2010年 · 第13卷第01期

Abstract：Objective:To retrospectively analyze the medical treatment of 332 patients with lower leg fracture in Wenchuan earthquake admitted in West China Hospital.Methods:From May 12,2008 to June 15,2008,332 patients with lower leg fracture injured in Wenchuan earthquake were treated in our hospital.The data on trauma condition and clinical treatment were collected and analyzed.Results:Among the 332 cases of lower leg fracture,there were 179 cases of open fracture,accounting for 53.9%,in which 91% belonged to Gustilo Ⅱ or Ⅲ injury with serious pollution.Many patients had posttraumatic complications,vascular and nerve injury,wound infection or osteofascial compartment syndrome.After medical treatment,blood vessels were reconnected,wound surface was repaired and wound infection was under control.Conclusion:For the patients with lower leg fracture in earthquake,we followed the principle of "complete debridement-restoring the continuity of bone bracket-timely recovering blood supply of limbs and repairing nerve damage-repair the wound surface at stage Ⅰ or Ⅱ" so as to reduce the incidence of amputation and infection。

Abstract：Objective:To investigate the effects of penehyclidine hydrochloride on apoptosis of lung tissue cells and its mechanism in acute lung injury following blunt chest trauma in rats.Methods:Sprague Dawley(SD)rats(n=54)weighing(250±25)g were divided equally and randomly into three groups:normal control group(C group,n=18),trauma model group(T group,n= 18)and penehyclidine hydrochloride treatment group(P group,n=18).Each group was further divided into three subgroups according to the time points of 3,12 and 24 hours after experiment(at each time point,n=6 for each subgroup).Rats of P group were intraperitoneally injected with penehyclidine hydrochloride for 2 mg/kg immediately after blunt chest trauma and rats in its 24 hours subgroup were once again injected with penehyclidine hydrochloride in the same dose 12 hours after injury.Lung tissue samples were collected at every time point and cell apoptosis in lung tissues were measured by TUNEL.Apoptotic index(AI)was calculated,expressions of bax and bcl-2 were detected by immunohistochemical staining of SABC,and lung tissue sections were taken for light and electron microscopic observation.Results:As compared with C group,at every time point,AI and expressions of bax and bci-2 in T group were higher(P＜0.05),and the ratio of bcl-2/bax markedly decreased(P＜0.05),especially in the 24 hours subgroup.The ratio in T group(0.468±0.007)was lower than that in C group (1.382±0.058,t=12.5,P＜0.01).Lung tissue injuries were significant under a light microscope,and the number of apoptotic cells increased obviously under a transmission electron microscope.As compared with T group at the same phase,AI and expression of bax decreased in P group(P＜0.05 and P＜0.01),while the expression of bcl-2 increased significantly(P＜0.01),and the ratio of bcl-2/bax markedly increased(P＜0.05),especially in the 24 hours subgroup.The ratio in P group(1.012±0.070)was much higher than that in T group(0.468±0.007,t=8.3,P＜0.01).The injury of lung tissues was relieved,and apoptosis of cells decreased obviously under a transmission electron microscopic observation.Conclusions:Apoptosis and expressions of bax and bcl-2 in lung tissues might be involved in the pathogenesis of lung injury induced by blunt chest trauma.Penehyclidine hydrochloride can alleviate lung injuries by inhibiting apoptosis of lung tissue cells,during which effects of penehyclidine hydrochloride on regulating expressions of bax and bcl-2 may play an important role。

Abstract：Objective:To retrospectively analyze 95 cases of traumatic carotid cavernous fistula treated by endovascular embolization.Methods:From January 1994 to December 2008,95 patients with traumatic carotid cavernous fistula were treated in our hospital.All patients received selective cerebral angiography through femoral artery catheterization.Accordingly,89 cases were treated by detachable balloon embolization,5 by platinum microcoils and 1 by coveredstent,respectively.Results:In the study,61 cases achieved successful balloon embolization at the first time.Fifty-six cases had multiple balloons due to the big fistula.Nine cases received balloon embolization twice.But among the 5 patients treated with platinum microcoils,one developed slight brainstem ischemia.After operation the patient had hemiparesis and swallow difficulty,but gradually recovered 3 months later.No neurological deficits were observed in other cases.All the cases recovered.Eighty-five cases were followed up for 1-15 years and no recurrence was found.Conclusions:The endovascular embolization for traumatic carotid cavernous fistula is minimally invasive,safe,effective and reliable.The detachable balloon emholization is the first choice in the treatment of TCCF。

