2006年 · 第09卷第01期

Abstract：Objective:To design a clinically applicable transoralpharyngeal atlantoaxial reduction plate (TARP),introduce the operation procedure, and evaluate its preliminary clinical effects.Methods: A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed.This system was applied clinically on five patients with irreducible atlantoaxial dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxial reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxial joints and TARP was used to immobilize subsequently the atlas and axis.Results: Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperational effect was satisfactory.Conclusions: The design of TARP is novel. The operational procedure is simple and easy to use.Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxial dislocation and may have excellent prospects for further clinical applications。

Abstract：Objective:To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.Methods: From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.Results: In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours,colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery(British Medical Research Council, BMRC ), the sense function of the flaps resumed S3 after operation for 1 year.In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.Conclusions: To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries.Postoperative flap color and texture are similar to normal fingers。

Abstract：Objective:To introduce a posteromedial approach through the medial border of the medial head of gastrocnemius for reduction and reattachment of bony avulsion of the posterior cruciate ligament (PCL) from the tibia.Methods: Eleven patients with avulsed tibial attachment of the PCL underwent an operative reduction and internal fixation through the posteromedial approach of the gastrocnemius in our department from February 1998 to March 2000. The skin incision was reversed L-shaped along the medial border of the medial head of the gastrocnemius and the posterior capsule was exposed by dissecting the medial border and lateral retraction, avoiding the damage of the popliteal neurovascular structures. After that, the posterior capsule was vertically dissected a little medially to the posterior intercondylar sulcus and just on the posterior medial tibial eminence positioned by finger palpation. Then the PCL and its tibial attachment were easily accessible. In the delayed cases, PCL peripheral releasing was necessary to overcome the ligament retraction and to refresh the fracture bed for optimal reduction and bony healing. At last, one or two biodegradable screws were used to fix the avulsed bone segment and 30° flexion knee plaster cast immobilization was regularly applied after the wound was closed. The evaluation included X-ray, posterior sag sign and posterior drawer test compared with the contralateral side. The functional assessment of the low limbs was not available because of concomitant injuries.Results: The posteromedial approach of the gastrocnemius used in repair of tibial attachment avulsed injury of the PCL could provide benefit of clear anatomical exposure, few blood loss (20 ml on average), no need for detachment or reattachment of any structure. The patients were followed up for 11 months on an average (ranging from 6 months to 2 years ). It demonstrated that bony healing was achieved within 4-6 weeks in cases of fresh injury and 7-9 weeks in cases of delayed injury. Six out of 8fresh cases showed totally negative posterior sag sign or posterior drawer test but 2 had extra laxity for 1-2 mm. In3 delayed cases, extra laxity for 3-4 mm was presented compared with the contralateral knee.Conclusions: The posteromedial approach of the gastrocnemius is ideal for internal fixation of avulsed tibial attachment of the PCL. It is fairly easy, safe, time-saving,applicable alternatives, in addition, the morbidity is rare and can also be used in management of posteromedial fracture of the medial femoral condyle and tibial plateau。

Abstract：Objective:To establish a simple, reproducible, and practical mechanical injury model of hippocampal neurons of Sprague-Dawley rats in vitro.Methods: Hippocampal neurons isolated from1-2-day old rats were cultured in vitro. Mild, moderate and severe mechanical injuries were delivered to the neurons by syringe needle tearing, respectively. The control neurons were treated identically with the exception of trauma. Cell damage was assessed by measuring the Propidium Iodide(PI) uptaking at different time points (0.5, 1, 6, 12 and24 hours) after injury. The concentration of neuron specific enolase was also measured at some time points.Results: Pathological examination showed that degeneration, degradation and necrosis occurred in the injured cultured neurons. Compared with the control group, the ratio of PI-positive cells in the injured groups increased significantly after 30 minutes of injury (P ＜0.05). More severe the damage was, more PI-positive neurons were detected. Compared with the control group,the concentration of neuron specific enolase in the injured culture increased significantly after 1 hour of injury (P ＜0.05).Conclusions: The established model of hippocampal neuron injury in vitro can be repeated easily and can simulate the damage mechanism of traumatic brain injury,which can be used in the future research of traumatic brain injury。

Abstract：Objective:To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell (BMCs) infusion.Methods: 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages.Results: No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱ in 15 hips, stage Ⅲ in 14hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6hips, stage Ⅱ in 13 hips, stage Ⅲ in 13 hips, stage Ⅳ in 7hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 (46-89), and improved to 86 (70-94)postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %.Conclusions: Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future。

