's law; Asymmetry bilateral ptosis; Levator palpebrae superioris muscle

Percataneous endoscopic lumbar discectomy for the treatment of lumbar intervertebral disc protrusion

To explore the clinical effects of percataneous endoscopic lumbar discectomy for lumbar intervertebral disc protrusion. The clinical data of 46 patients with lumbar intervertebral disc protrusion underwent percataneous endoscopic lumbar discectomy were retrospectively analyzed. There were 21 males and 25 females, aged from 23 to 65 years old with an average of 42 years. The course of disease was from 5 to 87 months with an average of 13.4 months. Protrusion located in L₂,₃ of 2 cases, L₃,₄ of 3 cases, L₄,₅ of 28 cases, L₅S₁ of 13 cases. There were 5 patients with central type, 34 with para-side type, 7 with extreme lateral type. VAS, ODI and JOA scores were used to analyze the condition of pain releasing and lumbar functional improvement. According to MacNab standard to evaluate the clinical effect at final follow-up. All the operations were successful, operative time was 125 to 210 min with a mean of 153.6 min; and all the patients were follow-up for 6 to 12 months with an average of 8 months; no injuries of nerve and blood vessel, infection were found. Postoperative 3 days and final follow-up, VAS score was 3.1±0.7, 2.2±0.6 respectively, and was obviously lower than preoperative 7.3±1.2(P<0.05). At final follow-up, JOA and ODI were (23.5±2.4) points, and (22.10±9.26)%, respectively, and was obviously improved compared with preoperative (13.2±2.8) points and (69.12±13.15)% (P<0.05). According to modified MacNab standard to evaluate the clinical outcome, 30 cases got excellent results, 14 good, 2 fair, no recurred and overhauling were found. Percataneous endoscopic lumbar discectomy is a minimally invasive technique, with advantage of safety and effectiveness, and apply to treatment of lumbar intervertebral disc protrusion.

EP04.15: Postnatal clinical course of the fetal vascular ring

The prenatal diagnosis of the vascular ring increases. However, the postnatal course of the vascular ring is not clear. Aim of this study is to clarify the postnatal course of the vascular ring. We reviewed the clinical record of 20 cases of vascular ring that were diagnosed in fetal echocardiography. Of these, double aortic arch were 3 cases, right aortic arch and left subclavian origin abnormality were 17 cases. All cases of double aortic arch were performed surgery in order to developing respiratory or digestive symptoms in their infancy. The operation were performed in 3 cases of right aortic arch and left subclavian origin abnormality. 2 cases of them get operated after their 1 year old, while a case got in infancy. There were no symptoms in remaining 14 cases at their 1 year old. There was not the case of the emergency that required respiratory care just after birth in this examination. Then patients of double aortic arch might need careful follow up and early operation from their neonatal period. Patients of right aortic arch and left subclavian origin abnormality have usually asymptomatic clinical course. Then they might not need operation in neonatal. Patients of right aortic arch and left subclavian origin abnormality should be observed carefully for their symptoms developing, and be examined surgical indication.

Adult peripheral primary neuroectodermal tumor: a case report and literature review

Objective: To analyze the clinical features, diagnosis and differential diagnosis of peripheral primary neuroectodermal tumor(pPNET). Methods: The clinical data and diagnosis of a patient with rapid progressive pPNET in Shandong Provincial Hospital affiliated to Shandong University in January 2016 was reported and the related literatures were reviewed.The literature reviews were carried out respectively in CNKI, Wanfang and PubMed by July 2016 with "primitive neurotodermal tumour" and "PNET" being the search term from March 1994 to July 2016, including 13 articles. Results: A 41 year-old male patient was admitted to the hospital because of shortness of breath and occasional chest tightness, accompanied by general asthenia of about 15 d. Positron emission and transmission-CT of total trunk showed a mass in the right femoral osteoperiosteal mass, and multiple nodules in the left lung, lumps and nodules in the right lung, and right pleural thickening and effusion. Thoracoscopy was performed and pathology study confirmed the diagnosis of peripheral primary neuroectodermal tumor. The patient was given 2 courses of chemotherapy, but had rapid progressive worsening and died 1 month after PNET diagnosis. A total of 13 literatures of PNET were retrieved, all of which were case reports, and a total of 15 cases were reported.There were 9 male and 7 female patients, with a median age of 26 years.The symptoms had no specificity and most of them were solid masses in chest images, with or without pleural effusion. Eight cases were diagnosed by imaging guided percutaneous biopsy, 7 by operation and pathology, and 1 by medical thoracoscopy. Four cases underwent chemotherapy, and the survival time was less than 6 months. Twelve cases got surgical resection: 2 with surgical treatment, 7 with postoperative chemotherapy, 2 with postoperative radiotherapy and chemotherapy, 1 with postoperative chemotherapy and autologous bone marrow transplantation treatment, among which 11 patients completed follow-up. During follow-up, 3 cases died, and the survival time was 10 months, 3 years and 7 years, respectively. Conclusions: PNET is rare.Due to the lack of specificity of clinical manifestations, clinical diagnosis depends on biopsy. Early diagnosis and surgical resection are especially important for prognosis and quality of life.

