2008年 · 第11卷第05期

Abstract：Objective: To investigate the surgical procedlures,options and surgical indications for far-lateral lumbar disc herniation between three different minimally invasive procedures.Methods: From January 2000 to October 2006, 52 patients with far-lateral lumbar disc herniation (29 males and 23 females, with the average age of 41.5 years) were treated with minimally invasive procedures. All the patients were assessed by X-ray and CT. Some were given additional myeography, discography, Computerized tomography myelography (CTM) and MRI examination. Yeung Endoscopy Spine System (YESS), METRx and X-tube procedures were performed in 25, 13 and 14 cases, respectively. All patients were followed up for a mean period of 13.5 months. Clinical outcomes were assessed by visual analog score (VAS) and Nakai criteria. Results: The results indicated that the three procedures could significantly improve the radiating leg symptoms (P<0.05). The postoperative overall excellent and good rates of YESS, METRx and X-tube procedures were 84.0%,84.6% and 92.8% respectively, with no statistical difference among three groups (P>O.05). The YESS procedure had several advantages including shortest operation time, simplest anesthesia and least trauma as compared with the other two procedures, especially for simple type I far-lateral lumbar disc herniation. METRx procedure was specially suitable for simple type II. And the procedure of posterior endoscopic facetectomy, posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was designed for far-lateral disc herniation combined with degenerative lumbar instability. Conclusion: Minimally invasive strategies and options should be determined by different types of far-lateral lumbar disc herniation。

Abstract：Objective: To explore a new method to treat brachial plexus root avulsion experimentally by reimplantation combined with transplantation of neural stem cells (NSCs) modified by neurotrophin-3 gene (NT-3).Methods: The total RNA was extracted from neonatal rat striatum and the NT-3 cDNA was obtained by reverse transcription and amplified by polymerase chain reaction.The NT-3 gene was transferred into NSCs via the pLEGFP-Cl,an expression plasmid vectors.The untransfected NSCs,the pLEGFP-Cl treated NSCs,and the pLEGFP-Cl-NT-3 treated NSCs were transplanted into corresponding spinal cord segment with brachial plexus root avulsion.The survival,differentiation,and migration of the transplanted cells were determined under confoeal laser scanning microscope or by immunohistochemistry method.The nerve regeneration was evaluated by gross observation,electrophysiologieal examination and reverse horseradish peroxidase tracing.Results: The NT-3 gene was successfully amplified and transferred into neural stem cells via the plasmid vectors.The transplanted cells survived,differentiated,and migrated and NT-3 was expressed within the spinal cord.The animals regained some muscle strength which was less than 3-degree muscular strength according to the British Medical Research Council (BMRC) evaluating system.The resuits of electrophysiological examination and reverse horseradish peroxidase tracing were superior in the pLEGFP-Cl-NT-3 group to the NSCs untransfected group orthe pLEGFP-Cl group.Conclusion: Transplantation of NSCs modified by NT-3gene combined with reimplantantion is a relatively effective way to treat brachial plexus root avuision experimentally.It still need further study to improve the results。

Abstract：Objective: To investigate the curative effect and histocompatibility of reconstruction of traumatic urethral defect of rabbit using urethral extracellular matrix (ECM).Methods: Urethral ECM was obtained by excision of the urethra in 20 donor rabbits.In experimental group,20rabbits were resected a 1.0 cm-1.5 cm segment of the urethra and artificially made a model of traumatic urethral defect,then reconstructed by the urethral extracellular matrix of the same length.The rabbit immunity response was assessed by lymphocyte transformation test and serum TNF-αlevel.The reconstructed urethral segments were stained with hematoxylin-eosin and Van Gieson stain and observed by histological examination postoperatively.The urethrography,urethroscopy and urodynamic examinations were performed.Results: There was no significant difference in stimulative index of lymphocyte transformation between ECM group and control group.The serum TNF-α levels of ECM group slightly rose,but the increase was not significant as compared with control group.On postoperative day 10,epithefial cell had migrated from each side and small vessels were found in the extracellular matrix.In the 3rd week,several layers of urothelium covered the whole surface of the matrix tube.In the 6th week,the disorganized arrangements of smooth muscle fibers were firstly observed by Van Gieson staining.In the 24th week,the smooth muscle cells increased and the matrix tube appeared fairly similar to normal urethral wall components.The urethroscopy and urodynamic evaluation revealed that the surface of reconstructed urethra was smooth and emiction was unobstructed.Conclusion: The urethral extracellular matrix might be an ideal and safe biomateriai for the reconstruction of urethral traumatic defect。

