2010年 · 第13卷第05期

Abstract：An unusual case of a suicidal firearm injury is presented, in which the victim placed the gun under his chin and fired. However, none of the vital structures of the head and face were injured because the victim's chin was considerably anterior to other facial structures as a result of a class Ⅲ facial deformity. This resulted in the trajectory of the bullet being anterior to vital facial structures and not causing injury to those structures。

Abstract：Traumatic brain injury (TBI) is a major cause ofmortality and morbidity in the world. Recent clinical investigations and basic researches suggest that strategies to improve angiogenesis following TBI may provide promising opportunities to improve clinical outcomes and brain functional recovery. More and more evidences show that circulating endothelial progenitor cells (EPCs), which have been identified in the peripheral blood, may play an important role in the pathologic and physiological angiogenesis in adults. Moreover, impressive data demonstrate that EPCs are mobilized from bone marrow to blood circulation in response to traumatic or inflammatory stimulations.In this review, we discussed the role of EPCs in the repair of brain injury and the possible therapeutic implication for functional recovery of TBl in the future。

Abstract：Objective: To compare the effect of extensive duraplasty and subsequent early cranioplasty on the recovery of neurological function in management of patients with severe traumatic brain injuries received decompressive craniectomy.Methods: The computer-aided designation of titanium armor plate was used as a substitute for the repair of skull defect in all the patients. The patients were divided into three groups. Twenty-three patients were in early cranioplasty group who received extensive duraplasty in craniectomy and subsequent cranioplasty within 3 months after previous operation (Group Ⅰ). Twenty-one patients whose cranioplasty was performed more than 3 months after the first operation were in the group without duraplasty (Group Ⅱ); while the other 26 patients in the group with duraplasty in previous craniotomy (Group Ⅲ). Both the Barthel index of activity of daily living (ADL) 3 months after craniotomy for brain injuries and 1 month after cranioplasty and Karnofsky Performance Score (KPS) at least 6 months after cranioplasty were assessed respectively.Results: The occurrence of adverse events commonly seen in cranioplasty, such as incision healing disturbance,fluid collection below skin flap, infection and onset of postoperative epilepsy was not significantly higher than other 2 groups. The ADL scores at 3 months after craniotomy in Groups Ⅰ-Ⅲ were 58.9±26.7, 40.8±20.2 and 49.2±18.6. The ADL scores at 1 month after cranioplasty were 70.2±25.2, 50.8±24.8 and 61.2±21.5. The forward KPS scores were 75.4±19.0,66.5±24.7 and 57.6±24.7 respectively. The ADL and KPS socres were significantly higher in group Ⅰ than other 2 groups.Conclusion: The early cranioplasty in those with extensive duraplasty in previous craniotomy is feasible and helpful to improving ADL and long-term quality of life in patients with severe traumatic brain injuries。

Abstract：Objective: To investigate the treatment of chronic subdural hematoma (CSDH) with burr-hole craniotomy in our hospital.Methods: From January 2004 to December 2009, 398patients with CSDH, 338 males and 60 females (male/female=5.63/1 ), received burr-hole craniotomy in our hospital.The median age was 60 years with the mean age of (58. 1± 18. 1 )years, (65.0±14.5) years for females and (57.0±18.2) years for males. Trauma history was determined in 275 patients (69. 1%).Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients.CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients' neurological status on admission and at discharge was also classified to judge the outcomes.Results: Generally, trauma history showed few differences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients (60.0% of 204 cases) suffering from head injuries were under 60 years,whereas 35 female patients (85.4% of 41 cases) with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was (84.0±61.7) days (range,0-1493 days). Traumatic accident was the leading etiology,other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors.Commonly, the elderly presented with hemiplegia/hemidysesthesia/hemiataxia and the young with headache.Most CSDH patients (95.6%) treated with burr-hole craniotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases.Conclusion: Burr-hole craniotomy is an easy, efficient and reliable way to treat CSDH。

