2008年 · 第11卷第02期

Abstract：To evaluate autogenous vein grafts and inside-out vein grafts as conduits for the defects repair in the rabbit facial nerves.Methods:The 10 mm segments of buccal division of facial nerve were transected for 48 rabbits in this study.Then the gaps were immediately repaired by autogenous vein grafts or inside-out vein grafts in different groups. All the animals underwent the whisker movement test and electrophysiologic test during the following 16 weeks at different time points postoperatively. Subsequently,the histological examination was performed to observe the facial nerve regeneration morphologically.Results:At 8 weeks after operation,the facial nerve regeneration has significant difference between the experimental group and the control group in electrophysiologic test and histological observation. However,at the end of this study,16 weeks after operation,there was no significant difference between inside-out vein grafts and standard vein grafts in enhancing peripheral nerve regeneration.Conclusion:This study suggest that both kinds of vein grafts play positive roles in facial nerve regeneration after being repaired immediately,but the autogenous inside-out vein grafts might accelerate and facilitate axonal regeneration as compared with control。

Abstract：To study the anatomy of veins of the lower lumbar spine and provide the anatomic basement for laparoscopic lumbar surgery.Methods:A total of 15 formaldehyde-preserved cadavers were studied with special attention to the variety and surrounding structure of ascending lumbar vein(ALV)and iliolumbar veins(ILV),and their relationship with lumbar plexus.Results:ALV and ILV can be found on every sides,which have four variants including separate entry and common entry. The ascending vein and iliolumbar vein separately enter common iliac vein in 18 cases, and as a common stem enter the common iliac vein in 12 cases. Retracting common iliac vein medially both the ascending lumbar and the iliolumbar veins are always at risk of avulsion on exposure of the disc space. The injury of obturator nerve and lumbosacral trunk of lumbar plexus should be avoided.Conclusion:Awareness of these anatomic variation can prevent the hemorrhage and be helpful for the surgeon in performing a careful ligation of these veins before medial retraction of the common iliac vein. Our findings emphasize the need for proper dissection of ALV and ILV before ligature during exposure of the lower lumbar spine。

Abstract：To investigate the effect on intramuscular connective tissue and passive range of joint motion by the stress produced in limb lengthening. Methods:An animal model of limb lengthening was established in the tibia of rabbits. Distraction was initiated at a rate of 1 mm/d and 2 mm/d in two steps respectively,and both proceeded until 10%and 20% of the tibia length was achieved. Muscle samples were harvested at the time when distraction ended and at the 4th week of consolidation after the distraction. Scanning electron microscope was applied to observe the morphological changes of the perimysium. The goniometer,which we made for this study,was used to measure the passive range of joint motion.Results:The collagen fibers were partitioned in bundles, crimped and interconnected closely and orderly.In the regime of 1 mm/d distraction with 10% lengthening,no apparent changes of the collagen fiber and passive range of joint motion was demonstrated. When tibia was increased to 20%,the crimped fibers showed a tendency of being straightened while the passive range of joint motion was reduced. The findings remained the same at the 4th week of consolidation. In the regime of 2 mm/d distraction with 10% lengthening,the crimped structure of the collagen fibers in the perimysium disappeared and the fibers were almost straightened. Additionally,the interconnection of the collagen fibers became loosened and interstice was presented among the fibers. At the 4th week of consolidation,the restoration to the original crimped structure was not completed. When the lengthening ratio was increased to 20%,the collagen fibers were straightened completely. This condition remained unchanged throughout all 4 weeks. The passive range of joint motion was reduced dramatically in the regime of 2 mm/d distraction.Conclusion:The ultrastructure of perimysium and the passive range of joint motion in the regime of 1 mm/d lengthening shows the condition closest to the normal ones. The regime of 2 mm/d lengthening may cause an apparent change in the ultrastructure of perimysium and passive range of joint motion。

Abstract：To investigate the properties of screwbone interface of expansive pedicle screw(EPS)in osteoporotic sheep by micro-CT and histological observation.Methods:Six female sheep with bilateral ovariectomyinduced osteoporosis were employed in this experiment.After EPS insertion in each femoral condvle, the sheep were randomly divided into two groups:3 sheep were bred for 3 months(Group A),while the other 3 were bred for 6 months(Group B). After the animals being killed,the femoral condyles with EPS were obtained,which were three-dimensionally-imaged and reconstructed by micro-CT. Histological evaluation was made thereafter.Results:The trabecular microstructure was denser at the screw-bone interface than in the distant parts in expansive section,especially within the spiral marking.In the nonexpansive section,however,there was no significant difference between the interface and the distant parts. The regions of interest(ROI)adjacent to EPS were reconstructed and analyzed by micro-CT with the same thresholds. The three-dimensional(3-D)parameters,including tissue mineral density(TMD),bone volume fraction(BVF,BV/TV),bone surface/bone volume(BS/BV) ratio, trabecular thickness(Tb. Th),and trabecular separation(Tb. Sp),were significantly better in expansive sections than non-expansive sections(P＜0.05).Histologically,newly-formed bony trabeculae crawled along the expansive fissures and into the center of EPS. The newly-formed bones,as well as the bones at the bone-screw interface,closely contacted with the EPS and constructed four compartments.Conclusions:The findings of the current study,based on micro-CT and histological evaluation, suggest that EPS can significantly provide stabilization in osteoporotic cancellous bones。