Abstract：Objective: To study the applied anatomy of the vascular and muscular innervations related to vascularized fibular grafts.Methods: Thirty-four cadaveric lower extremities were dissected for this study.The observations included fibular length,fibular nutrient artery,arcuate arteries,and innervation of fibular muscles.The fibulas were averagely divided into four segments and the locations of relevant vessels and nerves were ascertained.Results: All specimens had 1 fibular nutrient artery and 4-9 arcuate arteries except 1 specimen which had only 1 arcuate artery.The fibular nutrient artery and the first threearcuate arteries were constantly located between the distal half of the 1/4 segment and 2/4 segment of the fibula.The muscular branch of the superficial peroneal nerve passed through the surface of the periosteum in the 2/4 segment of the fibula.Conclusions: The most proximal osteotomy point locates at the midpoint of the 1/4 segment by which it ensure the maximal potential for preserving the nutrient vessels.The muscular branch of the superficial peroneal nerve is fragile to injury at the 2/4 segment of the fibula。

Abstract：Objective: To discuss damage control orthopaedics in 53 cases of severe polytrauma who have mainly sustained orthopaedic trauma.Methods: The data of 53 cases of severe polytrauma who had mainly sustained orthopaedic trauma were retrospectively analyzed.And the methods and timing of damage control orthopaedics were discussed in this study.Results: We succeeded in rescuing the lives of all the 53 patients,and 38 patients returned to their former work.Conclusions: Injury Severity Seore (ISS90) should be 17 in severe polytrauma patients,but in severe polytrauma patients who have mainly sustained orthopaedic trauma,the ISS90 of bone and joint injuries should be 16.We recommend that primary minimally-invasive external fracture stabilization should be made for extremities and pelvis in these patients to avoid additional surgical trauma and that definitive secondary fracture care should be performed after medical stabilization for these patients in intensive care unit (ICU)。

Abstract：Objective: To observe the influence of intra-articular injection of sodium hyaluronate (SH) on the expression of inducible nitric oxide synthase (iNOS) in the synovium and nitric oxide (NO) content in synovial fluid of rabbits with traumatic osteoarthritis (OA).Methods: Sixteen white rabbits underwent unilateral anterior cruciate ligament transection and were randomly divided into 2 groups 5 weeks after the operation.Rabbits in the experimental group received intra-articular injection of 0.3 ml of 1% SH,once a week for 5 weeks.Animals in the control group were treated under the same conditions using physiological saline.All the animals were sacrificed at the 10th week after surgery.The mRNA expression of iNOS in the synovium was analyzed using reverse transcriptionpolymerase chain reaction.The content of NO in the synovial fluid was assayed.Results: The level of iNOS expression of thesynovium in the experimental group was lower than that in control group (0.47 ±0.09 vs.0.65±0.12,t =3.45,P<0.01).Compared with control group,the content of NO decreased significantly in synovial fluid of SH injection group (134.11 μmol/L ± 12.47 μmol/L vs.152.17 μmol/L±15.69 μmol/L,t =2.55,P<O.05).Conclusions: SH significantly decreases the content of NO in the synoviai fluid of rabbits with traumatic OA.SH may exert the effect on synovial fluid NO level as a result of the suppression of iNOS expression in the synovium.It may be one of the mechanisms of the therapeutic effect of SH on early traumatic OA。