Abstract：Objective: To investigate prospectively the effectiveness of kyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/lumbar vertebrae and correction of the deformity.Methods: Twenty-five patients with thoracic/lumbar vertebral osteoporotic compression fracture were admitted to our hospital between March 2007 and March 2008, and treated by kyphoplasty with SKY bone expander system.Patient's pain status was rated with Visual Analogue Scale (VAS) score system 1 day before and 1 hour, 48 hours, 6months, 12 months after surgery. In addition, Rolland-Morris and Oswestry disability questionnaires (RDQ and ODI)were used for survey 1 day before and 1, 6, 12 months after surgery. Pre- and post-operative vertebral heights and Cobb's angles were measured based on the X-ray films and statistically analyzed.Results: There were 27 fractured vertebrae in these 25 patients. After SKY kyphoplasty, the Cobb's angles (9.8°±9.76°) were significantly reduced compared with preoperative angles (17.18o±9.35°, P＜0.05 ), and the average improvement rate was 39%. Patients' pain VAS scores were also greatly improved after operation (P＜0.05). Moreover, postoperative RDQ and ODI scores were significantly smaller than preoperative values (P＜0.05).Conclusions: Kyphoplasty with SKY bone expander system provides an effective method for treating thoracic/lumbar vertebral osteoporotic compression fracture, with the advantages of small surgical wound and short duration.It can effectively recover the anterior and medial heights of fractured vertebrae (33% and 50%, respectively), reduce the Cobb's angle, quickly alleviate pain and improve patients'quality of life in a relatively short time period。

Abstract：Objective: Seat belt use during pregnancy reduces injury to the mother and her fetus. During recent years, the use of seat belts has been mandated by law in Iran. The purpose of this study was to determine the attitudes and practices of pregnant women regarding seat belt use.Methods: In this cross-sectional study, we asked 335 pregnant women at a hospital-based prenatal care clinic on the use of safety belt before and during pregnancy. SPSS version 13.0 was used for data analysis.Results: The mean age of study subjects was 27.3 years±5.3 years with the median of 27 years. Compared with the seat belt use before pregnancy, no change was detected in 48.7% of the women; seat belt use had increased in 17.5 %of them and decreased in 33.8 %. Eighty-one percent of women knew the correct placing of both lap belt and shoulder belt. Only 4% of women had received education on proper restraint use during pregnancy.Conclusions: The prevalence of seat belt use during pregnancy is lower than reports which are mostly from developed nations. The fact that about one-third of women have decreased their seat belt usage during pregnancy highlights the importance of education of mothers on this topic。

Abstract：Objective: To investigate risks and clinical effects of operative treatment for cervical vertebral fracture and dislocation associated with unilateral vertebral artery injury.Methods: This group consisted of 76 cases of closed cervical spine trauma combined with unilateral vertebral artery injury (23 cases of bilateral facet dislocation, 28 unilateral facet dislocation and 25 fracture). All patients underwent prospective examination of cervical spine MRI and vertebral artery two-dimensional time-of-flight (2D TOF)magnetic resonance angiography (MRA), and anterior cervical decompression. The healthy vertebral artery paths were evaluated before the surgery, and were protected during the surgery according to the anatomical signs.Results: There were no acute or chronic clinical damage symptoms in 76 cases after surgery. No neural damage symptoms were observed in patients with normal neural functions. The neural functions of incomplete paralyzed patients were improved in different grades.Conclusions: Reliable anterior operation can produce good results for cervical fracture and dislocation with unilateral vertebral artery injury. Detecting the course of uninjured vertebral artery before operation and locating the anatomical site during operation are effective to avoid damaging vertebral artery of uninjured side。

