BACKGROUND: Heterotopic ossification (HO) is common following primary total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), which may cause certain influence on functional recovery.OBJECTIVE: To explore the risk factors for HO after primary THA in AS patients.METHODS: The clinical and radiological data from 87 patients (132 hips) with AS undergoing primary THA between June 2011 and December 2015 were retrospectively analyzed, and followed up for more than 6 months. The radiological information included preoperative and postoperative hip anteroposterior and lateral radiographs. The presence of HO surrounding the prosthesis was evaluated on the radiographs at the last follow-up and graded according to the Brooker classification. Risk factors for HO were divided into invariable factors (age, sex, course and with or without ankylosed hip) and variable factors (preoperative C-reactive protein level, preoperative erythrocyte sedimentation rate, intraoperative blood loss, operation time, prosthesis types and anesthesia methods) to determine the pertinent risk factors.RESULTS AND CONCLUSION: (1) Totally 43 hips (32.6%) were found to have developed into HO. (2) Invariable risk factors including male (P=0.029), preoperative ankylosed hip (P < 0.001), and course (P=0.029) increased the prevalence of HO. Among the variable risk factors, prolonged operation time (P=0.031) and general anesthesia (P=0.003)were associated with the increased occurrence of HO. Age, preoperative C-reactive protein level and erythrocyte sedimentation rate, intraoperative blood loss, and prosthesis types had no obvious correlation with HO. (3) These results suggest that to prevent the formation of HO following THA in AS, efforts to reduce the operation time and avoid general anesthesia should be considered.

BACKGROUND:The results of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in younger patients were not univocal. This study aims to evaluate the results of CoC bearing THA in patients younger than 50 years.METHODS:A total of 90 younger patients performed CoC THAs during March 2003 and May 2008 were included in this study. Hip function and activity were evaluated with Harris hip score and University of California Los Angeles activity score. We had discussed survival rates, radiological findings of component loosening or osteolysis, and ceramic-related complications in these patients.RESULTS:The mean Harris hip score increased from 46.3 ± 12.0 points (range, 28-70 points) before surgery to 92.5 ± 5.6 points (range, 78-100 points) at the final follow-up. The mean preoperative University of California Los Angeles activity score was 4.2 ± 1.1 points (range, 2-6 points), which improved to a mean of 7.2 ± 1.3 points (range, 4-10 points). At the time of the last follow-up, there was found to be 1 occurrence of hip dislocation, 1 squeaking, and 2 "sandwich" ceramic liners fractured during normal activity of daily living. No hips showed osteolysis or required revision for aseptic loosening. Kaplan-Meier survivorship with revision due to loosening or osteolysis was 100% and with revision due to ceramic fracture was 97.3% (95% confidence interval, 93.7%-100%) at a mean of 9.4 years.CONCLUSIONS:This study with the use of CoC bearings THAs in younger patients have shown promising results and higher rate of survivorship without evidence of osteolysis.

目的 探讨下肢静脉区域阻滞在老年单膝关节置换术中的可行性和安全性.方法 选择本院2011年3月～2013年6月择期行单侧膝关节置换术老年患者48例,随机分为全身麻醉(General anesthesia,GA)组(n=24),静脉区域阻滞(Intravenous regional anesthesia,IVRA)组(n=24).分别记录两组入室诱导前(T0)、气管插管或静脉区域阻滞成功后(T1)、切皮(T2)、截骨(T3)和松止血带10分钟(T4)的收缩压、舒张压和心率.患者感觉神经阻滞的起效时间,阻滞完善时间及维持时间,术后关节活动度,并记录与麻醉相关的不良反应.结果 静脉区域阻滞感觉阻滞起效时间为(5.04±1.08)分钟,维持时间(95.46±5.24)分钟.SBP和DBP在T3时心率和血压GA组低于IVRA组(P＜0.05),T4时GA组高于IVRA组(P＜0.05).IVRA组有7例在截骨时有体动反应,复合静脉用药可完成手术.IVRA组患者术后l周和2周所达到的最大活动度和GA组没有统计学差异(P＞0.05).IVRA组术后恶心、呕吐和术后高血压发生率低于GA组(P＜0.05).二组均无麻醉相关并发症.结论 静脉区域阻滞用于老年患者单膝关节置换术安全有效,尤其适用于术后接受抗凝治疗以及不适合全身麻醉的老年患者.