Minimally invasive internal fixation of pelvic ring for type C pelvic fracture

To evaluate the feasibility of minimally invasive internal fixation of pelvic anterior and posterior ring for the treatment of type C pelvic fracture, and to explore its operative techniques and therapeutic efficacy. From December 2010 to December 2015, 18 patients with type C pelvic fracture were treated by reconstructive plates fixation through minimally invasive ilioinguinal approach for pelvic anterior ring injuries, and by invasive percutaneous sacroiliac joint screw fixation for pelvic posterior ring injuries. There were 11 males and 7 females ranging from 29 to 68 years old with an average age of 43.6 years old. According to Tile classification, there were 14 cases of type C1, 3 cases of type C2, 1 case of Type C3. To be specific, 12 cases with hemi-fracture of rami ossa pubis accompanied with fracture of the sacrum, 2 cases with hemi-fracture of rami ossa pubis accompanied with sacro-iliac joint dislocation, 3 cases with bilateral-fracture of rami ossa pubis combined with pubic symphysis separation accompanied with single-fracture of the sacrum, 1 case with bilateral-fracture of rami ossa pubis combined with bilateral-fracture of sacro-iliac joint were included. Operation time, intra-operative blood loss, injuries of lumbosacral nerves and iliac blood vessels, and fracture reduction were observed. All wounds were primary healing. No complications such as infection, deep venous thrombosis, injuries of lumbosacral nerves and iliaca vessels or heterotopic ossification occurred. According to Matta criterion of fracture reduction, 14 cases got excellent results, 3 good and 1 fair. Sixteen patients were followed up in a period varying from 6 to 33 months with 16.7 months on average. And according to functional score of Majeed, 13 cases obtained excellent results, 2 good and 1 fair, with an average score of 92.13±5.44. Internal fixation with reconstructive plates through the ilioinguinal approach and with percutaneous iliosacral screw for type C pelvic facture on pelvic anterior ring and pelvic posterior ring respectively have advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Thus, this technique is safe and practicable, yielding satisfying results.

Clinical features of 11 cases of primary bone lymphoma

目的探讨原发性骨淋巴瘤患者的临床特征、治疗及预后。方法回顾性分析11例原发性骨淋巴瘤患者的临床资料，对其临床特征，诊治过程及预后进行分析总结。结果11例患者中女7例，男4例，中位发病年龄45岁，仅1例患者以无痛性肿块起病，其余均以骨痛为首发症状，主要病理类型为弥漫大B细胞淋巴瘤和间变大细胞淋巴瘤。Ann Arbor临床分期ⅠE期3例，ⅡE期2例，ⅣE期6例。6例患者采取化疗联合放疗，2例行骨关节置换术联合化疗，3例选择单纯化疗。11例患者经初始治疗后5例达完全缓解，4例达部分缓解，2例疾病稳定。中位随访时间为21（6~58）个月，中位无进展生存期为17（5~58）个月。结论原发性骨淋巴瘤诊断时多为晚期，临床表现及影像学检查缺乏特异性，目前治疗主要采取以化疗为主的综合治疗，预后相对较好。

WITHDRAWN: Evaluation of autogenous fibular reconstruction after enbloc excision of a giant cell tumor from the distal radius: Minimum two years follow up