Abstract：Objective:To evaluate the local risk factors of traumatic brain injury(TBI)patients developing gastrointestinal(GI)bleeding during the early hospitalization in neurosurgery intensive care unit(NICU).Method:From September 2005 to February 2006,41 patients admitted to NICU and 13 healthy volunteers were involved in our study.Blood samples at 24 hours,2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m.to measure the concentrations of serum adrenocorticotropic hormone(ACTH),total cortisol and gastrin.The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems.Data were analyzed by SPSS 11.5.Results:Within 24 hours following TBI,the concentrations of total cortisol,ACTH and gastrin increased proportionally to the severity of injury,especially significant in the experimental group(P＜0.05).The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group,(F=1.413,P=0.253)for ACTH and(F=9.371,P=0.006)for gastrin.GI bleeding had a positive correlation with gastrin concentration(r=0.312,P＜0.05)and a negative correlation with serum hemoglobin(Hb)(r=-0.420,P＜0.01).The clinical incidence of GI bleeding was 24.39%(10/41)in the experimental group.Within 24 hours,GI bleeding had a strong correlation with gastrin concentration(OR=26.643,P＜0.05)and hematocrit(Hct)(OR=5.385,P＜0.05).High ACTH concentration(＞100 pg/ml)increased the frequency of GI bleeding.For patients with severe TBI and treated with routine antacids,the incidence of GI bleeding was 40.91%(9/22)and the mortality rate was 20%(2/10).Conclusions:Low Glasgow coma scale scores,low Hb,high concentrations of gastrin and ACTH(＞100 pg/ml)are risk factors and can be predictive values for post-traumatic GI bleeding.Severe TBI patients have high risks of GI bleeding with high mortality。

Abstract：Objective:To illustrate mechanisms of spine fractures and the pattern of spinal injuries characterized by the major mechanisms in urban population of Iran.Methods:Data regarding spinal injuries including demographics,mechanism and level of spinal injury,abbreviated injury score,associated injuries and final fate of the patients were extracted from the Iranian national trauma registry database from 1999 to 2004.Results:A total of 619 patients with traumatic spine fractures were identified,of whom 68.5% were males.The peak frequency of these injuries occurred in the 21-40 year age-group.Accidental falls and road traffic crashes(RTCs)were the most common mechanisms of spinal fractures(47.2% and 44.1%,respectively).RTCs tended to occur in younger patients compared with accidental falls.The most common spinal region for spinal fracture was the lumbar spine(53.63%).Cervical spine fractures were significantly more common in RTCs,while lumbar spine fractures were more common in accidental falls(P＜0.001).A total of 171(27.6%)patients had associated non-spinal injuries,of whom 127 had associated extremity injuries,and 55 had head injuries.Thirty-six(5.6%)patients had spinal cord injury(SCI).The injury severity score of the RTC group was significantly higher than that of accidental falls(P=0.002).Fifteen(4%)patients died of traumatic injuries.The rate of death was significantly higher in RTCs compared with accidental falls(5.1% vs 2.1%,P=0.039).Conclusions:The patterns of spinal fractures are similar to those reported from developed countries.RTCs tend to affect the younger age population and are associated with a higher degree of associated injuries and mortality than accidental falls.Therefore preventive strategies should be based on reduction of the number and severity of RTCs。