肘管综合征是上肢最常见的周围神经卡压综合征之一，其发病率仅次于腕管综合征［1-2］。Feindel 等［3］于1958年首次提出肘管综合征是指尺神经在尺神经沟处受压而产生的神经压迫、损伤性病变，其主要表现为手肌肉萎缩、无力及手尺侧麻木。尺神经在行走过程中有多个潜在的卡压部位，但是最重要的部位是在肘关节。患者常见的症状是尺神经分布区的麻木、手内肌的萎缩和无力。症状较轻的患者可以采取保守治疗，中、重度的需要手术治疗。近几年出现大量关于尺神经原位松解和前置手术效果的比较研究。

Objective To evaluate the value of CTA and DSA in the diagnosis and treatment of intracranial aneurysm and provide evidence to improve clinical work .Methods The clinical data of CTA, DSA and surgical data of 54 cases of intracranial aneurysms were analyzed retrospectively .The results were compared and analyzed .Of 54 patients performed with CTA and DSA ,14 were treated with embolization and 40 were treated with craniotomy .Results CTA and DSA examination results were compared with the final diagnosis .The sensitivity of CTA was 96.3%, and the accuracy was 98.6%. While the sensitivity and accuracy of DSA were 98.1%and 98.6%.The sensitivity of CTA was little higher than that of DSA , but no statistical significance .In the accurate display of the three-dimensional shape of the aneurysm by CTA and DSA , the percentage were 77.9% and 57.3%respectively .Conclusions There is no significant difference between CTA and DSA in the detection rate of intracranial aneurysms .The two methods are all because they have some good points , they can complement each other , and they should not be used as a “gold standard”.CTA is superior to DSA in the stereoscopic display of intracranial aneurysms , it provides an important basis for the selection of treatment scheme .But for the intracavernous internal carotid artery aneurysm should refer to DSA , DSA still plays an important role in the process of diagnosis and treatment of aneurysm .

目的 比较尺神经原位松解术和皮下前置术两种手术方法治疗肘管综合征的疗效,为临床选择适当的治疗术式提供理论依据.方法 2009年3月～2012年10月收治64例肘管综合征患者,其中32例采用尺神经原位松解术(原位松解组),32例采用尺神经皮下前置(皮下前置组).两组患者性别、年龄、手术侧、病程及临床分型等一般资料比较,差异均无统计学意义(P＞0.05),具有可比性.测量手术前后两组患者手部第一背侧骨间肌肌力、小指展肌肌力以及小指末节指腹皮肤测量两点辨别觉,肘上5cm～肘下5cm尺神经传导速度和术后并发症,进行比较.结果 两组患者术后切口均Ⅰ期愈合.患者均获随访,随访时间24～32个月,平均27个月.末次随访时,二组患者手部第一背侧骨间肌肌力、小指展肌肌力及小指末节两点辨别觉,神经传导速度比较,差异均无统计学意义(P＞0.05);但均较术前显著改善,差异有统计学意义(P＜0.05).但尺神经原位松解组并发症的发生率6.25％明显低于皮下松解前置组25％,差异有统计学意义(P＜0.05).结论 尺神经单纯松解及皮下前置两种方法治疗肘管综合征均可达到良好疗效,其中尺神经原位松解法并发症较少.