Abstract Background A giant cell tumour is a benign neoplasm. The distal radius (10%) is the third most common site after distal femur and proximal tibia. It is usually associated with local aggressive behaviour and high recurrence rate. Multiple modalities are accepted for treatment of aggressive giant-cell tumour (GCT) of the distal radius. The purpose of our study was to investigate the autogenous fibular reconstruction after enbloc excision of a giant cell tumor from the distal radius. Method In this retrospective study ten cases of patients with GCT of the distal radius who have undergone en bloc resection and reconstruction with non-vascularised autologous proximal fibular graft of the ipsilateral side. Results The mean follow up duration in this study was 3.3 years. Eight patients (80%) achieved union while two patients had non-union. Two patients had non union for which iliac crest bone grafting was repeated at 9 and 12 months and graft ultimately united at 12 and 16 months respectively. One case got infection and there were two cases of wrist subluxation. Satisfactory range of movement was achieved in all patients. At last follow-up, the average combined range of motion was 101.5° Conclusion This procedure provides a valid treatment option in managing aggressive GCTs of the distal radius and provides good cosmetic and functional results.

Clinical profiles and trend analysis of newly diagnosed lung cancer in a tertiary care hospital of East China during 2011-2015.

More than one-third of lung cancer worldwide occurring in China. However, the clinical profiles of lung cancer patients in the mainland of China are rarely reported and largely unknown. The objective of this study is to analyze the characteristics and time trends of newly diagnosed lung cancer cases during the past 5 years in East China. The data came from an academic tertiary care hospital of East China. Patients who were newly diagnosed as lung cancer from 2011 to 2015 were enrolled. All new cases got pathological supports by lung biopsy or surgery. Tumor staging was performed according to the seventh edition of the tumor node metastasis (TNM) classification of malignant tumors. The patients' disease information was collected from the database of the hospital information system (HIS). From 2011 to 2015, aggregately 5,779 patients, including 3,719 males and 2,060 females, were diagnosed as lung cancer. The major histologic subtypes of lung cancer were adenocarcinoma (ADC, 60.0%), squamous cell carcinoma (SCC, 25.6%), small cell lung cancer (SCLC, 8.5%), large cell carcinoma (0.6%), adenosquamous carcinoma (1%), other non-small cell carcinoma (1.6%) and unclassified or rare carcinoma (2.8%). ADC proportion of female was much higher than that of male. A higher proportion of advanced stage (stage IIIB, IV) of lung cancer existed in patients who were admitted to hospital due to respiratory or cancer related symptoms (RCRS) than those without RCRS. Smoking rate in male patients reached 80.2%, while it was only 2.7% in females. EGFR mutation existed in 66% of female and 37% of male patients with ADC. This study demonstrates the clinicopathologic characteristics of lung cancer patients from East China, including histologic composition, staging proportion, smoking prevalence and gene mutation status. During the past 5 years, the proportion of ADC has increased gradually whereas SCC decreased.

Manipulative reduction and percutaneous Kirschner wire internal fixation for grade IV supination-external rotation ankle fractures

To investigate surgical skills and clinical effects of manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures. From May 2013 to October 2016, 35 patients with grade IV supination-external rotation ankle fractures were treated with percutaneous Kirschner wire internal fixation, involving 22 males and 13 females with an average age of 38.2 years ranged from 18 to 65 years old. The time from injury to operation ranged from 2 h to 10 d with an average of 5 d. Reduction quality was assessed by Burwell-Charnley radiological criteria. Baird-Jackson ankle scoring system was used to assess clinical effects. Thirty-three patients were followed up from 10 to 28 months with an average of 14 months. Fracture healing time ranged from 10 to 18 weeks with an average of 12 weeks. According to Burwell-Charnley radiological criteria, 30 cases were obtained anatomic reduction, 3 cases moderate. According to Baird-Jackson ankle scoring system, total score was 93.8±5.4, 17 cases got excellent result, 12 good, 2 fair and 2 poor. Manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures has advantages of reliable efficacy, less complications. But higher require techniques were required for closed reduction. It is not suitable for severe crushed fracture and compressive articular surface fracture.

Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon for the treatment of teenagers' recurrent patellar dislocation

To investigate surgical method and clinical curative effects of medial patellofemoral ligament (MPFL) reconstruction with great adductor muscular tendon in treating teenagers' recurrent patellar dislocation. From May 2012 to September 2014, 19 patients with recurrent dislocation of patellar, including 6 males and 13 females with an average of 16 years old (ranged from 13 to 17 years), the courses of disease ranged from 3 to 18 months(averaged 6 months). All patients were underwent great adductor muscular tendon transposition to reconstruct medial patellofemoral ligament. The curative effects were evaluated by preoperative and postoperative with Lysholm scores and Patellofemoral angle and Q angle. All patients were followed up from 12 to 18 months with an average of 16.5 months. Primary healing was achieved at stage I. No pain, swelling and patellar dislocation or subluxation occurred. Patellofemoral angle increased from preoperative (-3.8±4.9)° to (10.3±4.1)° postoperatively. Q angle decreased from preoperative(16.4±3.1)° to(10.5±1.2)° postoperatively; Lysholm scores were improved from preoperative (68.6±8.5) to (93.7±6.5) final follow-up (P<0.01), and 15 cases got excellent results, 3 good, and 1 fair. Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon could obviously recover stability of patellar, and it is one of the effective methods for the treatment of teenagers' recurrent patellar dislocation.

Minimally invasive percutaneous plate osteosynthesis for the treatment of acetabulum anterior column fracture with intact true pelvic brim

To discuss feasibility and clinical effects of minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim. From May 2013 to December 2015, 8 patients with acetabulum anterior column fracture with intact true pelvic brim were reviewed retrospectively. According to Judet-Letournel classification, all were simple unstable acetabulum anterior column fracture. Among them, there were 5 males and 3 females with an average age of 42.8 years old ranging from 22 to 63. The injury was caused by crush in 4 cases, smash of heavy object in 3 cases, and falling down in 1 case. The time from injury to operation was ranged from 5 to 19 days with an average of 9.5 days. Preoperative CT showed high anterior column fracture of acetabulum with intact true pelvic brim, the fracture separation was less than 1 cm. All the patients were treated with closed reduction and minimally invasive percutaneous plate osteosynthesis. The quality of fracture reduction, operation time, blood loss, fracture healing time, hip function and postoperative complications were observed and recorded. All patients were followed up from 10 to 19 months with an average of 14.5 months. The quality of reduction was classified as anatomical in 4 patients, imperfect in 3, poor in 1 by Matta's score system. The operation time was 30 to 80 min, averaged 51.3 min;the blood loss was 50 to 120 ml, averaged 86.2 ml; fracture healing time was 10 to 19 weeks, averaged 13.3 weeks. At the latest follow-up, the hip function was evaluated by Merle D'Aubigne scoring system, 5 cases got excellent results, 2 cases in good, and 1 case in fair. No vascular nerve injury, wound infection, bleeding, deep vein thrombosis and other complications occurred in 8 patients. Minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim has advantages of less trauma, less bleeding, quick recovery and good curative effect, and it is a good surgical procedures for acetabulum anterior column fracture.

Observation on surgical resection combined with lacrimal duct reconstruction for peripunctal neoplasm

Objective To observe the efficacy of surgical resection combined with lacrimal duct reconstruction for the peripunctal neoplasm. Methods The data of 32 eyes of 32 cases with peripunctal neoplasm were reviewed. All cases underwent the peripunctal neoplasm excision combined with annular sililone tube intubation for lacrimal reconstruction. The neoplasm was carried out by pathological examination. The sililone tube was removed after 4-12 weeks. The peripunctal neoplasm recurrence, the location of punctum and lacrimal duct unobstructed were observed. Results Histopathology showed nevus in 24 cases, papilloma in 4 cases, verruca in 2 cases and granuloma in 2 cases. Followed-up for 1 year or more, 28 cases(87.5%) got lacrimal patency, 2 cases cured of punctum remain a slight expansion of the stimulation of tears. Two cases of the lower lacrimal puncta occlusion and they were cured after punctoplasty under the microscope. Conclusion The surgical resection combined with lacrimal duct reconstruction for peripunctal neoplasm is an effective method in clinical application. It improves the recovery of lacrimal punctum drainage function. Key words: Neoplasm, peripunctal; Eyelid; Punctoplasty; Lacrimal reconstruction

Automatic identification of coronary tree anatomy in coronary computed tomography angiography

An automatic coronary artery tree labeling algorithm is described to identify the anatomical segments of the extracted centerlines from coronary computed tomography angiography (CCTA) images. This method will facilitate the automatic lesion reporting and risk stratification of cardiovascular disease. Three-dimensional (3D) models for both right dominant (RD) and left dominant (LD) coronary circulations were built. All labels in the model were matched with their possible candidates in the extracted tree to find the optimal labeling result. In total, 83 CCTA datasets with 1149 segments were included in the testing of the algorithm. The results of the automatic labeling were compared with those by two experts. In all cases, the proximal parts of main branches including LM were labeled correctly. The automatic labeling algorithm was able to identify and assign labels to 89.2% RD and 83.6% LD coronary tree segments in comparison with the agreements of the two experts (97.6% RD, 87.6% LD). The average precision of start and end points of segments was 92.0% for RD and 90.7% for LD in comparison with the manual identification by two experts while average differences in experts is 1.0% in RD and 2.2% in LD cases. All cases got similar clinical risk scores as the two experts. The presented fully automatic labeling algorithm can identify and assign labels to the extracted coronary centerlines for both RD and LD circulations.

