2007年 · 第10卷第01期

Abstract：Objective:To explore the application of the spiral computerized tomography (CT) image three-dimensional(3D ) reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture. Methods:Using the multi-slice spiral CT image 3D reconstruction technique,we analysed 11 cases of talar neck fracture.The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws. Results:In the 11 cases,the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type H.And the remaining 5 cases of Hawkins types Ⅲ and Ⅳ could not be classified exactly only by radiographs,one of whom was misdiagnosed.After using the CT image 3D reconstruction,the 5 cases were classified exactly before osteosynthesis.The classifications of these 11 cases were confirmed finally by surgical findings.The duration of operation were 45-140 min,averaging 81min (including the duration of C-arm fluoroscopy).X-ray exposure time was 6-58 seconds,averaging 22 seconds.The blood loss was less than 100 ml.The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred.Postoperative follow-up was from 1 to 25 months.According to Hawkins score,excellent result was found in 6 type Ⅱ cases and 1type Ⅲ case;good result in 1 type Ⅲ case with both medial and lateral malleolar fracture,1 type Ⅲ with medial malleolus fractures and 1 open type Ⅲ;fair result in 1 open type Ⅳ with lateral malleolus fracture. Conclusions:By using the multi-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures,the accuracy of diagnosis can be improved obviously. Based on this technique,more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect。

Abstract：Objective:To evaluate the technique and outcome of arthroscopic single-bundle reconstruction of posterior cruciate ligament (PCL) with quadrupled hamstring tendon. Methods:From April 2001 to October 2004,49 knees with PCL tears in 49 patients were verified with arthroscope in this department. Of them, 13 were combined with anterior cruciate ligament tears,14 with disruptions of the posterolateral corner,6 with ruptures of the posteromedial corner and medial collateral ligament,9 with lateral meniscus tears,5 with medial meniscus tears and 2 with popliteal vascular tears.All the damaged PCLs were reconstructed with single-bundle of autogenous quadrupled hamstring tendons under arthroscope.Biodegradable interference screws or blunt titanium interference screws were used for direct anatomic fixation of the reconstructed ligament. Results:After operation,no severe complications occurred at early stage in the 49 patients.All of them were followed up for 10-52 months with an average of 22.0 months±10.7 months.Lysholm score was remarkably improved from 30-60 ( mean:47.96 ± 8.16) preoperatively to 70-95 ( mean:89.08 ± 6.10) at the last postoperative follow-up (P ＜ 0.01 ).Furthermore,there was a significant improvement in International Knee Documentation Committee (IKDC) score from abnormal ( Grade C) in 10 knees and severely abnormal ( Grade D ) in 39 preoperatively to normal ( Grade A) in 20,nearly normal ( Grade B) in 24 and abnormal in 5 at the last follow-up.Of the 49 patients,40 returned to the same activity level as before and 9 were under the level. Conclusions:Single-bundle reconstruction of PCL with quadrupled hamstring tendons has the advantage of minimal trauma in surgery and satisfactory outcome。

Abstract：Objective:To investigate the diagnostic value of computerized tomographic angiography ( CTA ) and magnetic resonance angiography (MRA) for intracranial traumatic aneurysms (TAs). Methods:CTA and MRA of six patients with intracranial TAs verified by digital subtraction angiography (DSA) and surgery were retrospectively analysed. All patients were examined by nonenhanced computerized tomography (CT) and two by CTA.The source data were reconstructed by volume rendering (VR) and multi-planar reconstruction (MPR) from CTA. Four of them had maximum intensity project (MIP) from MRA.Results:Of the six patients,a total of seven TAs were detected by CTA and MRA examinations.Five cases had only one TA and one case had two TAs. The average diameter was 2.3 cm ( 1.1-3.3 cm).CTA demonstrated two TAs appeared at the cavernous segment of the internal carotid artery (ICA) and the middle cerebral artery (MCA) respectively.MCA TA was definitely and clearly demonstrated on VR images,whereas VR images failed to depict the cavernous ICA TA,which was detected on MPR images.Two TAs were found irregular saccular shape,irregular margin of parent artery and wide neck on CTA.Four MRA examinations demonstrated five TAs,including the cavernous segment ICA TAs (2 cases),the supraclinoid segment ICA TA (1 case ),and the cavernous segment associated with opposite side of the petrosal segment ICA TA (1 case).In a cavernous ICA TA,MRA only revealed aneurysm body,whereas aneurysm neck and distal segment of the parent artery were not revealed.In the remaining cases,MRA clearly depicted aneurysm body and parent artery,whereas the neck was not displayed.ICA TAs showed irregular capsule-like high signal intensity on MRA images.Four TAs exhibited irregular distal segment of the parent artery.TAs at the supraclinoid segment or MCA failed to find fracture signs on nonenhanced CT. Conclusions:Both CTA and MRA examinations are the effective non-invasive method of imageology for diagnosing intracranial TAs,while CTA is more eligible for diagnosing TAs after nonenhanced CT has demonstrated skull base fractures。

