2009年 · 第12卷第02期

Abstract：Objective: To study the influence distal tibiofibular synostosis on ankle function.Methods: From October 1998 to October 2004,a total of 281 consecutive patients underwent operations because of ankle fractures or distal fractures of the tibia and fibula.Distal tibiofibular synostosis occurred after operation in 8 Patients.The duration of follow-up averaged 20.6 months (14-44 months).The ankle function was assessed on the basis of functional rating system described by Mazur.1Results: According to Mazur's ankle evaluation system,4 patients achieved an excellent result,2 a good result and 2 a fair result.The dorsiflexion of the synostosis ankle reduced by 8.26 degrees as compared with that of the contralateral ankle.and there was little influence on the plantar flexion.All the Patients had a normal gait.Conclusion: The distal tibiofibular synostosis after the operation of ankle fractures or distal fractures of the tibia and fibula usually gives rise to few symptoms and needs no specific treatment。

Abstract：Objective: To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures.Methods: From July 2005 to January 2007,22 cases (18 males and 4 females,aged 28-57 years,42.7years on average) of lumbar burst fractures were treated with surgical procedures in our hospital.Based on the routine posterior approach,one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebralbody.After all the displaced fracture fragments were cleared away and the spinal canal was decompressed,the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns.The adjacent above and below segments of the vetebral body were fixed with transpedicular screws.The operation time,intraoperative blood loss,vertebral height,degree of kyphotic deformity and comprised spinal canal were documented.Results: The average operation time was 3.5 hours (ranging 2.8-5.8 hours) and the average blood loss was 820 ml (ranging 650-2 100 ml).All the cases were followed up for 17.2 months on average (ranging 12-28 months).The height of the injured vetebral body was restored from 24% (12%-45%) preoperatively to 96% (95%-99%) postoperatively (P＜0.05).The natural spinal curvatures and spinal canal were restored.Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively.Conclusions: The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures。

Abstract：Objective: To explore the treatment methods and outcome of posterior Wall fractures of the acetabulum.Methods: The data of 31 patients(25 males and 6females,aged 19-59 years,mean:40.5 years)with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study.The types of fractures,number of fragments,combined dislocations,and sciatic nerve function were documented before admission.All the fractures were treated with open reduction and internal fixation.Based on the fracture type and site,either screws alone or reconstructive plates were used.The Patients were immobilized for an average of 12 weeks before partial weight bearing was permitted.After follow-up for 12-70months(43.6months on average),modifled Merle d‘Aubigne score was adopted to evaluate the outcomes of the operations.Results: The percentages of the excellent,good,fair and poor results were 48.4%,41.9%,6.5%,and 3.3%,respectively.with a good to excellent rate of 90.2%.Idio-pathic sciatic nerve injury occurred in only one case.Conclusions: The sciatic nerve should be routinely exposed and protected during the surgery.The type of fixation should be based on the fracture type and site.Prolonged immobilization may be helpful in improving the final outcomes。

Abstract：Obiective: To discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal iniuries.Methods: A retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries.ResuIts: of 1166 cases,72.3%were found with shock.The operation rates of thoracic and abdominal injuries were 14.8%(119/804)and 83.5%(710/850)respectively(X2=780.683,P＜0.01).The operation rates of blunt and penetrating thoracic injuries was6.8%(42/617)and 40.6%(76/187)respectively(X2=131.701,P＜0.01).The operation rates of blunt and penetrating abdominal injuries were77.1%(434/563)and 96.1%(276/287)respectively(x2=50.302,P＜0.01).Theoperation rates of blunt thoracio-abdominal injuries were 6.8%(42/617)in thoracic region and 77.1%(434/563)in abdomen respectively (x2=544.043,P＜0.01).Among the cases of abdominal injuries,41 received arteriography embolism,with the efficacy of 95.1%(39/41).Total mortality rate was 6.1%.The mortality rates of blunt and penetrating injuries were 7.3%(62/854)and 2.9%(9/312)(x2=6.51,P＜0.005).The deaths were mainly due to large volume of blood loss.Conclusions: When both thoracic and abdominal injuries exist,laparotomy is frequently required rather than thoracotomy.Laparotomy is seldomly used for blunt thoracic injuries,but usually used forpenetrating thoracic and abdominal injuries.Mortality rate of penetrating thoracic and abdominal injuries is markedly lowerthan that of blunt injuries.Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries。