The analysis of modified hamstring post surgery for the treatment of spastic cerebral palsy with knee flexion deformity

Objective To explore the curative effect of knee flexion deformity on spastic cerebral palsy treatment meth-od. Methods All of 30 patients with spastic cerebral and knee flexion deformity were randomly divided into two groups: tradi-tional operation group and modified operation group, using the commonly used operation (In 15 cases, with traditional ham-string post surgery) and) modified operation (In 15 cases, with modified hamstring post surgery), two groups of patients were treated with Ilizarov external fixation drafting device in the correction of knee flexion deformity after soft tissue release. Adjust-ment began 7 days after the soft tissue release operation of external fixation, and stretched approximately 0.2 degrees each time, 3 times/d, until knee flexion deformity was corrected to hyperextension for 10 degree and maintained for 3 weeks, and the flexion contracture degree of knee joint was measured every 2 weeks; then the Ilizarov external fixation drafting device was removed. Then wear a walking straight leg brace for more than 3 months, until the knee walking function is good. Clinical eval-uation included the joint pain index, walking function index, knee flexion deformity degree and range of joint motion score of Dimeglio standard. Results Flexion contracture deformity of knee joint in 30 cases (60 knees) was corrected when Ilizarov ex-ternal fixator was removed, knee extension to 0 degrees-5 degrees. The two groups of patients had the knee flexion angle range of-1.2 degrees to 13.3 degrees, with an average of (7.32°±3.41°) after removed of the walking straight leg brace, in which 4 cases (8 joints) got recurrent deformity of 10°-15° at the time of removing of the walking straight leg brace. Knee ac-tivity significantly was improved at the end of treatment. 60 cases of knee joint activity were close to normal, with flexion of 100 degrees to 135 degrees, extension of 0 degrees to 10 degrees. Two groups of patients were statistically significantly im-proved before and after surgery. Curative effect comparison: The walking function index of the modified operation group was ob-viously superior to that of the traditional operation group, there was significant statistical difference. There were no statistically significant differences in pain index, knee flexion, and range of joint motion. Conclusion For the treatment of flexion deformi-ty of the knee joint in spastic cerebral palsy, traditional surgery using the semitendinosus and gracilis, post and semimembranosus lysis, combined with the Ilizarov draft external fixation could improve the walking function of the patients, simplify the surgical in-cision and reduce trauma. As a result, modified hamstring post surgery is an ideal, effective treatment method. Key words: Cerebral palsy; Knee joint; Tendon transfer; Ilizarov technique

Comparison of transthoracic or percutaneous balloon pulmonary valvuloplasty in the therapy of pulmonary valve stenosis

