2006年 · 第09卷第02期

Abstract：Objective: To investigate the different ways of measuring the main axial strain during treatment with an external fixator and to find the suitable compression loaded by the external fixator at an early stage.Methods: Eighteen healthy big-ear rabbits were randomly divided into two groups according to different measuring methods: Group A and Group B. In Group A,a strain gauge was affixed to the external tibial cortex with 502 glue, and in Group B, a bone cement-coated strain gauge was installed on the internal tibial cortex. Groups A and B were divided into two subgroups A1, A2 and B1,B2, respectively, according to the pressure of half of and the same as the body weight. A Z-shaped left mid-shaft tibial osteotomy was performed and fixed by an external fixator. Results: The scaler curves of Group A changed dramatically during the early stage. The trendlines of the internal and external cortex went consistently after reaching the stable stage while the latter strain value was higher than the former. The time for Group B reaching the stable stage was short, but its absolute strain value was less than that of Group A. Before they were pressed to the stable stage, the declined speed of Subgroup A1 was more slowly than that of Subgroup A2 while the results of Subgroups B1 and B2 were same. Group A had an ascending trend after it declined while Group B didn't have. After they reached the stable stage, both Subgroups A1 and A2 had a declining trend while Subgroup A2 was more quickly than Subgroup Al, Subgroup B1 was kept at a definite level while Subgroup B2 fluctuated.Conclusions: The axial strain under external fixator can be measured by bone cement coated-strain gauge in vivo. The data may suggest that half of the body weight load was suitable for external fixator。

Abstract：Objective: To improve the cure rate of patients with abdominal visceral injury complicated by craniocerebral injury. Methods: Clinical data of 176 cases of abdominal visceral injury complicated by craniocerebral injury were retrospectively analyzed.Results: In this series, 44 cases died and the mortality was 25.0%. The main cause of death is abdominal visceral injury combined with shock and severe craniocerebral injury.Conclusions: It is essential to improve the cure rate by accurate diagnosis at early stage. Abdominal paracentesis and CT should be performed promptly and dynamically. Priority should be given to the treatment of life-threatening injuries。

Abstract：Objective: To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries.Methods: The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively.Results: In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4 % were in shock state on admission. The operative rates were 15.0% (181/1 206) and 79.9% ( 612/766 ) in patients with thoracic and abdominal injury (P ＜ 0.01 ), 5.2% (39/758)and 31.7% (142/448) in patients with blunt and penetrating chest trauma (P ＜0.01), and 72.4% (359/496) and 93.7% ( 253/270 ) in patients with blunt and penetrating abdominal injuries (P ＜0.01), respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9% (75/950) and 3.6% (21/590), respectively (P＜0.01). Most patients died from exsanguination.Conclusions: The first "golden hour" after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury。

Abstract：Objective: To investigate the alternations of thyroid hormone in traumatic patients with severe inflammatory response syndrome (SIRS).Methods: Fifty traumatic patients with severe SIRS were enrolled and divided into two groups according to whether they presented multiorgan dysfunction syndrome (MODS). Thyroid hormone measurements were taken, including total triiodothyronine ( TT3 ), total thyroxine (TT4), free triiodothyronine ( FT3 ), free thyroxine (FT4) and thyroid stimulating hormone (TSH). The acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ )score was calculated according to clinical data. The outcomes of recovery or deterioration were recorded, as well as the length of time from the onset of SIRS to the time thyroid hormones were measured.Results: Euthyroid sick syndrome (ESS) was presented in 45 cases. TT3 level was negatively correlated with APACHE Ⅱ score (r = -0.330, P ＜ 0.05), and TT3/TT4 value was negatively correlated with the duration of SIRS( r = -0.316, P＜0.05). TT3, TT4 and FT3 levels in MODS patients were significantly lower than those without MODS (P ＜ 0.05). MODS patients got low TT4 or FT4 level more frequently than those without MODS (P ＜0.05). Compared with the patients in normal TSH group, the patients with decreased TSH had lower T3, T4,recovery rate and higher APACHE Ⅱ scores, MODS incidence, but there was no difference between two groups (P＞0.05).Conclusions: Trauma patients with severe SIRS have high possibility to get ESS, which occurs more frequently and severely in MODS patients. It shows the influences of SIRS on the thyroid axes. With the persistence and aggravation of SIRS, there is a progressive reduction of thyroid hormone。

