Objective To investigate the effects and mechanism of local injection of nerve growth factor (NGF) and basic fibroblast growth factor (BFGF) on tibial fracture healing in rats. Methods Forty-eight clean mature male SD rats were randomly divided into four groups: NGF group, BFGF group, NGF+ BFGF group and control group. Each group was randomly divided into two subgroups (2 weeks after operation and 4 weeks after operation) according to different observation time points, six rats in each subgroup. The left tibial fracture model was established in 48 rats, and intramedullary fixation with 1 mm Kirschner wire was performed. On the third day after surgery, local percutaneous injection was given around the fracture end. The NGF group was injected with 0.8 μg+ 0.3 mL normal saline, the BFGF group received local injection of BFGF 1.2 μg + 0.3 mL normal saline, the NGF+ BFGF group received local injection of NGF 0.8 μg+ BFGF 1.2 μg+ 0.3 mL normal saline, and the control group received 0.3 mL normal saline. Each group was injected once a day for 7 consecutive days.X-ray films were taken at 2 weeks and 4 weeks after the operation, and blood samples of femoral artery of rats in each group were taken, then the rats were killed by cervical vertebra disconnection.The content of alkaline phosphatase (ALP) was detected by enzyme-linked immunosorbent assay (ELISA). The callus tissue was made into pathological sections, and HE staining was performed to observe the histological characteristics. Osteoblastic index (IOB), trabecular width (TW) and trabecular area percentage (TV) of bone tissue were calculated by multifunctional true-color cell image analysis and management system. The contents of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) in serum of rats were detected by protein chip technique. Results (1) X-ray film: the fracture healing of NGF, BFGF and NGF+ BFGF group was faster than that of the control group, and that of NGF+ BFGF group was the fastest. (2) ELISA: the content of ALP at 2 weeks after surgery in the callus of the control group, NGF group, BFGF group and NGF+ BFGF group were(110.02±1.92), (140.87±2.22), (136.12±1.23) and (187.44±0.90)ng/mL, respectively. The ALP contents in callus were (91.23±1.47), (106.62±1.64), (104.83±1.05) and (130.59±1.18)ng/mL, respectively, at 4 weeks after surgery. The content of ALP in the callus of the NGF+ BFGF group was the highest, and the difference between the groups was statistically significant (all P values 0.05), and all other indicators had statistical significance between the two groups (all P values 0.05). The VEGF content at 2 weeks after surgery, and the BMP-2 and IGF-1 content at 2 weeks and 4 weeks after surgery of NGF group, BFGF group and NGF+ BFGF group were all higher than those of the control group, and the content of NGF+ BFGF group was the highest. Pairwise comparison between groups showed statistically significant differences (F=198.285, 368.060, 2 006.017, 33.332, 292.643, all P values<0.05). Conclusions Both NGF and BFGF can promote the healing of tibial fracture in rats, and the combination of them has synergistic effects. The mechanism may be related to the better promotion of VEGF, BMP-2 and IGF-1 expression in the process of fracture healing. Key words: Fracture healing; Bony callus; Rats; Tibial fractures; Nerve growth factor; Basic fibroblast grouth factor; Local injection; Protein chip

Objective To investigate the effect and safety of staged incremental balloon dilatation in the interventional treatment of Budd-Chiari syndrome (BCS) with inferior vena cava thrombosis. Methods From January 2016 to December 2018, the clinical data of 34 BCS patients with inferior vena cava thrombosis (18 males and 16 females aged 32-53 years) admitted to vascular surgery of the First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively. All patients were treated by staged incremental balloon dilatation, namely whether the thrombus was fresh or not, the small balloon (8 mm) was dilated for the first time and anticoagulant treatment was given after the guide wire was opened, the small balloon (12 mm) was dilated for the second time after one week, and the large balloon (18-25 mm) was dilated after one month. The success rate, perioperative complications, short-term patency rate and laboratory related indexes were observed. Results Thirty-three cases were successfully opened, the total success rate was 97.06% (33/34). The other patient was a long segment occlusion of the inferior vena cava. Repeated attempts at the first dilation failed to pass the occlusion segment, and the operation of the inferior vena cava-right atrial bypass was performed instead; among them, 14 cases (14/34) of