Abstract：To examine whether TLR-4 has an effect on hemorrhage induced changes in lung,and to investigate the change of heine oxygenase-1(HO-1)on acute lung injury(ALI)induced by hemorrhagic shock in mice.Methods:Forty-eight mate mice,including C3H/HeN mice and C3H/HeJ mice, were randomly divided into sham group(n=12),hemorrhagic shock group with twelve mice in each phase. Blood pressure (BP) was monitored continuously by attaching carotid artery catheter to a strain gauge pressure transducer/ polygraph. Arterial blood samples were taken for blood gas analysis. A mouse model of non-lethal hemorrhagic shock and resuscitation was used to observe pulmonary myeloperoxidase(MPO)activity and wet/dry weight ratio (W/D). The expression of HO-1 was observed by means of RT-PCR and immunohistochemistry.IL-6 and IL-10 in lung tissue homogenate were assayed by enzyme-linked immunosorbent assay (ELISA). The pulmonary pathologic changes were observed under electron microscope and light microscope.Results:Compared with sham group,the expression of HO-1 in lung tissue was significantly higher in Hem 24 h and Hem 48 h of C3H/HeN mice(P＜0.01).The expression of HO-1 mRNA and the levels of IL-6, IL-10 and MPO in lung tissue were markedly increased in Hem 24 h (P＜0.01 or P＜0.05);Compared with C3H/HeN mice, the expression of HO-1 mRNA and the levels of IL-6 and IL-10 in C3H/HeJ mice significantly decreased in Hem 24 h and Hem 48 h (p＜0.01or P＜0.05),and the W/D,MPO in C3H/HeJ mice were obviously lower in Hem 24 h(P＜0.05).The injuries of lung tissues after hemorrhagic shock have been demonstrated by histological examination with electron microscope and light microscope.Conclusions:TLR-4 and HO-1 might modulate the balance of pro-and anti-inflammatory processes in inflammatory reaction of hemorrhagic shock-induced ALI, and the activation of Toll-like receptor might induce the transcription activity of HO-1,which may play a key role in acute lung injury。

Abstract：To study the factors affecting extracellular glycerol(Gly)in patients with severe traumatic brain injury(STBI).Methods:Perilesional extracellular Gly and cerebral blood flow(CBF)in 53 patients with STBI were consecutively monitored. Simultaneously,the intracranial pressure(ICP)and cerebral perfusion pressure(CCP)were monitored.The hourly minimum of CCP and CBF and the hourly maximum of ICP levels were matched with the hourly Gly. Gly values were divided into several groups according to regional ICP(＜15mm Hg or＞15 mm Hg),CCP(＜70 mm Hg or ＞70 mm Hg),CBF(＜50 AU or 50-150 AU)and the outcomes(death or persistent vegetative state group,severe or moderate disability group,and good recovery group).Results:In comparison with the severe or moderate disability group,the Gly concentration of the death or persistent vegetative state group increased significantly,but CBF and CCP decreased significantly. In comparison with the good recovery group,the Gly concentration of the severe or moderate disability group increased significantly,but CBF and CCP decreased significantly. The Gly concentrations in patients with ICP＞15 mm Hg,CCP＜70 mm Hg and CBF＜50 AU were respectively higher than those of patients with ICP＜15 mm Hg,CCP＞70 mm Hg and 50 AU ＜CBF＜150 AU. In patients with diffuse axial iniury,the mean Gly concentration was(201.17±55.00)μmol/L,which was significantly higher than that of the patients with epidural hematoma(n=7,73. 26±8.37,P＜0.05)or subdural hematoma (n=9,114.67±62.88,P＜0.05),but it did not increase significantly when compared with those in patients with contusion (n=24,167.48±52.63).Conclusion:Gly can be taken as a marker for degradation of membrane phospholipids and ischemia,which reflects the severity of primary or secondary insult。