Abstract：Objective: To investigate the feasibility of using natural poritos as scaffolds in bone tissue engineering (TE)and repair of caprine mandibular segmental defect with titanium reticulum reinforced.Methods: Natural poritos with a pore of 190-230 μm in size and porosity of about 50 %-65 % was molded into the shape of granules 5 mm × 5 mm × 5 mm in size. Expanded autologous caprine marrow mesenchymal stem cells were induced by recombinant human morphogenetic protein-2 (rhBMP2) to improve osteoblastic phenotype. Then marrow derived osteoblasts were seeded into poritos in density of 4 × 107/ml and incubated in vitro for 48 hours prior to implantation. Then osteoblastic cells/poritos complexes were implanted into mandibular defect and the defect was reinforced by titanium reticulum.Implantation of poritos alone acted as the control. Bone regeneration was assessed 4, 8, 16 weeks after implantation using roentgenographic analysis and histological observation was done after 16 weeks.Results: New bone could be observed histologically on the surface and in the pores of natural coral in all specimens in the cell-seeding group, whereas in the control group there was no evidence of osteogenesis process in the center of the construction. The results showed that new bone grafts were successfully restored 16 weeks after implantation. Conclusions: This study suggests the feasibility of using porous coral as scaffold material transplanted with marrow derived osteoblasts by TE method. By means of titanium reticulum reinforcement, mandibular defect could be successfully restored. It shows the potentiality of using this method for the reconstruction of bone defect in clinic。

Abstract：Objective: To study the effects of Ginkgo biloba extract (GBE) on lipid peroxidation and apoptosis after spinal cord ischemia/reperfusion (I/R) in rabbits.Methods: Spinal cord I/R injury model was established according to the description of Erten et al. 1A total of 27 New Zealand white rabbits were divided into three groups randomly: a sham group (9 rabbits treated with sham operation but without aortic occlusion), a model group (9 rabbits treated with aortic occlusion and volumematched saline), and a GBE group (9 rabbits treated with aortic occlusion and Ginaton (100 mg/ kg) injected 30 minutes before aortic clamping and at the onset of reperfusion). The neurological outcomes were evaluated at 24 and 48 hours after reperfusion, respectively. The spinal cord malondialdehyde (MDA) level, superoxide dismutase (SOD) were then detected. Neural cell apoptosis was determined by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-fluorescence nick end labeling (TUNEL) method and the expression of bcl-2 and bax were examined histologically in the spinal cord with immunohistochemistry.Results: I/R produced a significant decrease in neurological scoring. The motor scores of the GBE group were significantly higher than those of the model group at 24 and 48 hours after reperfusion (P ＜ 0.05). Compared with the model group, GBE ameliorated the down-regulation of SOD and produced a significant reduction of the MDA level (P ＜ 0.01 ). The positive cells for TUNEL in the model group were much more than those of the GBE group (P ＜0.01). The bcl-2 was up-regulated after I/R, especially in the GBE group (P ＜0.01). The up-regulation of bax was greatly diminished by GBE (P ＜ 0.01 ).Conclusions: GBE has protective effects against spinal cord I/R injury, and the mechanism may be that it can scavenge oxygen free radicals and inhibit the apoptosisof neural cells。

Abstract：Objective: To choose a proper method of lumbar transpedicular screw fixation at different lumbar levels among the three methods ( Roy-Camille's method, Magerl's method and Du's method) in the Chinese population.Methods: Three-dimensional ( 3-D ) images were reconstructed with image data of 42 adult lumbar segments that were scanned by Electron Beam CT. The three methods of lumbar pedicle screw fixation were simulated on the 3-D reconstructed images and the parameters of implanting pedicle screws were measured.Results: There was statistically significant difference at the distance from the entrance point to the pedicle axis between the three methods (P ＜ 0. 001). The distances measured by Du's method were shortest from L1 to L4,and the distances measured by Magerl's method were shortest at L5 (P ＜ 0.05). There was no significant difference from L1 to L2 (P ＞ 0.05) but significant difference from L3 to L5 at inserting safe ranges of TSA (transverse section angle) was found between the three methods (P ＜0.05). From L3 to L4, the inserting safe ranges of TSA measured by Du's and Magerl's methods were significantly larger than that measured by Roy-Camille's method (P ＜0.05), but there was no significant difference between them (P ＞ 0.05). At L5, the inserting safe ranges of TSA measured by Magerl's method were largest among the three methods (P ＜ 0.05).Conclusions: Among the three methods, Du's method is the best choice from L1 to LA because its distance from the entrance point to the pedicle axis is shortest and the safe range of TSA is largest; Magerl's method can be used from L3 to L5 and is the best choice at L5; Roy-Camille's method is applicable at L1 and L2。