Abstract：Objective:To study biomechanical changes of newly formed bones 24 weeks after repairing large defects of long bones of goats using heterogeneous deproteinated bone(DPB)prepared by modified methods as an engineering scaffold.Methods:According to a fully randomized design,18 goats were evenly divided into three groups:normal bone control group(Group A),autologous bone group(Group B)and experimental group(Group C).Each goat in Groups B and C were subjected to the periosteum and bone defect at middle-lower part of the fight tibia(20% of the whole tibia in length),followed by autologous bone or DPB plus autologous MSCs + rhBMP2 implantation,respectively and semiring slot fixation;while goats in Group A did not perform osteotomy.At 24 weeks after surgery,biomechanical tests were carried out on the tibias.Results:At 24 weeks after surgery,the results of anticompression test on tibias in three groups were recorded by a functional recorder presented as linear pressure-deformation curve.The shapes of the curves and their change tendency were similar among three groups.The ultimate pressure values were 10.74 Mpa±1.23 Mpa,10.11 Mpa±1.35 Mpa and 10.22 Mpa±1.32 Mpa and fracture compression rates were 26.82%±0.87%,27.17%±0.75% and 28.22%±1.12% in Groups A,B and C,respectively.Comparisons of anti-compression ultimate pressures and fracture compression rates among three groups demonstrated no significant difference(P_(AB)=0.415,P_(BC)=0.494).Three-point antibend test on tibias was recorded as load-deformation curves,and the shapes of the curves and their change tendency were similar among three groups.The ultimate pressure values of the anti-bend test were 481.52 N±12.45 N,478.34 N±14.68 N and 475.62 N±13.41 N and the fracture bend rates were 2.62 mm±0.12 mm,2.61 mm±0.15 mm and 2.81 mm±0.13 mm in Groups A,B and C,respectively.There was no significant difference between groups(P_(AB)=0.7,P_(BC)=0.448).The ultirates were 29.51°±1.64°,28.88°±1.46° and 28.81°±1.33° in Groups A,B and C,respectively.There was no significant difference between groups(P_(AB)=0.123,P_(BC)=0.346).Conclusions:The biomechanical characteristics of newly formed bones from heterogeneous DPB for repairing large segmental long bone defect are comparable to those of normal bones and autologous bones.DPB has the potential for clinical usage as bone graft material。

Abstract：Objective:Subtrochanteric femoral fractures are severe injuries.Although many treatment methods have been developed,controversy exists regarding the optimal management of these fractures.This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation(PFNA-long).Methods:Between October 2006 and February 2008,25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long.Closed reduction and fixation were performed in 20 cases.In the remaining 5 cases,closed reduction was difficult,so limited open reduction was performed,with bone grafting in 4 cases and circumferential wiring in 4 cases.Results:The average follow-up time was 16.1 months.All subtrochanteric femoral fractures healed uneventfully except one case of delayed union.The mean union time was 26.2 weeks.Technical difficulties with nail insertion were encountered in 3 cases.No implant failure was observed.Conclusion:PFNA-long is effective in treatment of subtrochanteric femoral fractures,with a high rate of bone union,minor soft tissue damage,early return to functional exercise and few implant-related complications。

Abstract：Objective:To investigate the changes and effects of arginine vasopressin(AVP)in patients with acute traumatic subarachnoid hemorrhage(tSAH).Methods:The plasma and cerebrospinal fluid(CSF)level of AVP,and intracraniai pressure(ICP)were measured in a total of 21 patients within 24 hours after tSAH.The neurological status of the patients was evaluated by Glasgow Coma Scale(GCS).Correlation between AVP and ICP,CrCS was analyzed respectively.Meanwhile,18 healthy volunteers were recruited as control group.Results:Compared with control group,the levels(pg/ml)of AVP in plasma and CSF((x)±s)in tSAH group were significantly increased within 24 hours(38.72±24.71 vs 4.54±1.38and 34.61±21.43 vs 4.13±1.26,P＜0.01),and was remarkably higher in GCS≤8 group than GCS＞8 group(50.96±36.81 vs 25.26±12.87 and 44.68±31.72 vs 23.53±10.94,P＜0.05).The CSF AVP level was correlated with ICP(r= 0.46,P＜0.05),but no statistically significant correlation was found between plasma AVP,CSF AVP and initial GCS(r=-0.29,P＞0.05 and r=-0.32,P＞0.05,respectively).The ICP(mm Hg)in tSAH patients was elevated and higher in GCS≤8 group than in GCS＞8 group(25.9±9.7 vs 17.6±5.2,P＜0.05＝.Conclusion:Our research suggests that AVP is correlated with the severity of tSAH,and may be involved in the pathophysiological process of brain damage in the early stage after tSAH.It seems that compared with the plasma AVP concentration,CSF AVP is more related to the severity of tSAH。