fresh thrombus underwent transcatheter thrombolysis followed by removal of inferior vena cava thrombus, recovery of blood flow and opening of lesion segment. Thirty-three cases underwent 12 mm balloon dilatation after 1 week and 1 month, respectively, the large balloon dilatation was successfully performed, and the guide wire could pass through the lesion. The levels of alkaline phosphatase, bilirubin and platelet were (111.91±22.38) U/L, (20.76±1.82) U/L and (103.85±21.98)×109/L before the first dilation of the small balloon in 33 patients with successful dilation, and (78.88±10.04) U/L, (19.79±2.03) U/L and (137.27±17.68)×109/L before the first dilation of the large balloon, respectively. The differences were statistically significant (t=7.741, 2.039, 6.802, all P values<0.05); but the changes of red blood cells, white blood cells, alanine aminotransferase and aspartate aminotransferase were not obvious. Six months after the operation, the symptoms of portal hypertension were significantly improved, such as the reduction of ascites, the reduction of liver and spleen, and the reduction of liver function score. No patient died during hospitalization and follow-up. There were no serious complications such as fatal pulmonary embolism, inferior vena cava rupture and pericardial tamponade in the perioperative period, and no symptomatic pulmonary embolism and fatal pulmonary embolism in the thrombolysis period. The results showed that the patency rates of inferior vena cava were 96.97%(32/33) and 90.91%(30/33), when 33 patients were rechecked by color ultrasound 6 months and 1 year after operation. Conclusions Staged incremental balloon dilatation is a safe and effective technique in the treatment of BCS with inferior vena cava thrombus. Key words: Budd-Chiari syndrome; Inferior vena cava thrombosis; Incremental balloon dilatation

Objective To compare the spine-pelvic sagittal parameters of the healthy and young Han males in standing, erect sitting and natural sitting.Evaluate the effect of pelvic rotation on sagittal balance. Methods This was a cross-sectional study. Thirty-two volunteers were recruited from the graduate students of Nanjing Drum Tower Hospital from September 2017 to October 2017. All the volunteers were males, aged between 23 to 27 (24.8±1.6) years old, 171-185 (176.4±5.3) cm in height, 57.7-88.4 (69.5±8.6) kg in weight, and BMI 21.2-24.7 (22.5±2.3) kg/m2. EOS-X-ray imaging system was applied to all subjects, and vertical scanning method was adopted. Full-length images were scanned once, and standing position, erect sitting and natural sitting position were taken. Parameters were measured included thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), T1 pelvic angle (TPA). Paired-samples T test was used to compare the changes of parameters in different positions, and Pearson correlation analysis was used to analyze the relationship between spinopelvic parameters. Results For 32 volunteers, in standing position, the average PI was 49.06°±6.22°, PT was 13.38°±6.06°, SS was 35.03°±2.32°, LL was -47.16°±7.64°, TK was 32.22°±9.74°, SVA was (3.29±13.64)mm, TPA was 9.47°±5.26°. In erect sitting position, the average PI was 48.22°±6.07°, PT was 29.06°±10.35°, SS was 18.84°±5.90°, LL was -26.38°±8.45°, TK was 31.78°±9.95°, SVA was (34.73±13.62)mm, TPA was 26.06°±8.71°. In natural sitting position, the average PI was 49.22°±6.20°, PT was 40.50°±10.42°, SS was 9.84°±4.87°, LL was -4.03°±6.14°, TK was 31.69°±9.73°, SVA was (63.37±13.70)mm, TPA was 49.66°±11.22°. Compared with the parameters of standing position, PT, SVA and TPA parameters of erect and natural sitting position increased, SS and LL parameters decreased. Compared with the parameters of erect sitting position: PT, SVA and TPA parameters of natural sitting position increased, SS and LL parameters decreased. The differences were statistically significant(all P values<0.05). Pearson correlation analysis results showed that: (1) In standing position, PI was correlated with PT, LL, TK and TPA. PT was correlated with LL, TK and TPA. LL was correlated with TK and TPA. TK was correlated with TPA. (2) In erect sitting position, PI was correlated with PT, SS, LL, TK and TPA. PT was correlated with SS, LL, TK and TPA. SS was correlated with LL, TK and TPA. LL was correlated with TK and TPA. TK was correlated with TPA. (3) In natural sitting position, PI was correlated with PT, SS, LL, TK and TPA. PT was correlated with SS, LL, TK and TPA. SS was correlated with LL, TK and TPA. LL was correlated with TK and TPA. Differences were statistically significant ( all P values<0.05). Conclusions In the process of from the standing position to the upright sitting position, the upright sitting position to the natural sitting position, Han people the LL of normal Han young men is decreasing and SVA, TPA are increasing.It indicates that SVA moves anteriorly and the pelvic rotates posteriorly. Some correlation between spinal parameters and pelvic parameters are also shown. The changing of pelvis can influence the sagittal alignment and balance of the spine. Key words: Spine; Pelvis; Spinopelvic parameters; Upright sitting; Natural sitting; Pelvic rotation; Sagittal alignment