Abstract：Objective:To observe the distribution of the nerve fibers in the bone tissue and the entry points of these fibers into the bone. Methods:The adult tibia was used for the ground sections which were afterwards made into the slice sections by decalcification in ethylenediamine tetraacetic acid (EDTA).The ground sections were stained in silver and the slice sections were stained in silver and haematoxylin and eosin (HE) respectively.Then,the samples of the transmission electron microscope and the atomic force microscope were made and observed. Results:In the human long bone tissue,many nerve fibers were distributed in the membrane,cortical bone,cancellous bone and marrow.The nerve fibers entered the bone from the nutrient foramen,and passed through the nutrient canal,Haversian's canal and Volkmann's canal,and finally into the bone marrow.In the nutrient canal,the nerve fibers,mainly the medullary nerve fibers,followed the blood vessel into the bone.In the cortical bone,the nerve fibers also followed the blood vessels and were mainly distributed along Haversian's canal and Volkmann's canal.In the bone trabecular and bone marrow,there were many nerve fiber endings arranged around the blood vessels,mainly around the tunica media of medium-size arteries in the marrow and around capillary blood vessels,and a few scattered in the bone marrow. There were sporadic nerve endings in epiphyseal plate and no nerve fibers permeated epiphysis to diaphysis.No distribution of nerve fibers could be found in cartilaginous part.Conclusions:There are many nerve fibers in bone and the nerve passageway is nutrient foramen,Volkman's canal,Haversian's canal and bone marrow。

Abstract：Objective:To evaluate the effects and mechanism of radiation-sterilized allogeneic bone sheets in inducing vertebral plate regeneration after laminectomy in sheep. Methods:Twelve adult male sheep (aged 1.5 years and weighing 27 kg on average ) provided by China Institute for Radiation Protection underwent L3-4 and L4-5 laminectomy.Then they were randomly divided into two groups:Group A (n =6) and Group B (n =6).The operated sites of L4-5 in Group A and L3-4 in Group B were covered by "H-shaped" freeze-drying and radiationsterilized allogeneic bone sheets ( the experimental segments),while the operated sites of L3-4 in Group A and L4-5 in Group B were uncovered as the self controls ( the control segments ). The regeneration process of the vertebral plate and the adhesion degree of the dura were observed at 4,8,12,16,20 and 24 weeks after operation.Xray and CT scan were performed in both segments of L3-4 and L4-5 at 4 and 24 weeks after operation. Results:In the experimental segments,the bone sheets were located in the anatomical site of vertebral plate,and no lumbar spinal stenosis or compression of the dura was observed.The bone sheets were absorbed gradually and fused well with the regenerated vertebral plate.While in the control segments,the regeneration of vertebral plate was not completed yet,the scar was inserted into the spinal canal,compressing the dura and the spinal cord,and the epidural area almost disappeared. Compared with the control segments, the dura adhesion degree in the experimental regenerated segments was much milder (P ＜0.01 ),the internal volume of the vertebral canal had no obvious change and the shape of the dura sack remained well without obvious compression. Conclusions:Freeze-drying and radiation-sterilized allogeneic bone sheets are ideal materials for extradural laminoplasty due to their good biocompatibility,biomechanical characteristics and osteogenic ability.They can effectively reduce formation of post-laminectomy scars,prevent recurrence of post-laminectomy spinal stenosis,and induce regeneration of vertebral plates.1.Department of Orthopaedics,Affiliated Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;2.Medical Tissue Bank, China Institute for Radiation Protection,Taiyuan 030000,China;3.Department of Medical Biology,Tongji Medical College,Huazhong University of Science and Technology, Wuhan 430030,China