Abstract：Objective:To investigate the molecular pathway of substance P(SP)to induce osteoblastic differentiation.Methods:Mesenchymal stem cells were isolated and cultured.The cultures were divided into four groups with Group A(control group)cultured without any factors,Group B cultured with SP,Group C cultured with SP and SP receptor neurokinin-1(NK_1)antagonist,and Group D cultured with SP NK_1 antagonist respectively to induce osteoblastic cells differentiation.Osterix gene expression was detected by reverse transcription-polymerase chain reaction(RT-PCR)for three times after 1-2 weeks of cultivation and the results were analyzed by one-way analysis of variance(ANOVA).Results:The log phase of bone marrow stromal cells appeared at 4-6 days.ALP staining revealed that the majority of cells,more than 95%,were positive and small bluepurple granules were found in the cytoplasm.And Group B,treated with SP,showed a higher level of ALP activity than the other three groups.Meanwhile,RT-PCR found that Osterix expression in Group B was obviously up-regulated,compared with other groups.But Osterix expression in Group D had no remarkable differences,compared with the controls.Conclusions:SP can up-regulate Osterix gene expression to stimulate differentiation of mesenchymal stem cells into osteoblastic cells at the final stage.The regulatory effect of SP on Osterix expression was dependant on SP NK_1 receptors。

Abstract：Objective:To study the effect and indications of intracranial pressure(ICP)monitoring for frontal lobe contusion patients.Methods:During January 2005-December 2008,34 cases of frontal lobe contusion received ICP monitoring in our department(monitoring group).Different treatment protocols were adopted according to the results of ICP.Meanwhile 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group.Results:We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence,bilateral undersurface of frontal lobe or dispersed in bilateral lobe.After half a year follow-up and on the basis of Glasgow Coma Scale assessment,the monitoring group showed better outcome than the control group with good recovery in 24 cases(70.6%),moderate disability in 7 cases(20.6%),severe disability in 2(5.88%)and death in 1(2.94%).The outcome of control group displayed good condition in 25 cases(54.3%),moderate disabilities in 8(17.4%),severe disability in 7(15.2%),and death in 6(13.0%).Conclusions:Frontal lobe contusions are vulnerable and complex head injuries,especially when the contusions are located in frontal longitudinal dehiscence,bilateral undersurface of frontal lobe or diffused in bilateral lobes.These patients should undergo ICP monitoring regardless of their consciousness status.If ICP elevates over 25 mm Hg,the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients。

Abstract：Endogenous electric fields(Efs)have been detected at wounds and damaged tissues.The potential roles of Efs in tissue repair and regeneration have been an intriguing topic for centuries.Recent researches have provided significant insights into how naturally occurring Efs may participate in the control of tissue repair and regeneration.Applied Efs equivalent to the size of fields measured in vivo direct cell migration,cell proliferation and nerve sprouting at wounds.More remarkably,physiological Efs are a guidance cue that directs cell migration which overrides other well accepted directional signals including initial injury stimulation,wound void,contact inhibition release,population pressure and chemotaxis.Efs activate many intracellular signaling pathways in a directional manner.Modulation of endogenous wound Efs affects epithelial cell migration,cell proliferation,and nerve growth at cornea wounds in vivo.Electric stimulation is being tested clinically for the treatments of bone fracture,wound healing and spinal cord injury.Efs thus may represent a novel type of signaling paradigm in tissue repair and regeneration.Combination of the electric stimulation and other well understood biochemical regulatory mechanisms may offer powerful and effective therapies for tissue repair and regeneration.This review introduces experimental evidence for the existence of endogenous Efs and discusses their roles in tissue repair and regeneration。

Proximal humeral epiphyseal injuries in neonate are rare.We reported a case of proximal humeral epiphyseal injury diagnosed by ultrasonography.This kind of injury usually occurs during birth or is caused by child abuse,~(1-9) and mostly present as Salter-Harris type Ⅰ or Ⅱ injuries.~(1-3,10) It is difficult to be diagnosed on radiography.Though the treatment is generally conservative,early diagnosis is important to avoid complications and ultrasonography can serve as a guide for the treatment and prognosis。