Objective To evaluate the clinical results of the total hip replacement in the patients with ankylosing spondy-litis. Methods A total of 20 ankylosing spondylitis patients(27 hip joints)underwent total hip replacement. All the patients had obvious restriction in daily life before operation:7 cases had to walk with the help of crutches,4 cases had to sit on wheel-chair,and 8 cases(11 hip joints)were stiff. The range of motion of the hip joint,the Harris score,and the postoperative compli-cations were compared and analysed in this study. Additional spinal operation for their kyphosis was required in 1 patient. Re-sults The patients were followed up for an average age of 4. 2 years(ranged from 1. 2 to 7. 8 years)in our department. The pain was completely released in 23 hips(85. 2% )at the last time of follow-up. Only one patient still needed two crutchs to walk. The mean Harris score was 14. 9 averagely and the mean total range of the hip joint movement was 40°before surgery. The Harris score of hip joint was 82. 9 averagely,including 8 hips excellent,10 good,7 possible,and 2 poor,with an excellent and good rate of 74. 1% . The mean total range of the hip joint movement was 190. 5°after surgery. 4 hips(14. 8% )appeared hetero-topic ossification in all patients according to Brooker's calssification,one was of Class Ⅱ and the other ClassⅢ,and 1 hip ap-peared aseptic loosening. Conclusion The total hip replacement is an effective solution for the treatment of affected hip with ankylosing spondylitis. It can relieve the pain of the joint,restore the hip function and improve the life of the patients with an-kylosing spondylitis.

Objective To compare open reduction and internal fixation using dual plating to a hybrid fixation construct with intramedullary nailing of the ulna and plate fixation of the radius in both-bone forearm fractures. Methods A total of 57 skeletally mature individuals treated surgically for acute both-bone forearm fractures between July 2007 and December 2011. 28 patients were treated with dual plate fixation, and 29 patients were treated using a hybrid fixation construct. We compared the clinical outcomes of the two groups by Time to union, range of motion as assessed using a Grace-Eversmann score, and presence of complications. Results There was no significant difference in either time to union or Grace-Eversmann scores between the 2 groups. There was 1 nonunion in each of the 2 groups. Ten overall complications, outside nonunions, were reported:6 in the dual plating group and 4 in the hybrid fixation group. Conclusion Ulnar intramedullary nailing and radial plate group was recommended as the preferred method because of the operation was simple, fewer trauma, achieve the best combination in the biomechanical and biological fixation. So it is recommended as the suitable method.

目的 探讨肩关节镜微创手术病灶清理治疗肩袖钙化性肌腱炎(calcific tendinitis)所致急症肩痛的临床疗效.方法 2013年1月-2013 年6月对12 例肩袖钙化性肌腱炎所致急症肩痛患者行肩关节镜微创病灶清理术.术前患侧肩关节行正位X片、CT及MRI检查.分别于术前1天、术后第1天、末次随访时采用UCLA肩关节评分标准及疼痛视觉模拟评分(visual analog scale,VAS)进行评价.结果 手术前1天、术后第1天、末次随访(末次随访时间5~10个月,平均6个月)时的UCLA评分、VAS评分与术前相比差异有统计学意义(P<0.01).肩关节评分优10例,良2 例.结论 肩关节镜微创手术是治疗肩袖钙化性肌腱炎所致急症肩痛安全并行之有效的方法.

Objective To explore the diagnosis and microsurgical techniques of spinal hemangioblastoma.Methods Clinical data including clinical manifestations,imaging data,surgical treatment and prognosis in 11 patients with spinal hemangioblastoma were reviewed retrospectively.Microsurgery was performed in all the patients for tumor resection.Results Total tumor resection was achieved in all the patients.The mean hospital stay was 15 days.The preoperative symptoms improved in 8 patients and did not obviously change in 3.No patients died.Eight patients were followed up for 6 to 36 months.There was no recurrence during follow-up period,and the neural function was improved to different degrees in all the patients.Conclusions MRI examination is essential for the diagnosis of spinal hemangioblastomas.The skillful microsurgical technique and rich experience in tumor resection are necessary for a successful surgery.