Objective To summarize application of hepatic and blood in anatomic so as to provide reference for performing hepatectomy. Methods In China Knowledge Network, Wanfang Data and other databases, PubMed, Web of Science, 肝脏血管 , 肝切除 , 肝移植 , 肝脏血供 and vascular hepatectomy , the liver blood supply were used as key words to search for relevant literatures on liver vascular anatomy from January 2000 to December 2018. The results were summarized and analyzed. Results A total of 786 literatures were retrieved, and 26 literatures were included according to inclusion criteria and exclusion criteria, including 9 Chinese literatures and 17 English literatures. Preoperative understanding of changes in hepatic blood vessels was helpful for both living-related liver transplantation and partial hepatectomy. A good grasp of anatomy and blood of hepatic blood vessels could determine a good plane during operation, which could reduce number of blood vessels encountered in process of liver resection and reduce intraoperative bleeding to a certain extent. The realization of accurate mainly depended on imaging positioning technology of hepatic vascular system, anatomical exposure and selective occlusion technology of access and exit hepatic vessels, determination of plane and intrahepatic vascular exposure technology. Conclusions Mastering fully anatomy and blood of hepatic vessels, selecting best surgical method, and complementing with good surgical anatomic techniques are keys to ensure success of and improve accuracy of resection. Key words: Liver; Blood vessels; Anatomic hepatectomy; Liver transplantation; The liver blood

Objective To compare the early clinical effect of posterolateral approach(PLA) and direct anterior approach(DAA) for total hip arthroplasty. Methods Retrospective cohort study was conducted. A total of 153 patients, including 64 males and 89 females, aged between 21 and 81 years old, who were treated with total hip replacement in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from April 2017 to June 2018. They were divided into the DAA group (79 cases) and the PLA group (74 cases) according to different surgical approaches. The operative time, incision length, visual analog score(VAS), Harris score, postoperative hospitalization time, independent walking time without walker and complications rate were compared and analyzed between the two groups. On the first postoperative day, the pelvic anterior radiograph was taken, and the PACS image processing system was used to measure the prosthetic angle . Then the position of the femoral prosthesis was determined according to the Nakata method ( the femoral false body curl over 3°- 3° for fixed prosthesis was centricity fixed). and the acetabular abduction angle and anteversion angle were measured according to the Pradhan method ( the acetabulum abduction angle of 30°-50°, the anteversion angle of 5°- 25°, which was the safe range of acetabular prostheses). Results Compared with the PLA group, the DAA group had longer operative time [(68.61±7.15)min vs (63.45±8.82)min], shorter incision length[(10.47±0.88)cm vs (12.06±0.91)cm], less intraoperative blood loss [(131.40±42.83)mL vs (155.70±48.09)mL], and shorter postoperative hospital stay[(3.94±0.92)d vs (4.79±0.95)d]. The walking time away from the walker was shorter[(3.91±1.09)d vs (6.34±1.35)d], and the postoperative VAS was lower at 1st and 3rd day after surgery(4.05±0.70 vs 4.38±0.75, 2.47±0.80 vs 2.82±0.88). The Harris scores were higher in the first and third month after operation (82.46±3.82 and 77.59±4.78, 89.11±3.61 and 85.82±3.18), and the differences were statistically significant (all P values 0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusions Compared with the PLA, the DAA with lateral decubitus is a safe and effective minimally invasive approach with less trauma, less postoperative pain and faster recovery . Key words: Arthroplasty, replacement, hip; Direct anterior approach; Posterolateral approach; Rehabilitation