Objective: To compare the clinical outcome of patients with pulmonary valve stenosis underwent transthoracic and percutaneous balloon pulmonary valvuloplasty. Methods: Clinical data of 806 patients diagnosed as pulmonary valve stenosis underwent transthoracic(171 patients as group A)or percutaneous balloon pulmonary valvuloplasty (635 patients as Group B) in Fuwai Hospital from February 2006 to January 2016 were analyzed retrospectively. There were 72 males in group A (42.1%) and 344 males in group B (54.2%). The average age was (1.6±1.1) years in group A and (21.0±18.5) years in group B. The median weight was 7.65 (7.68) kg (M(Q(R))) in group A and 43.75 (47.38) kg in group B. There were 732 (90.9%) patients followed up from 3 months to 10 years, with an average interval of (6.3±3.6) years. Sixty cases were ligated patent ductus arteriosus simultaneously, and 20 cases got Blalock-Taussig shunt at the same time of valvuloplasty in group A. There were 47 cases of transcatheter closure of atrial septal defect and 6 cases of transcatheter closure of patent ductus arteriosus in group B. The t test, rank sum test and χ(2) test were used to compare data of two groups. Results: There were no hospital death or cardiac tamponade and other serious complications for all patients. The postoperative hospital stayin group A was significantly longer than that in group B (8(5) days vs. 2(2) days, Z=-9.404, P=0.000). In every further consultation, patients were reviewed with transthoracic echocardiography to assess transpulmonary gradient and pulmonary regurgitation. There were significant difference between group A and B of preoperative transpulmonary pressure gradient ((80.6±22.4) mmHg vs.(72.6±20.5) mmHg, t=1.611, P=0.032, 1 mmHg=0.133 kPa) and so as transpulmonary pressure gradient reduction value ((55.9±21.0) mmHg vs. (46.6±23.4) mmHg, t=-1.710, P=0.026). Patients in both groups had good cardiac function during follow-up interval. One patient needed surgical valvuloplasty 10 months after percutaneous balloon pulmonary valvuloplasty and 1 case occurred moderate to severe tricuspid regurgitation in group B. During follow-up period, there was no significant difference between group A and B of transpulmonary pressure gradient ((22.3±6.5) mmHg vs. (25.2±12.6) mmHg, t=1.320, P=0.072), the incidence of pulmonary valve regurgitation in patients of group A was significantly lower than patients of group B (56.1% vs.65.2%, χ(2)=4.755, P=0.029). Conclusions: The clinical outcome and complications are similar between patients underwent two different routes of balloon pulmonary valvuloplasty. Transthoracic balloon pulmonary valvuloplasty is more suitable for infant and underweight children patients with pulmonary valve stenosis. Percutaneous balloon pulmonary valvuloplasty is more suitable for the treatment of the elder children or adults.

Clinical outcomes Tight rope versus traditional screw fixation for the treatment of injury of distal tibiofibular syndesmosis in ankle fracture

To compare the clinical effectiveness for Tight rope fixation and traditional screw fixation in treating injury of distal tibiofibular syndesmosis in ankle fractures. A retrospective study was carried out in patients with injury of distal syndesmosis in ankle fractures who received 2 surgical operations(observation group: 33 cases with Tight rope fixation; control group: 35 cases with traditional screw fixation) from May 2014 to February 2016. There were 18 males and 15 females, aged from 20 to 55 years old with an average of(32.4±5.2) years old in observation group; of them, 19 cases were caused by traffic accidents, 10 by sprain, and 4 by falling; according to Lauge-Hansen typing of ankle fractures, all of the 33 cases were pronation-extorsion fracture, 12 cases were III degree and 21 cases were IV degree. There were 19 males and 16 females, aged from 21 to 54 years old with an average of (32.8±5.5) years old in control group; of them, 20 cases were caused by traffic accidents, 11 by sprain, 4 by falling; according to Lauge-Hansen typing of ankle fractures, 1 case was with pronation-outreach, 34 cases with pronation-extorsion, 13 cases were III degree and 21 cases were IV degree. Fixation time and complication were compared between two groups and AOFAS scores were observed in two groups 3 and 6 months after the operation as well as final follow-up. All the patients were followed up from 8 to 24 months with an average of (16.3±3.8) months. Fixation time of observation group and control group were (10.1±2.8) min and (9.5±2.3) min(P>0.05) respectively. There were significant difference in complication and AOFAS of 3, 6 months postoperatively between two groups(P<0.05). In observation group, 23 case got excellent result, 9 good, 1 fair; and in control group, 18 cases got excellent results, 12 good, 5 fair; there was no significant difference between two groups(P>0.05). Tight rope for the treatment of injury of distal tibiofibular ligament union in ankle fractures has advantages such as easier techniques, earlier weight-bearing exercises without risk of screw breakage, thus is a new choice. However, it is still necessary to further study the angle, direction and tension of button steel plate.