目的 探讨膝关节镜微创囊肿切除手术治疗膝关节交叉韧带囊肿的方法和临床疗效.方法 2012年1月--2012年6月对11例患者行膝关节镜微创手术治疗膝关节交叉韧带囊肿.随访3～9个月,平均(6±3.5)个月.手术前、后采用Lysholm评分和手术后疗效评定的Glasgow评定法对膝关节镜微创手术治疗交叉韧带囊肿结果进行评估.结果 11例患者均未复发,手术前Lysholm评分为(72.8±5.6)分,手术后评分为(93.7±3.5)分(=7.52,P＜0.01).Giasgow疗效:11例患者全部评估为优.结论 膝关节镜微创囊肿切除手术治疗膝关节交叉韧带囊肿创伤小、恢复快,是一种安全并行之有效的方法.

Objective To compare and evaluate several operative approaches for microsurgical treatment of craniopharyngiomas.Method Of 32 patients,14 cases were operated via pterional approach,3 via subfrontal approach,5 via transcortical-transforaminal approach combied with subfrontal approach,6 via transcallosal-interseptal-interforniceal approach,2 via transcallosal-interseptal-interforniceal approach combined with subfrontal approach,2 via transfrontal interhemispheric approach.Results Of 32 patients,total removal of tumor was achieved in 26 cases,4 subtotal removal,and 2 partical removal.Conclusions Selection of a suitable operative approach on the basis of different types of tumor is the key for total removal of craniopharyngioma.For Samii types,gradeⅠ～Ⅱcan be operated via subfrontal and pterional approach;grade Ⅲ～Ⅴ (without expansion) can be operated via transcallosal-interseptalinterforniceal approach;grade Ⅲ～Ⅴ(with expansion) can be removed by combined approaches,such as transcallosal- interseptal- interforniceal approach combined with subfrontal approach,transcorticaltransforaminal approach combied with subfrontal approach or transfrontal interhemispheric approach.

Objective To explore the curative effect of microsurgery via the longitudinal fissure approach on anterior cerebral artery-pericallosal artery aneurysms.Methods A retrospective analysis was conducted on the clinical data of 6 patients with anterior cerebral artery-pericallosal artery aneurysms,who underwent microsurgery via the longitudinal fissure approach.Results All the 6 patients showed favorable recovery,with no death from surgery,nor occurrence of operative complications in the nervous system.Conclusions The application of the longitudinal fissure approach in the microsurgery for anterior cerebral artery-pericallosal artery aneurysms has satisfactory clinical effect.

Objective To summarize and analyze micrurgy therapeutic effect of complicated intracranial arteriovenous malformations in brain functional region and/or profound parts.Methods 18 cases with complicated intracranial arteriovenous malformations were retrospectively analyzed in the past 4 years.All the 18 patients were treated with designed individualization of microsurgery operations based on MR,CTA and DSA.Results All the malformed blood vessel were perfectly resected in 14 patients.Main feeding arteries of vascular malformations were clipped in 4 patients.Conclusion The complicated intracranial arteriovenous malformations in brain domain and/or profound part brain could be satisfactorily cured by designed individualization of microsurgery operations based on MR,CTA and DSA.

目的通过对替莫唑胺的毒副作用的研究,最大限度的减轻药物的毒副作用,提高患者的生存质量。方法通过对使用替莫唑胺化疗的患者的毒副作用的观察及采取防范措施的处理。结果56例接受替莫唑胺化疗的胶质瘤患者中有7例骨髓抑制,20例出现恶心呕吐,4例出现周围神经毒性症状,16例有头痛症状。结论采取一系列防范措施可以有效的减轻替莫唑胺的毒副作用。