Abstract：Objective: To provide the experience on medical rgscue and care for any giant earthquake by analysing the Patients treated by the Chinese Medical Rescue Team in the Barakott earthquake of Pakistan.Methods: On October 8,2005,a giantearthquake(7.8Richter scale)earthquake occurred in the northwest Pakistan.Wle belonged to the Chinese Medical Rescue Team and worked in the earthquake-affected town-Bardkott from October28,2005 to November17,2005.The Patients wcre classifted into upper respiratory tract infection,diarrhea,trauma and other diseases.All the data of patients who were in jured during the earthquake were analysed.The difference was analyzed by X2 test.Results: Of the 2194 patients treated by the Chinese Medical Rescuc Team.trauma patients only accounted for 29%,diarrhea patients for 4%,upper respiratory infection patients for 14%.and Other types of diseases for 52%.Among the 630 trauma patients,426 patients were injured during the earthquake.Of the 426 patients,291(68%)patients were found having open wounds,85(20%)patients mainly complained of soft tissue pain without any wound orfracture,and76(18%)patients had fractures with or without open wound.The most frequent site of wound was lower extremity.Head injury in children was 30%,obviously higher than that in the adults.Wound infection Was common among the injured patients,with the rates of 72%,64%and 78%in male,female adult patients and children,respectively.Conclusions: Prcvalence of common diseascs,trauma,wound infection and fracture are main problems presented at late stage of the giant earthquake.Great attention should be paid to head and lower extremity injuries。

Abstract：Obiective: To evaluate the sensitivity and specificity of CT scan findings in Patients ith blunt abdominal trauma admitted to the university hospital.Methods: All the atients ith blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study.In the absence of any clinical anifestations,he patients underwent a diagnostic CT scan.Laparatomy was performed in those with positive CT results.Others were observed for 48 hours and discharged in case no problem as reported;otherwise they underwent laparatomy.Information on patients'demographic ata,mechanism of trauma,indication for CT scan,CT scan findings,results of laparotomy ere gathered.The sensitivity,specificity and accuracy of the CT-scan images in regard ith the organ injured were calculated.The sensitivity,specificity and accuracy of the T scan were calculated in each case.Results: CT Scan had the highest sensitivity for etecting the injuries to liver (100%) and spleen (86.6%).The specificity of the method or detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher han other organs.The accuracy of CT images to detect the injuries to spleen,liver,idney and retroperitoneal hematoma was reported to be 96.1%,94.4%,91.6% and 91.6% espectively.Conclusion: The findings of the present study reveal that CT scan could econsidered as a good choice,especially for patients with blunt abdominal trauma in eaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts。

Abstract：Ohiective: To observe the role and mechanism of Coreleasing molecule (CORM)-2 in lung injury induced by ischemia-reperfusion (IR) of hind limbs in rats.Methods: A rat model of lung injury induced by IR of hind limbs was established.A total of 40 Sprague Dawley (SD) rats were randomly divided into 5 groups (n=8):sham,shanl+CORM-2,IR,IR+CORM-2and IR+dimethyl sulfoxide (DMSO).Rats in the IR group received hind limb ischemia for 2 hours and reperfusion for 2 hours,rats in the sham group underwent sham surgery without infrarenal aorta occlusion.rats in the IR+CORM-2 group and in the sham+CORM-2 group were given CORM-2 (10 pmol/kg in travenous bolus) 5 minutes before reperfusion or at the corresponding time points.while rats in the IR+DMSO group was treated with the same dose of vehicle (DMSO) at the same time.The lung tissue structure,polymorphonuclear neutrophil (PMN) count,wet-to-dry weight ratio (W/D),malondialdehyde (MDA) content,myeloperoxidase (MPO) activity,intercellular adhesion molecule-1 (ICAM-1) expression,I κ Bo degradation and nuclear factor (NF)-κB activity in the lungs were assessed.Results: As compared with the sham group.lung PMNs number,W/D,MDA content,MPO activity,ICAM-1 expression and NF-κB activity significantly increased in the IR group,but the level of I κ Bo decresed (P＜0.01).Compared with the IR group,lung PMNs number,W/D,MDA content.MPO activity and ICAM-1 expression significantly decreased in the IR+COMR-2 group (P＜0.01),while the level of I κ Ba increased.Conclusions: These data demonstrate that CORM-2 attenuates limb IR-induced lung injury through inhibiting ICAM-1 protein expression.NF-κ B pathway and the leukocytes sequestration in the lungs following limb IR in rats,suggesting that CORM-2 may be used as a therapeutic agent against lung injury induced by limb IR。