Abstract：Objective:To compare the clinical efficacy of percutaneous kyphoplasty (PKP) with pedicle screw system(PS) in the treatment of vertebral compression fracture(VCF). Methods:Eighty-six patients with VCF were treated either by PKP (Group A,n = 30) ) or PS ( Group B,n =56).The anterior,intermediate,and posterior heights of the vertebrae body,visual analogue pain scale(VAS) before and after operation,the duration of operation,and amount of blood loss between two groups were compared. Results:No statistical difference was noted regarding the vertebral height between two groups. Significant difference was seen in VAS,duration of operation and amount of blood loss between the two groups ( P ＜ 0.01). Conclusions:Percutaneous kyphoplasty has the similar therapeutic efficacy with pedicle screw system in treatment of VCF with a minimal invasion,less operation time and blood loss. For those with posterior wall destruction,PS is deemed favorable。

Abstract：Objective:To investigate the stress distribution and fracture mechanism of proximal femur under impact loads. Methods:The image data of one male's femur were collected by the Lightspeed multi-lay spiral computed tomography.A 3D finite element model of the femur was established by employing the finite element software ANSYS,which mainly concentrated on the effects of the directions of the impact loads arising from intense movements and the parenchyma on the hip joint as well as those of the femur material properties on the distribution of the Mises equivalent stress in the femur after impact. Results:The numerical results about the effects of the angle δ of the impact loads to the anterior direction and the angle γ of the impact loads to the femur shaft on the bone fracture were given.The angle δ had larger effect on the stress distribution than the angle γ,which mainly represented the fracture of the upper femur including the femoral neck fracture when the posterolateral femur was impacted.This result was consistent with the clinical one.The parenchyma on the hip joint has relatively large relaxation effect on the impact loads. Conclusions:A 3D finite element analysis model of the femoral hip joint under dynamic loads is successfully established by using the impact dynamic theory。

Abstract：Objective:To study the effect of delayed release particles from vascular endothelial growth factor (VEGF)on the reparation of ischemic injury of spinal cord in rats. Methods:The spinal cord ischemia model of rats was established.The delayed release particles from VEGF were injected via the intubation of spinal subarachnoid space.The rehabilitation was observed by the assessment of unfold claw reflection,space between toes,spinal evoked potential (SEP) and motor evoked potential (MEP). Results:VEGF prompted SEP and MEP appearance,improved the motor function of hind limbs. Conclusions:VEGF can promote the rehabilitation of spinal cord ischemic injury of rats。

Abstract：Objective:To make further improvement of outcome of patients with polytrauma and coma. Methods:The data of 3 361 patients (2 378 males and 983 females,aged from 5-95 years,38.2 years on average) with severe polytrauma and coma admitted to Chongqing Emergency Medical Center (Level I Trauma Center), Chongqing,China, from November 1978 to December 2004 were analyzed retrospectively in this study.Results:The overall survival rate and mortality were 93.2 % (3 133/3 361 ) and 6.8 % ( 228/3 361 ),respectively.The mortalities in patients with coma duration ＜ 1 hour and combined with neural dysfunction and in patients with coma duration ≥ 1 hour and combined with or without neural dysfunction were significantly higher than that of those with coma duration ＜ 1 hour but without neural dysfunction[39.5 % (136/344) vs 3.0 % ( 92/3 017 ),P ＜ 0.01 ].There existed significant differences in GCS,ISS,and revised trauma score (RTS) between the death group and the survival group (P ＜0.01). RTS was in good correspondence with patient's pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure (SBP).The mortality in patients with SBP ＜ 90 mm Hg was significantly higher than that of those with SBP ≥ 90 mm Hg [33.3 %(68/204) vs 5.1%(160/3 157),P ＜0.01].The mortality in polytrauma patients combined with serious head injury (AIS≥3) was 8.2%,among which,76.5% died from lung complications.The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury (23.9 %,61.1%vs 27.3%,50.0%).The mortality reached up to 61.9% in patients complicated with severe head,chest and abdomen injuries simultaneously. Conclusions:It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe polytrauma and coma。