采用显微手术治疗中央回区矢状窦旁镰旁脑膜瘤28例。术中注意保护中央沟静脉、代偿回流静脉,妥善处理受累的矢状窦。肿瘤全切除20例,近全切除8例。术后出现偏瘫2例,无手术死亡病例。认为显微手术治疗中央回区矢状窦旁镰旁脑膜瘤,肿瘤全切除率高,提高手术技巧有利于减少脑重要功能区的损伤。

Objective To evaluate CTA (Computerized tomography angiography, CTA ) in the diagnosis and treatment of ruptured anterior communicating artery aneurysm. Method 26 cases of ruptured anterior communicating artery aneurysm with spontaneous subarachnoid hemorrhage underwent the preoperative CTA examination and the simulating surgery on CTA. All of the 26 cases underwent the pterional approach surgery to clip aneurysm. The demonstrated from CTA were compared to intraoperative visualization. Results The coincidence rate of CTA to diagnose the anterior communicating artery aneurysmand intraoperative visualization is 100%. The demonstrated from preoperative CTA is basically consistent with intraoperative visualization. Conclusions CTA is invaluable for planning operative strategy of ruptured anterior communicating artery aneurysm.

Objective To investigate the effects of early hyperbaric oxygenation treatment(HBOT) on the expression of apoptosis genes Bcl-2 and Bax following the rat brain injury and study the neuronal protecting mechanism.Methods 100 Sprague-Dawley rats were divided into 3 groups: Normal group(20 rats),TBI group(40 rats),HBOT group(40 rats).Based upon the Feeney′s model of modified Allen′s method,experimental animals were treated with HBO within 6 hours.The animals were sacrificed at the 8th hour,and on days 1,3,5 and 8,respectively.Their hippocampus cells were observed for morphological changes by H-E staining;the apoptosis rate of injured hippocampus cortex was detected by flow cytometry;and the expression of protein Bcl-2 and Bax was detected with immunohistochemical staining.Results H-E staining indicated that,in contrast to TBI group,in HBOT group the hippocampus cortex and the hippocampus cells at appropriate times had regular morphology,orderly arrangement and more stratal distributions,with a significant reduction in nuclear dense-staining and pyknosis,and marked decrease in apoptosis rate of hippocampus cells(P0.05 or P0.01);increased expression of Bcl-2 in HBOT group(P0.05) and significantly decreased expression of Bax(P0.01).Conclusion The early HBOT can promote Bcl-2 expression and inhibit Bax expression,which is effective in inhibiting apoptosis rate following craniocerebral injury.

Objective To improve the surgery for 4th ventricle tumor in child patients.Methods From April 1995 to June 2003, the 29 cases of children's 4th ventricle tumor operated in our hospital were analyzed retrospectively.Results 18 cases got the tumors totally removed, 5 cases subtotally, and 6 cases partially. The histological diagnosis showed 13 cases of medulloblastoma, 9 ependymoma, 3 choroid plexus papilloma, 3 astrocytoma and 1 dermoid cyst. Postoperative hydrocephalus developed in 8 patients, and ventriculoperitoneal shunt was done in 6 of them. 9 patients developed intracranial infection, and 2 of them died of it. 27 of the 29 patients were followed up (10 days to 7 years).Most of them enjoyed normal life; 4 tumors recrudesced within 1 year, with 2 of them removed again.Conclusion To obtain better results of the surgical treatment, preoperative MRI to show the site of the tumor, use of microsurgical technique, management of postoperative hydrocephalus and prevention of intracranial infection are all necessary.

Objective To explore the clinical classification and surgical methods of Arnold-Chiari anomaly with myelosyringosis.Methods Fifty-four patients with Arnold-Chiari anomaly companying myelosyringic were pure decompression of posterior fossa or posterior fossa decompression with the cavity shunt on the base of syringomyelic cavity size.Result Both the surgical methods could decrease the clinical symptoms and shrink the cavity in the patients with Arnold-chiari anomaly companying myelosyringosis.Conclusion The size of the syringomelic cavity is important to the surgical treatment in the patients with Arnold-chiari Anomaly companying myelosyringosis.