Abstract：Objective: To study the differences in expression of nuclear factor-κB (NF-κB) between human traumatic cataract and normal lenticular epithelial cells.Methods: Total RNA of anterior capsule specimens was taken under the microscope from normal cadaveric eyes donors and those suffering from traumatic cataract to make semi-quantitative RT-PCR and conduct analysis of differences in expression of NF-κB between them.Results: As compared with the mcan of 0. 8337 in normal control group, the expression equivalent of NF-κB was 0.9074 for the lenticular epithelial cells in traumatic cataract sufferers, and the differences are of noticeable significance (t = 2. 447, P ＜ 0.05) accordingly.Conclusions: NF-κB is likely a kind of transcription factor necessary to maintain metabolism of normal lenticular epithelial cells. Higher NF-κ B available in the traumatic cataract sufferer's lenticular epithelial cells means NF-κB is of possible relevance to occurrence and development of traumatic cataract。

Abstract：Objective: To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency.Methods: From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years [median: 38 years, mean: (38.5±18.1) years]. The intervals between trauma and operation ranged from 1 month to 20 years [ median: 19 months, mean: ( 52.5±80.3 ) months) ]. In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association (NYHA) classes Ⅱ-Ⅳ.During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients.Results: No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months [ median: 39 months, mean: (53.4 ± 42.8) months ], all patients were classified as NYHA class I, without any changes.Conclusions: The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function。

Abstract：Objective: To study the differences of gene expression between earlier gestational skin and later gestational skin of rats with the aids of single primer amplification (SPA) and high-density oligonucleotide DNA array to understand the molecular mechanism of scarless healing.Methods: Total RNAs were isolated from fetal rat skin of the scarless (E15) and scar-forming ( E18 ) periods of gestation ( term = 21.5 days). The RNAs from earlier gestational skin (EGS) and later gestational skin (LGS)were both reversely transcribed to cDNAs, then labeled with the incorporation of fluorescent dCTP for preparing the hybridization probes by SPA method. The mixed probes were then hybridized to the oligonucleotide DNA arrays which contained 5 705 probes representing 5 705 rat genes. After highly stringent washing, these DNA arrays were scanned for fluorescent signals to display the differentially expressed genes between the 2 groups of skin.Results: Among 5 705 rat genes, there were 53 genes (0.93 % ) with differentially expressed levels between EGS and LGS groups, 27 genes, including fibroblast growth factor 2 (FGF2) and follistatin were up-regulated (0.47 % ) and 26 genes were down-regulated ( 0.46 % ) in fetal skin during scarless period versus scar-forming period. Higher expressions of FGF2 and follistatin in EGS than those in LGS were also revealed by RT-PCR method. Conclusions: High-density oligonucleotide DNA array provided a powerful tool for investigating differential gene expression in earlier and later gestational fetal skins. This technology validates that the mechanism of fetal scarless healing is very complicate and the change of many gene expressions is associated with fetal scarless healing。

Abstract：Angiogenesis plays a fundamental role in the development of the embryonic vascular tree as well as in several normal and pathologic conditions during postnatal life. Blood supply, established by neovascularization, is imperative for histogenesis during wound healing as well as the limb lengthening applied extensively in the treatment of skeletal trauma sequalae. But little attention has been paid to this area. This review aims to summarize angiogenesis regulation, the process of angiogenesis in wound healing and angiogenesis under mechanical stress, particularly in association with the tension-stress principle。

Abstract：Objective: To review the epidemiological feature, clinical and diagnostic data of post-traumatic diaphragmatic hernia (TDH) associated with pelvis fracture reported in recent 10 years.Methods: A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity and mortality of patients with traumatic diaphragmatic hernia associated with pelvis fractures. A total of 46 cases in our country were reviewed.Results: The incidence of TDH associated with pelvis fractures was relatively rare and the diagnosis was often delayed or missed. A total of 72.34% of these patients were diagnosed as TDH associated with pelvis fractures after injury for 36 hours to 1 week. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality still reached 8.51%.Conclusions: TDH associated with pelvis fractures is difficult to be diagnosed because of its varied clinical and radiological signs and the patients may not present with symptoms for a long time after injury. In clinical, a high index of suspicion with appropriate examination is the mainstay of management, which can be helpful in prognosis。

Abstract：Objective: To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament ( ACL ) with autograft or allograft tendon.Methods: Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively.Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylineosin (HE) stain under light microscope.Results: The insertion structure of normal ACL typically consisted of four layers, I. E., dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone.There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperatively, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenous fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group.Conclusions: At the 6th month postoperatively,although the ligament-cartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon。