2008年 · 第11卷第04期

Abstract：Objective: To investigate the role of large decompressive craniectomy LDC in the management of severe and very severe traumatic brain injury TBI and compare it with routine decompressive craniectomy RDC. Methods: The clinical data of 263 patients with severe TBI GCS≤8 treated by either LDC or RDC in our department were studied retrospectively in this article. One hundred and thirty-five patients with severe TBI, including 54 patients with very severe TBI GCS ≤ 5, underwent LDC LDC group. The other 128 patients with severe TBI, including 49 patients with very severe TBI, underwent RDC RDC group. The treatment outcome and postoperative complications of the two treatment methods were compared and analyzed in a 6-month follow-up period. Results: Ninety-six patients 71.7 % obtained satisfactory treatment outcome in the LDC group, while only 75 cases 58.6 % obtained satisfactory outcome in the RDC group P< 0.05. Moreover, the efficacy of LDC in treating very severe TBI was higher than that of RDC 63.0 % vs. 36.7 %, P < 0.01. The chance of reoperation due to refractory intracranial pressure ICP in the LDC group was significantly lower than that of the RDC group P < 0.05, while the incidences of delayed intracranial hematoma and subdural effusion were significantly higher than those of the RDC group P < 0.05. Conclusions: LDC is superior to RDC in improving the treatment outcome of severe TBI, especially the very severe ones. LDC can also efficiently reduce the chances of reoperation due to refractory ICP. However, it increases the incidences of delayed intracranial hematoma and contralateral subdural effusion。

How time flies! In a twinkle, ten years have passed since the Chinese Journal of Traumatology started her maiden publication in 1998. During this period of time, great achievements has been harvested in the whole medical science, such as the progress in researches on stem cells and genomics, as well as traumatology. I address here the principle progresses achieved so far in domestic traumatological field。

It has been ten years since the Chinese Journal of Traumatology (CJT) started publication in November 1998. CJT is sponsored and published by the Chinese Society of Traumatology affiliated to the Chinese Medical Association (CMA). Being a peer-reviewed medical journal with its high academic quality and the sole English-language joumal conceming wounds and injuries in China, it has contributed a lot to the development of traumatic medicine in China and academic communication in the world。

Stress or neuroendocrine response usually occurs soon after trauma, which is central to the maintenance of posttraumatic homeostasis. Immune inflammatory response has been recognized to be a key element both in the pathogenesis of post-traumatic complications and in tissue repair. Despite the existence of multiple and intricate interconnected neuroendocrine pathways, the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system have been considered to be the most important in trauma. Although the short-term and appropriate activation of these

Stem cells are defined by their capacity of self-renewal and multilineage differentiation, which make them uniquely situated to treat a broad spectrum of human diseases. Based on a series of remarkable studies in several fields of regen-erative medicine, their application is not too far from the clinical practice。

It is estimated that more than 1 million Chinese people sustain traumatic brain injury (TBI) annually, nearly 10% of whom are dead and 30% are complicated with physical, cognitive, behavioral and/or psychosocial impairments in China. A lot of experimental researches and clinical trials of head trauma have been made in China recently, which improves the understanding of pathological mechanisms and prognosis of severe traumatic brain injury。

Abstract：Objective: To evaluate the surgical procedure of endoscopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis. Methods: From June 2004 to May 2006, 42 patients with classic features of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis underwent endoscopic transforminal lumbar interbody fusion TLIF. Under the guidance of fluoroscopy, a 2.8 to 3.0 cm incision with 4.5 to 5.0 cm apart from the posterior middle line was made on the symptomatic side and the working portal X-Tube was docked unilaterally on the facet joint. A total facetectomy was then performed to expose neural foramina and nerve root. Discectomy and endplate preparation were completed through the tube. A Telamon cage was placed obliquely into the intervertebral space after interbody grafting, and then the Dynalok pedicle screw fixation sys- tem was performed. This procedure was accomplished on the lateral side when it is necessary. Results: Clinical outcomes were determined using the Oswestry Disability Index ODI which revealed that 62.2% of patients got excellent results, 29.2% good and 8.6% fair. The average hospital stay was 12.5 days 5-25 days. Operation time averaged 240 min 110-320 min, blood loss averaged 140 ml 80-420 ml and incision length averaged 3 cm 2.8-3.2 cm. Five patients had complications including wound infection in 1 case, incision dehiscence and focal skin necrosis in 1, progressive radicular pain of contralat-eral leg in 1 and residual radicular numbness after transient radicular pain in 2. Conclusions: This surgical procedure of endoscopic transforminal diskectomy, bone grafting, cage placement and pedicle screw fixation can be effectively accomplished under X-Tube operation system with predominant benefits such as small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery。