Abstract：Objective:To prepare and observe the physicochemical properties of scaffold materials of heterogeneous deproteinized tissue-engineered bone.Methods:Deproteinized bone was made through a series of physicochemical treatments in pig ribs and analyzed with histological observation,scanning electron microscopy, infrared spectrum, X-ray diffraction and energy dispersive analysis, Kjeldahl determination and mechanics analysis.Results:Interstitial collagen fiber was positive and mucin was negative in deproteinized bone,but,both were positive in fresh bone. Deproteinized bone maintained natural pore network.Its pore size was 472.51 μm±7.02μm and the porosity was 78.15 % ± 6.45 %.The results of infrared spectrum showed that collagen was present in deproteinized bone.Both fresh and deproteinized bone had curve of hydroxyapatite.The Ca/P ratios were 1.71 ±0.95and 1.68 ± 0.76 ( P ＞ 0.05 ),and the protein contents were 26.6% ± 2.23% and 19.1% ± 2.14% (P ＜ 0.05)in fresh and deproteinized bone,respectively.There was no significant difference of destruction load under compression and maximal destruction load between fresh and deproteinized bone (P ＞ 0.05).The elastic modulus was higher in deproteinized bone than that in fresh bone (P ＜ 0.05).Conclusions:Physicochemical properties and mechanic strength of deproteinized tissue-engineered bone meet the demands of ideal scaffold materials. But,its immunogenicity should be observed through further experiments for its clinical applications。

Iliac artery rupture is a rare complication of poststenting angioplasty and can lead to massive lifethreatening haemorrhage. Conventional surgery can not repair the damaged vessel easily and may cause substantial blood loss and high operative morbidity and mortality. We report our experience with a selfexpanding covered endoprosthesis for endovascular repair of the rupture of an iliac artery caused by stenting angioplasty。

Abstract：Objective:To label the primary articular chondrocytes overexpressing human insulin-like growth factor ( hIGF-1 ) with green fluorescent protein (GFP) for repair of articular cartilage defects in rabbits. Methods:GFP cDNA was inserted into pcDNA3.1-hIGF-1 to label the expression vector.The recombinant vector,pcGI,a mammalian expression vector with multiple cloning sites under two respective cytomegalovirus promoters/enhancers,was transfected into the primary articular chondrocytes with the help of lipofectamine.After the positive cell clones were selected by G418,G418-resistant chondrocytes were cultured in medium for 4 weeks.The stable expression of hIGF-1 in the articular chondrocytes was determined by in situ hybridization and immunocytochemical analysis and the GFP was confirmed under a fluorescence microscope. Methyl thiazolyl tetrazolium (MTT) and flow cytometer methods were employed to determine the effect of transfection on proliferation of chondrocytes. Gray value was used to analyze quantitatively the expression of type Ⅱ collagen. Results:The expression of hIGF-1 and GFP was confirmed in transfected chondrocytes by in situ hybridization, immunocytochemical analysis and fluorescence microscope observation. Green articular chondrocytes overexpressing hIGF-1 could expand and maintain their chondrogenic phenotypes for more than 4 weeks.After the transfection of IGF-1,the proliferation of chondrocytes was enhanced and the chondrocytes could effectively maintain the expression of type Ⅱ collagen. Conclusions:The hIGF-1 eukaryotic expression vector containing GFP marker gene has been successfully constructed.GFP,which can be visualized in real time and in situ, is stably expressed in articular chondrocytes overexpressing hIGF-1.The labeled articular chondrocytes overexpressing hIGF-1 can be applied in cell-mediated gene therapy as well as for other biomedical purposes of transgenic chondrocytes。