目的 探讨意外发现的宫颈癌(UDCC)行腹腔镜下广泛宫旁切除＋阴道上段切除＋盆腔淋巴清扫术的安全性及可行性。 方法 回顾性分析蚌埠医学院第一附属医院2017年2月—2018年3月收治的6例全子宫切除术(5例经腹手术、1例腹腔镜手术)术后UDCC患者的临床病理资料及随访资料。6例患者44～62岁，宫颈鳞癌5例、宫颈腺癌1例，临床分期ⅠB1期5例、ⅠB2期1例，均行腹腔镜下广泛宫旁切除＋阴道上段切除＋盆腔淋巴清扫术。观察患者两次手术间隔时间，再次腹腔镜下手术时间、术中出血量、手术并发症发生情况，术后留置尿管时间、残余尿量、住院时间，术后病理检查观察阴道壁、宫旁组织、卵巢有无累及、盆腔淋巴结转移情况。 结果 6例患者两次手术间隔时间平均19.3 d。腹腔镜手术时间平均154.2 min，术中出血量平均116.7 mL，术后留置导尿管时间平均14.5 d，测定残余尿量平均88.3 mL，术后住院时间平均8.5 d。术中、术后无手术相关并发症发生。再次手术后病理检查提示：阴道壁、宫旁组织、卵巢未见癌累及，阴道切缘、宫旁切缘阴性；清扫盆腔淋巴结平均18.6枚，其中1例患者有2枚盆腔淋巴结转移，并伴有癌栓形成。6例患者术后随访14～27个月，期间未发现复发和远处转移。 结论 UDCC临床少见，在掌握娴熟的手术技巧的基础上，行腹腔镜下广泛宫旁切除＋阴道上段切除＋盆腔淋巴清扫术治疗UDCC是安全、可行的。

Objective To evaluate the clinical efficacy of microscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment spondylolisthesis. Methods From June 2015 to August 2016, 32 patients with single-segment spondylolisthesis treated with microscope-assisted MIS-TLIF in Department of Orthopaedics of Shanxi Provincial People's Hospital were retrospectived analyzed, including 18 males and 14 females with an age of 32-64(52.4±6.2)years. In term of spondylolisthesis category, there were 25 patients of degenerative spondylolisthesis and 7 patients of isthmic spondylolisthesis. With respect to spondylolisthesis degree, 26 patients were grade I and 6 patients were grade Ⅱ. Besides, 5 patients were located at L3-4 , 17 patients at L4-5 and 10 patients at L5-S1. The operation time, intraoperative blood loss, postoperative drainage and hospital stay were recorded. All patients were followed up regularly. The visual analogue scale (VAS) scores, Japanese Orthopaedic Association(JOA) scores and Oswestry disability index (ODI) were compared and evaluated at preoperation and at 3 d, 3 months, 12 months postoperation and last follow-up. Furthermore, to evaluate the recovery of the intervertebral foramen and of lumbar sagittal curvature, average height of intervertebral space, Cobb angles of lumbar vertebrae and operative segments were measured at preoperation and 3 months after operation and last follow-up. At the last follow-up, the clinical efficacy was evaluated using the modified MacNab criteria, and intervertebral fusion was assessed according to the Siepe criteria. Results All 32 patients underwent successfull operation. The operative time was (120.3±10.8)min, the intraoperative blood loss was (85.2±35.6)mL, the postoperative drainage was (34.7±12.5)mL, hospital stay was (5.2±1.8) days and microscope operative time was (56.4±8.2)min. No serious complications were noted, such as dural rupture, nerve root injury, incision infection, fusion cage displacement, sinking, loosening of internal fixation, etc. All patients were followed up for 12-18 months. The back pain VAS scores, leg pain VAS scores and ODI were significantly lower than those preoperation on each time stage after operation, and the difference was statistically significant(F=105.080, 148.420, 493.080, all P values<0.05). The JOA scores were significantly higher than those preoperation on each time stage after operation, and the difference was statistically significant(F=154.870, all P values<0.05). At the 3rd month postoperation and the last follow-up, the height of intervertebral space was (10.4±1.7) mm and (10.1±1.8) mm, respectively, Cobb angle was 39.0°±5.4° and 38.6°±7.3°, respectively. The Cobb angle of the operative segment was 18.6°±3.2°and 18.0°±5.1°, respectively. The difference was statistically significant compared with the preoperative (F=87.310, 33.820, 3.950, all P values<0.05). All lumbar spondvlolisthesis vertebrae were restored completely at last follow-up. In terms of the modified MacNab at the last follow-up: excellent in 27 patients, good in 3 patients, and fair 2.The excellent and good rate was 93.8%(30/32). According to Siepe criterion for fusion, 29 patients obtained complete fusion, and 3 patients got possible fusion. Conclusions Microscope-assisted MIS-TLIF is a reliable, safe and effective minimally invasive surgery for single-level lumbar spondylolisthesis. It has the advantages of less bleeding, minimal trauma and precisely clinical effect. This method is worthy of clinical promotion and application. Key words: Spondylolysis; Minimally invasive transforaminal lumbar interbody fusion; Lumbar spondylolisthesis; Single segmental lumbar degenerative diseases; Microscope