Abstract：Objective: To investigate the compensative mechanism of no further impairment of the upper limb after ipsilateral C7 transfer for treatment of root avuision of C5-C6 of the bra- chial plexus. Methods: Sixty Sprague Dawley SD rats were randomly divided into a CT-transection group and a control group, 30 rats each. In the C7-transection group, the left forelimbs of the animals underwent transection of ipsilat- eral C7 nerve root while C5 and C6 nerve roots were avulsed. In the control group, the left forelimbs only underwent C5 and C6 root avulsion. The representative muscles of C7 innervated mainly by C7 including latissimus dorsi, triceps, extensor carpi radialis brevis and extensor digitorum com- munis were evaluated with neurophysiological investigation, muscular histology and motor end plate histomorphometry 3, 6 and 12 weeks after operation. The right forelimbs of all rats were taken as the control sides. Results: Three weeks after operation, the recovery rates of amplitudes of compound muscle action potential CMAP and CMAP latency, muscular wet weight and cross-sec-tional area of muscle fibers, and area of postsynaptic membranes of those four representative muscles in the C7transection group were significantly lower than those of the control group P <0.05 or P <0.01. Six weeks postoperatively, the recovery rates of CMAP amplitude and latency of the triceps showed no significant difference between the C7transection group and the control group P0.05. For the extensor carpi radialis brevis and the extensor digitorum communis, the recovery rates of the cross-sectional area of muscle fibers, the amplitude and latency of CMAP and the area of postsynaptic membranes showed no significant difference between the two groups P 0.05, while the rest parameters were still significantly different between the two group P <0.05 or P <0.01. As far as the ultramicrostructure was concerned in the C7-transection group, more motor end plates of four representative muscles were observed and their ultramicrostructure also had a tendency to mature as compared with those of 3 weeks postoperatively. Twelve weeks after operation, all parameters of the C7-transection group were not significantly different from those of the control group P 0.05. In the C7-transection group, the motor end plates were densely distributed and their ultramicrostructure in four representative muscles appeared to be mature as compared with those of the control group. Conclusions: After ipsilateral C7 transfer for treatment of root avulsion of C5-C6 of the brachial plexus, the nerve fibers of the lower trunk can compensatively innervate fibers of C7-representative muscles by means of motor end plate regeneration, so there is no further impairment on the injured upper limb。

Abstract：Objective: To improve the prognosis of patients with abdominal trauma. Methods: Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years ranging from 3-82 years. All abdominal traumas consisted of closed traumas 360 cases, 86.7% and open traumas 55 cases, 13.3%. Results: Atotal of 407 cases 98.1% were fully recovered from trauma and the other 8 cases 1.9% died of multiple injuries. The mean injury severity score ISS of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds 6 cases, pancreatic fistula 2 cases and intestinal fistula 1 case. All these postoperative complications were cured by the conservative treatment. Conclusion: Careful case history inquisition and physical examination are the basic methods to diagnose abdomi- nal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma。

Abstract：Objective: To analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005. Methods: We collected data on possession of motor-cycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package. Results: During 6 years, the number of motorcycle accidents were up to 122 300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26 200 deaths and 157 500 injuries in 2005. The mortality per 10 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles P<0.01. Conclusions: China has attached great importance to the management of traffic safety, which is beneficial to control and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries。

Traumatic brain injury (TBI) is defined as an injury caused by a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. It is a common emergency and severe case in neurosurgery field. Nowadays, there are more and more evidences showing that TBI, which is apparently similar in pathology and severity in the acute stage, may have different outcomes。

General condition Population growth, urbanization process speeding up, fast industry development, especially irrational exploitation of the land, water resources, and forest, get our living environment worse and worse. A sound ecological system of the globe becomes unbalance. As a result, natural disasters have the tendency to increase.