Abstract：Objective: To evaluate the value of ultrasonography in non-displaced and mini-displaced humeral lateral condyle fractures in children.Methods: Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography.The fracture line through the joint surface was visualized by ultrasonography in 6 case,in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients' or their parents'refusal.In the remaining 3 children,ultrasonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted.Results: The average follow-up period was 8 months.The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treatment and another child who received percutaneous pinning.The elbow function and fractttre healing were good in cases received closed reduction and percutaneous pinning.Among the three cases who refused to receive closed reduction and internal f'txation,re-displacement occurred in 1 case and delayed union in 1 case.All three cases receiving conservative treatment had good results both in elbow function and fracture healing.Conclusion: High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved.For these cases,arthrography or magnetic resonance imaging is unnecessary。

Abstract：Objective: To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty (THA) for acetabular reconstruction in patients with posttraumatic arthritis and bone loss afteracetabular fractures.Methods: Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department.There were 10 males and 5 females with mean age of 48.2 years (ranging from 36 to 73 years).Eight cases had the fracture at left hips,7 at right hips.The average age at injury was 28 years (ranging from 18 to 68 years).The mean follow-up period was 4.3 years (ranging from 2 to 7 years).Results: Compared with mean 42 points (ranging from 10 to 62) of the preoperative Harris score,the survival cases at the final follow-up had mean 84 points (ranging from 58 to 98).One patient had mild pain in the hip.No revision of the acetabular or femoral component was undertaken during the follow-up.Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side.All of them had a stable radiographic appearance.Progressive radiolucent fines were observed in I,III zones in 2 cases.One patient had a nonprogressive radiolucent fine in zone III.The cup prosthesis was obviously displaced (6 mm) in one patient,but had not been revised.Conclusion: Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture,which can not only restore acetabular bone stock but also repair normal hip anatomy and its function。

Abstract：Since loss of of oligodendrocytes and consequent demyelination of spared axons severely impair the functional recovery of injured spinal cord,it is reasonably expected that the reduction of oligodendroglial death and enhanced remyelination of demyelinated axons will have a therapeutic potential to treat spinal cord injury.Amelioration of axonal myelination in the injured spinal cord is valuable for recovery of the neural function of incompletely injured patients.Here,this article presents an overview about the pathophysiology and mechanism of axonal demyelination in spinal cord injury and discusses its therapeutic significance in the treatment of spinal cord injury.Moreover,it further introduces the recent strategies to improve the axonal myeliantion to facilitate functional recovery of spinal cord injury。

Massive hemorrhage from infected anastomosed site between the graft artery and the external iliac artery is one of the most serious complications of renal transplantation. Clinically, it is a rare but fatal occasion. We reported here one case of hemorrhage with infection in the iliac artery anastomosed site treated successfully with hypogastric artery autograft interposition in March 2003。

Cloward technique of cervical discectomy and fusion is a long and complex surgical proce dure and instrumentation, by which compli-cated infection is rare in an era of routine prophylactic antimicrobial agent, especially in procedures by anterior approach. A study in the journal of Spine suggested that the incidence of unintentional laceration of the dura mater during spinal surgery might be as high as 14%。

The coverage of large soft tissue defects in heel is a problem for surgical reconstruction. Various reconstructive materials are available depending on the location, size and depth of heel defect, but unique function of heel skin cannot be restored easily by means of reconstruction. We used prefabricated flap of the foot heel to cover heel defect in a child and obtained satisfactory clinical results。

Abstract：Objective: To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures.Methods: A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005,including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury.There were 4 cases of type I fracture,12 type II,9 type III,12 type IV and 2 type V according to Schatzker criteria.Firstly,the combined injuries were treated.Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed.Finally,the internal fixation was observed by X-ray equipment.Postoperative management was early motion and delayed weight bearing.Results: All the fractures healed in 3 or 4 months.All patients were followed up for 1 to 5 years after operation.No case had severe complications,such as poor wound healing,infection,osteofascial compartment syndrome and osteoarthritis.According to the Rasmussen scoring system,36 cases obtained excellent or good results and the other 3 cases had moderate clinical results.The average score was 26 ± 3.Conclusions: As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture,arthroscopy has many advantages.It can treat associated intraarticular soft tissue components,visualize the chondral surface reduction,lavage the hematoma and smaller loose fragments,decrease soft tissue dissection,reduce the risk of scarring and promote rapid recovery。