Abstract：Objective:To study the therapeutic efficiency and effecacy of laser-directing approach on searching for the nasal broken end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration.Methods: Forty-nine patients ( 49 eyes ) suffering from traumatic inferior canalicular laceration were divided into control group and laser-directing group. The distance between the lacrimal punctum and the nasal broken end of lacerated lacrimal canaliculus was more than 6 mm. During the course of management of eyelid trauma, the patients were treated by canalicular anastomosis operation with traditional method and laser-directing method in searching for the nasal broken end of lacerated lacrimal canaliculus respectively. The silicone tube of 1 mm diameter was intubated in the lacrimal passage as a stent for 4 to 6months.Results: In the laser-directing group, the mean time in searching for the nasal broken end of lacerated lacrimal canaliculus was (5.75 ± 1.49) minutes and the mean time of operation was (49.21±3.37) minutes; both were significantly shorter than that of the control group(P ＜0.01). The cure rate of the laser-directing group was96.55 %, higher than that of the control group but without statistical significance (P ＞ 0.05).Conclusions: The laser-directing method is much quicker and more convenient to searching for the nasal broken end of the lacerated lacrimal canaliculus than the traditional approach, and patients suffer less pain and damaging in canalicular anastomosis operation。

Abstract：Objective:To investigate the effects of seawater immersion on the function of myocardium and hepatocyte mitochondria in experimental hemorrhagic shock rats.Methods: Twenty-four male Wistar rats were divided into three groups (n = 8 in each group): control group,HSL group (hemorrhagic shock group on land) and HSS group (hemorrhagic shock group in seawater ). The hemodynamic parameters, activities of H + -ATPase( adenosinetriphosphatase ), succinate dehydrogenase(SDH) and Ca2+-Mg2+ -ATPase, the calcium contents in myocardium and hepatocyte mitochondria were measured and the changes of proton translocation across the inner mitochondrial membrane were analyzed.Results: The hemodynamic indexes and the activities of H + -ATPase, SDH, Ca2 + -Mg2 + -ATPase in HSS group were significantly lower than those in control group and HSL group (P ＜0.05). In HSS group the calcium levels in tissue and mitochondria of myocardium and hepatocyte were elevated significantly compared with control group and HSL group(P ＜ 0.05). There was no significant difference in proton translocation among three groups.Conclusions: This investigation demonstrates that seawater immersion can aggravate the conditions of hemorrhagic shock rats。

Abstract：Objective:To explore the feasibility to construct genetic engineering human neural stem cells (hNSCs)mediated by lentivirus to express multigene in order to provide a graft source for further studies of spinal cord injury (SCI).Methods: Human neural stem cells from the brain cortex of human abortus were isolated and cultured, then gene was modified by lentivirus to express both green fluorescence protein (GFP) and rat neurotrophin-3(NT-3); the transgenic expression was detected by the methods of fluorescence microscope, dorsal root ganglion of fetal rats and slot blot.Results: Genetic engineering hNSCs were successfully constructed. All of the genetic engineering hNSCs which expressed bright green fluorescence were observed under the fluorescence microscope. The conditioned medium of transgenic hNSCs could induce neurite flourishing outgrowth from dorsal root ganglion (DRG). The genetic engineering hNSCs expressed high level NT-3 which could be detected by using slot blot.Conclusions: Genetic engineering hNSCs mediated by lentivirus can be constructed to express multigene successfully。

Abstract：Objective:To evaluate the applicability of Porthsmouth modified physiological and operative severity score for the enumeration of mortality and morbidity ( PPOSSUM) in predicting the mortality of the patients undergoing hip joint arthroplasty.Methods: A total of 141 patients (75 males and 66females, aged 63.22 years ± 14.45 years on an average)undergoing hip joint arthroplasty during January 2002 and March 2005 were studied retrospectively with P-POSSUM.Their average physiological score and operative severity score were 17.48 ± 5.16 and 12.43 ± 3.05, respectively.The predicted postoperative mortality with P-POSSUM was compared with the observed value. Subgroup analysis was performed to investigate the predictive capability of PPOSSUM. POSSUM scoring system was used as the control.Results: Three patients died after operation in this study actually. The average physiological scores were32.33 ±9.87 in the death group and 17.16 ±4.56 in the survival group. The former was obviously higher than the latter, which showed statistical difference between the two groups (Wilcoxon rank sum test, P＜0.05). Perfect agreement was found between the observed death number and the predicted death number calculated by P-POSSUM( Cochran-Mantel-Haenszel χ2 test, P ＞ 0.05), though POSSUM overestimated the overall mortality.Conclusions: P-POSSUM can predict the mortality accurately in the patients undergoing hip joint arthroplasty,which is superior to POSSUM。

Abstract：Objective:To research the diagnosis and effective treatment of penetrating anorectal wounds.Methods: Retrospective analysis was done in 16 cases of penetrating anorectal wounds from 1985 to 2004.Debridement and suture of anorectal and vesical wounds,effective diversion of fecal and urinary stream and sufficient presacral drainage were performed in all cases.Results: All the 16 cases were cured. Among them, 2cases with infection in presacral space were cured by sufficient drainage after operation, one case was cured by secondary repair after anal sphincter was repaired unsuccessfully and one case with rectovesical fistula was cured with conservative treatment. None of them suffered from complications such as anal stenosis, dysuria or importence etc.Conclusions: For penetrating anorectal wound, to master early recognition of concomitant injures, to select appropriate surgical intervention and to strengthen perioperative treatment are the keys to improve the curative effects。