Objective To investigate the application of the customized and personalized osteotomy guide plates by using 3D printing technology in artificial knee arthroplasty. Methods The patients who were treated with unilateral total knee arthroplasty in the First Affiliated Hospital of Shenzhen University from June 2011 to September 2015, were retrospectively analyzed, which included 11 males and 16 females, aged from 57 to 82 years, average 63.2 years. The pre-operation Hospital for Special Surgery(HSS) score of the knee joint was 40-56, average 49.7 points. All enrolled patients took X-ray examination of the two limbs full-length line, the anteroposterior and lateral of the knee and the patella axis to evaluate the joint degeneration and external deformity. Twenty-seven patients underwent a thin-layer CT scan of the knee, the three-dimensional reconstruction was carried out after the scan data were collected. The three-dimensional reconstruction of lower extremity was obtained to determine the osteotomy of the distal femur and posterior condyle, the proximal tibia and osteotomy angle by measuring femur extroversion and extorsion, tibial platform posterior slope angle. Finally, we printed 1∶1 femur and tibial osteotomy guiding plate by using the US Stratasys company ObjetEden260VS printer with resin printing material MED610.Then, the osteotomy plates were used for total knee arthroplasty. The operation time and intraoperative blood loss were observed. Patients were followed up regularly after surgery to observe the recovery of joint function, pain, incision infection and other complications. Twelve months after surgery, pain was assessed by VAS and knee range of motion, degree of deformity correction, stability and knee function were assessed by HSS. Results All 27 patients completed the operation successfully. The operation time was 40-80 min, averaged 55 min. Intraoperative blood loss was 150-250 mL, averaged 180 mL. Two patients incision healing was delayed with diabetes and 1 diabetes patient occured the incision infection but the incision healed with conservative treatment. Postoperative joint pain was significantly relieved in 4 cases, pain complete alleviate in 23 cases, joint extension and flexion activities were significantly improved, varus deformity, flexion contracture deformity and extension deformity were significantly corrected. Post-operative VAS score, knee range of motion, stability, and HSS score of knee joint function were (29.07±1.98)point, (16.81±1.55)point, (9.93±0.35)point and(89.41±3.23)point, respectively. Preoperative scores were (15.19±5.96)point, (12.52±2.06)point, (7.33±1.66)point and(49.70±4.40)point, respectively. The postoperative scores were all higher than those before the operation, and the differences were statistically significant(t=9.088, 6.186, 6.575, 27.050, all P values<0.01). Conclusions Using the 3D printing technology for customized and personalized osteotomy guiding plate has the advantages of accurate osteotomy, time saving and small trauma during the total knee replacement. It has important clinical application value, especially, for patients with severe osteoarthritis, joint deformity, rheumatoid arthritis and traumatic arthritis of the knee joint. Key words: Arthroplasty, replacement, knee; Bone cutting guide; 3D print

Objective To study the one, two and three-dimensional distribution of posterior malleolus fracture lines in ankle fracture of supination-external rotation. Methods Computed tomography scans of a consecutive series and clinical data of 70 ankle fractures of supination-external rotation type Ⅲ/Ⅳ treated in Tongji Hospital Affiliated to Tongji University from January 2012 to March 2017 were retrospectively analyzed. The initial digital imaging files were analyzed by Mimics 16.0 and 3D reconstruction. The three-dimensional fracture lines were identified using 3-Matic software after virtual fracture reduction. The three-dimensional fracture lines of all posterior malleolar fracture blocks were drawn in the same three-dimensional image after standardization. Then, a heatmap of fracture line and surface was drawn. Results Although the distribution of posterior malleolus intra-articular fracture lines varied, most of them were concentrated in a curved region. This region started at 1/7-2/7 tangent of the posterior edge in the posterior malleolusa standardized image and ended at 5/11-7/11 . The proportion of the articular surface of posterior malleolus fracture fragment to the total area of articular surface was averaged 14.96% (range, from 2.23% to 38.45%). The region with the highest frequency of the three-dimensional fracture block was located in the posterior 2/11 at bottom view, in the posterior 1/9 at standard medial view and in the posterior 1/11 at lateral view. Conclusions The position of the posterior malleolus fracture is highly variable, and most of the fracture block is located in the posterolateral side, which are mainly Haraguchi type I or Bartonicek-Rammelt type 2 fractures. The line-surface-3D study of posterior malleolus fractures facilitates the development of surgical plans, the exploration of injury mechanisms, and provides a theoretical basis for biomechanical or finite element modeling. Key words: Ankle injuries; Ankle fractures; Imaging, three-dimensiond; Tomography, X-ray computed; Heatmap