The repair of wound refers to multiple fingers and fingerweb

Objective To discuss the concrete method and clinical effects of the wound refers to multiple fingers and fingerweb. Methods Twenty-six patients were used four different flaps to repair the wound refers to multiple fingers and fingerweb. Dorsalis pedis flap in 18 cases, 2 cases were distal dorsal foot flap, a nterolateral thigh flap, 3 cases, toe web flap, 4 cases, dorsal carpal branch of ulnar artery flap, 1 case in this group. Results All of 25 flaps survived, the distal part of 1 case got necrosis and use skin grafting to treat.6 cases of dorsal foot flap and 1 case of anterolateral thigh flap use the operation of spliting fingers and finger web deepen operation. Conclusion According to the specific injury of the patients' hands refers fingerweb, using the suitable flap to repair the wound, can make a satisfactory results in the appearance and function of patients’ hands. Key words: Surgical flap; Graft; Fingerweb; Microsurgical technique

Laparoscopic repair of primary unilateral inguinal hernia is it to pamper the ego of the surgeon

Background: The study compared the procedure of open Lichtenstein tensionless repair of primary unilateral incomplete uncomplicated inguinal hernia with laparoscopic preperitoneal repair by TEP in a rural secondary level hospital for plantation workers. The aim of the study was to compare both the procedures and if laparoscopic repair had any specific advantage over the conventional open repair with specific relation to time of return to work, recurrence and cost effectiveness of the procedures.Methods: This was a prospective study involving 200 cases which were detected and operated between 2006 and 2014 at our hospital and subsequently followed up till 2016 which is 2 years. The patients selected were plantation workers.Results: In all 200 cases got enrolled in the study 100 underwent open tensionless Lichtenstein repair and 100 of them underwent Laparoscopic repair-TEP.Conclusions: Primary unilateral uncomplicated incomplete inguinal hernia repaired by laparoscopic method has no distinct advantage with reference to return to work recurrence of hernia and the cost involved is more as compared to open Lichtenstein repair.

Choices of the internal fixation and approaches on unstable pelvic ring fractures

To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures. From May 2010 to May 2015, 45 patients with unstable pelvic fractures were treated with different approaches and fixations, including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young-Burg classification, 23 patients were lateral compression injuries, 6 patients were vertical shearing injuries, 16 patients were anterior-posterior compression injuries. All patients had hip pain and limitation of motion, the X-rays showed the pelvic ring fracture. All wounds healed well without complications, 45 cases were followed up for a mean period of 13 months (ranged 9 to 21 months). Patients with hip pain had a good postoperative pain relief. The post-operative X-rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards, the final follow-up score was 93.5±11.6, 35 cases got excellent results, 8 were good, 2 were fare. The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction, to decrease the second surgery trauma should take into consideration as well, the intra-articular reduction and the stability of the pelvic were especially valued, so combined the different approach with minimal invasive technique can get good clinical result.

Retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome

Objective To report our experience of retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome. Methods The clinical data of 12 nutcracker syndrome patients (10 males and 2 females; mean age 26 years) who underwent retroperitoneal laparoscopic extravascular stent placement from March 2014 to Febuary 2016 were retrospectively reviewed. The main symptoms were gross hematuria in 8 patients(one with proteinuria)and flank pain was noted in 1 patient. Three male patients had left-sided secondary varicoceles. Ultrasonography and computed tomography showed the left renal vein clamped by the superior mesenteric artery and the aorta. The anteroposterior diameter of the left renal vein in the renal hilum was three-fold than the aortomesenteric area, and the peak velocity ratio of the aortomesenteric area was much faster than the renal hilum.Twelve patients underwent laparoscopic extravascular stent placement under general anesthesia.The preaortic fibrous tissue between the aorta and the superior mesenteric artery was released intraoperatively.Renal vein became flat when the superior mesenteric artery was elevated.The 6-8 cm extravascular stent was set on the surface of the renal vein to prevent the compression. Results Stenting was successfully accomplished in all 12 patients. Mean operative time was 62 min (50-125 min), estimated blood loss was 35 ml(20-100 ml), and the hospital stay after operation was 8 days(6-12 days). Three patients had a transient orthostatic intolerance, and they were cured by conservative treatment. With a mean follow up of 14 months (5-30 months), symptoms of hematuria and flank pain resolved in 7/8 and 1/1, respectively. Varicoceles were cured in all three patients. One case got partial relief because of recurrent hematuria due to excessive exercise. Ultrasonography showed that extravascular stent was in the right place, and the angle between abdominal aorta and superior mesenteric artery became normal. The inner diameter of left renal vein was decreased, and the narrow segment was diminished in diameter meanwhile the blood outflow was smooth. Conclusions Retroperitoneal laparoscopic extravascular stent placement in the renal vein is a safe and effective approach for nutcracker syndrome. Key words: Nutcracker syndrome; Retroperitoneoscopy; Left renal vein; Extravascular stent; Hematuria.