Abstract：To evaluate the applicability of the modified physiological and operative severity score for enumeration of mortality and morbidity(POSSUM)scoring system in predicting mortality in the patients undergoing hip joint arthroplasty.Methods:A total of 295 patients with hip fractures were analyzed using the modified POSSUM surgical scoring system. The mean ages of the patients were 66.59 years in the complicative group,62.28 years in noncomplicative group,77.89 years in the death group and 63.25 years in the living group,respectively. The comparisons between the observed and predicted morbidity,between the observed and predicted mortality were made within 30 days after operation.Results:The average physiological scores and operative severity scores was 18.96±4.83 and 13.47±2.01 in compticative group, while 15.65±3.66 and 11.74±2.26 in noncomplicative group(P＜0.05).The average physiological scores and operative severity scores was 25.56±3.78 and 14.22±0.67 in death group,while 16.46±4.09 and 12.25 ±2.33 in living group (P＜0.05).Though POSSUM scoring system over-predicted the overall risk of death,its estimate was very close in the high risk groups(＞10%). There was perfect consistence between the observed and the predicted morbidity as calculated by published predictor equation for morbidity,and consistence for mortality in the high risk band.Conclusions:Modified POSSUM scoring system may be used to predict the morbidity in patients with hip fracture.Furthermore,POSSUM scoring system overpredicts the overall risk of death, but its estimate iS close to the actual data in the high risk band(＞10%)。

Abstract：To study the regularity of migration and distribution of bone marrow stromal cells (BMSCs)in iniured spinal cord with intradural space transplantation.Methods:Forty Wistar rats were randomly assigned into 4 groups. The spinal cord injury,model was prepared according to the modified Allen method. BMSCs were labeled by CM-Dil. And 5.0×10 6 cells were transplanted by different channels including intraventricular injection(Group A),injured spinal cord intrathecally injection(Group B),remote intrathecally injection at the L3-L4 level(Group C),and intravenous injection(Group D). Spinal cord was dissected at 24 hours,1,2,3 and 4 weeks after transplantation.Sections of 4 μm were cut on a cryostat and observed under fluorescence microscopy.Results:No fluorescence was observed 24 hours after transplantation in spinal cord injury parenchyma except Group B. One week later,BMSCs in Groups A and C began to migrate to the injured parenchyma;2-4 weeks later,BMSCs penetrated into the injured parenchyma except Group D.The number of BMSCS decreased at 3-4 weeks after transplantation. The number of cells in Group B decreased faster than that of Groups A and C.Conclusions:BMSCs transplanted through intraventricular injection,injured spinal cord intrathecally injection and remote intrathecal injection could migrate to the injured parenchyma of spinal cord effectively. The number of BMSCs migrated into injured spinal cord parenchyma is rare by intravenous injection。

Abstract：To observe the expression and distribution of adult rat axon guidance cues Netrin-1 and Slit2 at different time points after spinal cord injury and to investigate the guidance mechanism of regenerated axons.Methods:Twenty adult Sprague Dawley(SD)rats were divided randomly into five groups with 4 in each.Four groups of them were used to make Allen's spinal cord punch models and we took materials randomly from one of them on the 2nd,4th,7th and 14th day respectively after operation.The left one group was taken as the control group.Immunofluorescence laser confocal scan was used to examine the co-expression and localization of Netrin-1 and Slit2 proteins in the injured site of the spinal cord.Results:Within two weeks after SCI,the expression of Netrin-1 and Slit2 proteins increased temporarily and there was co-expression of them on the neuron plasma membrane.Conclusions:Synchronous high expression and co-expression of axon attractant Netrin-1 and repellent Slit2 are found in the adult rat injured spinal cord in the damaged local and vicinity parts,and probably,they act as the key regulators of axon guidance regeneration。

Abstract：Traumatic brain injury(TBI)remains a complicated and urgent disease in our modernized cities. It becomes now a public health disease. We have got more and more patients in Neurosurgery Intensive Care Unit following motor vehicle accidents and others causes. TBI brings multiple disorders,from the primary injury to secondary injury. The body received the disturbances in the brain,in the hypothalamo-pituitary-adrenocortical(HPA)axis,in the gastric mucosa,in the immune and neuroendocrine systems.The mortality of TBI is more than 50 000 deaths/year, the third of the mortality of all iniuries. Cushing ulcer is one of the severe complications of TBI and its mortality rate is more than 50%. Many studies have improved the management of TBI and the associated complications to give patients a better outcome. Furthers studies need to be done based on the similar methodology to clarify the different steps of the HPA axis and the neuroendocrine change associated. The aim of the present review is to assess the clinical and endocrinal features of hypopituitarism and stress ulcer following TBI。

The mortality of pelvic fracture caused by high energy trauma is very high. If the fracture is combined with massive blood loss, the mortality will reach 50%-60%。

Treatment of factures in children is different from that of adults because improper internal fixation,including selection of internal fixation device and epiphysis approaching,may cause epiphysis injury,which may result in a series of secondary lesions in bone development,such as growth arrest,limb length discrepancy, osteonecrosis, and other deformities。

There are few rerorts on delayed neurologic deficit after stab injury with a retained intraspinal foreign body and granuloma formation。