Abstract：Objective: To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury.Methods: A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization.The renal injuries resulted from renal biopsy in 7 patients,endovascular intervention in 2.percutaneous puncture and pyelostomy in 2.local resection of renal tumor in 1 and trauma in 4.With regards to clinical manifestations,there was hemorrhagic shock in 8 patients,severe flank pain in 14,and hematuria in 14.CT and ultrasonography confmued that 15 Patients had perirenal hematoma.The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients,associated with polyvinyl alcohol particles (PVA) in 9,and gelfoam particles in 6 cases.Results: Renal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases,pseudoaneurysm in 3 and extravasation of contrast media in 4.The arterial embolization was successful in all 16 cases in a single session.The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion.In 13 patients with hemodynamical compromise,blood loss-related symptoms were immediately relieved after blood transfusion.In 14 patients with severe flank pain,the pain was progressively relieved.Hematuda ceased in 14 patients 2-14 days after the embolization procedures.The renal function was impaired after the procedure in 6 cases,in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3.2 of whom received hemodialysis.The ultrasonography showed that perirenal hematoma was gradually absorbed within 2.6 mortths after the procedure.A11 patients were followed up in 6-78 months (mean,48 months).Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor).Ten patients survived without bleeding and further intervention.The deteriOration of renal function did not occur and the serum creatinine and blood urea were in normal range.Conclusion: Transcatheter selective renal arterial embolizationis a safe and effective method in the treatment of renal vascular injuries。

Abstract：Objective: To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in scarehing the hasal cut ends and anastomosing the lacerated lacrimal carlaliculus.Methods: Eighty-seven patients (including 87 eyes) suffering from canalicular laceration were randomized into two groups:41 patients treated with tradidonal pigtail probes (Group A) and 46 with modified pigtail probes (Group B).During the reconstruction of the lacerated canaliculi,the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi.Peripherally inserted central catheter (PICCTM) silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months.The surgical outcomes were retrospectively analyzed after stent removal.Results: In Group B,the primary Success rate of searching the hasal cut ends of lacerated lacdmal canaliculi was 93.48% (43/46) and the final success rate was 97.83% (45/46).No false passage formed in Group B.Statistical significance was found between Group Aand Group B as the primary success rates of searching the nasal cut ends (χ2=10.522,P＜0.01) and the false passage forming rates were concerned (χ2=4.704,P＜0.05),whereasno significance was found between the two groups as the final success rates were concerned (χ2=0.007,P＞0.05).The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was (5.02±2.73) minutes and the mean time of operation was (33.9±4.84) minutes,and both were significantly shorter than those of Group A (t1=9.779,t2=10.700,P＜0.01).The cure rate of Group B was 95.65%,though higher than that of Group A,no statistical significance was found (Z=-1.007,P＞0.05).Totally,2 patients (2.30%) were found to be absent of common canaliculus and underwent bicanalicular hasal intubation in the two groups.Conclusions: Pigtail probes arc efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration.Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair。

Abstract：Objective: To testify the effect of the stem cells derived from the widely distributed fat tissue on repairing full-thickness hyaline cartilage defects.Methods: Adipose-derived stem cells (ADSCs) were derived from adipose tissue and cultured in vitro.Twentyseven New Zealand white rabbits were divided into three groups randomly.The cultured ADSCs mixed with calcium alginate gel were used to fill the full-thickness hyaline cartilage defects created at the patellafemoral joint,and the defects repaired with gel or without treatment served as control groups.After 4,8 and 12 weeks,the reconstructed tissue was evaluated macroscopically and microscopically.Histological analysis and qualitative scoring were also performed to detect the outcome.Results: Full thickness hyaline cartilage defects were repaired completely with ADSCs-derived dssue.The result was better in ADSCs group than the control ones.The microstructure of reconstructed tissue with ADSCs was similar to that of hvaline cartilage and contained more cells and regular matrix fibers,being better than other groups.Plenty of collagen fibers around cells could be seen under transmission electron microscopy.Statistical analysis revealed a significant difference in comparison with other groups at each time point(t=4.360,P＜0.01).Conclusion: Thcse results indicate that stem cells derived from mature adipose without induction possess the ability to repair cartilage defects

Avascular necrosis of a vertebral body,a relatively uncommon entity,is caused by malicgnancy,infection,radiation,systemic stemid treatment,trauma,and the ike.1 Vertebral osteonecrosis induced by trauma is called Kümmell's disease,because it was initially described by Hermann KLimmell of Germany in 1891.2 This paper reported a young female with posttraumatic vertebral osteonecrosis and analyzed the causes.She was treated by thoracoscopic Surgery successfully。

Abstract：Obiective: To determine the patterns of traumatic extremity injuries leading to amputation in Iran.Methotis: Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation.This project was conducted in 8 major cities during 2000-2004.Results: of 17 753 traumatic Patients,164 (0.92%) had injuries to the extremities that resulted in the limb amputation.Of these,143 (87.2%) were men.The patient's mean age was 29.0 years±15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%).One hundred and four cases were occupational accidents (63.4%).Blunt trauma was in 54.9% of the cases.The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%).Amputation of hand fingers was the most frequent type of amputation (125 cases,76.2%).One patient died from severe associated injuries.Conclusions: This study shows the patterns of traumatic limb amputation in Iran,a developing country.Resuits of this study may be used in preventive strategic planning。