Abstract：Objective: Vascular endothelial growth factor (VEGF) plays important roles in establishing collateral circulation of ischemic myocardium. This study aimed to investigate the effect of isoflurane on VEGF expression and the potential intracellular signal transduction pathway in cultured rat myocardial cells in order to further reveal the molecular mechanism of myocardial preservation of isoflurane.Methods: Primary myocardial cells of Sprague-Dawley rats were isolated and cultured. They were divided randomly into control group, isoflurane group, protein kinase C (PKC)inhibitor group and PKC inhibitor+isoflurane group where cells were respectively incubated without any treatment,treated by 0.5, 1.0 and 1.5 minimum alveolar concentration (MAC) of isoflurane for 6 hours, by PKC inhibitor calphostin C at a final concentration of 50 nmol/L and by 50 nmol/L calphostin C+ 1.0 MAC isoflurane for 6 hours. VEGF expression was detected by enzyme-linked immunosorbent assay (ELISA) and the expression levels of PKC isoforms were determined by Western immunoblotting method.Results: Isoflurane increased the VEGF expression in myocardial cells in a dose-dependent way. VEGF levels were significantly higher in 1.0 and 1.5 MAC isoflurane groups than in the control group (both P＜0.01). The effect of isoflurane on upregulating VEGF expression was blocked by PKC inhibitor calphostin C (P＜0.01), but calphostin C did not alter VEGF expression (P＞0.05). Isoflurane induced the activation and translocation of PKC ε. Immunoblotting analysis revealed that the immunoreactivity of PKCε increased significantly in the membrane fractions and deceased significantly in the kytoplasm fractions for cells treated with 1.0 MAC isoflurane as compared with the untreated cells,but not of PKC α, PKCδ and PKCζ (P＜0.01).Conclusion: Isoflurane induces myocardial cells to release VEGF through activating PKCε from the endochylema to the cytomembrane, suggesting a possible novel mechanism of isoflurane protecting myocardial cells。

Abstract：Objective: To observe the clinical efficacy of artificial skin combined with vacuum sealing drainage (VSD) in treating large-area skin defects.Methods: Totally 18 patients with skin defects, treated with artificial skin combined with VSD from September 2008to May 2009 in our hospital, were retrospectively analyzed in this study. There were 15 males and 3 females, aged 7-66years, 34.3 years on average. Among them, 10 cases had skin laceration caused by traffic accidents (7 with open fractures), 1 mangled injury, 1 blast injury, 1 stump infection combined with skin defects after amputation and 5 heel ulcers.Results: All skin grafts in 16 cases survived after being controlled by VSD for one time. For the rest 2 patients,one with skin avulsion on the left foot was given median thickness skin grafts after three times of VSD, the other with open fractures in the left tibia and fibula caused by a traffic accident was given free flap transplantation. Skin grafts of both patients survived, with normal color and rich blood supply.Conclusion: Skin grafting in conjunction with artificial skin and VSD is much more effective than traditional dressing treatment and worth wide application in clinic。

Abstract：Objective: To assess the preventive effect of sodium valproate on early posttraumatic seizures in traumatic brain injury (TBI) patients.Methods: The retrospective study was based on 159patients with TBI treated at Department of Neurosurgery,Nanjing General Hospital of Nanjing Command enrolled between January 1, 2008 and December 31, 2009. The inhospital section of the retrospectively collected database includes information on age, sex, initial Glasgow Coma Score (GCS), results of CT scanning, operation, usage of sodium valproate, seizures in the first week after injury and outcome.Results: Seven patients (4.4%) showed early posttraumatic seizures. Although the incidence was zero in patients who received sodium valproate treatment, the difference between the treatment and control groups was not statistically significant. Of the 87 severe TBI patients (GCS 3-8), 6 patients in the control group (6.9%) suffered from early seizures during the first week after TBI and no patient who received preventive therapy suffered from seizures.The difference between the treatment and the control groups was still not statistically significant. Of the 72 mild and moderate TBI patients (GCS 9-15), only I patient in the control group suffered from seizures and no patient in the treatment group suffered.Conclusions: Although the results suggest that the study is not sufficiently powerful to detect a clinically important difference in the seizure rates between the treatment and control groups, sodium valproate is effective in decreasing the risk of early posttraumatic seizures in severe TBI patients. Further prospective studies are recommended。

Abstract：Objective: A catastrophic earthquake struck Wenchuan region of West China on May 12, 2008and caused more than 69 225 deaths. This study was to analyze injury characteristics and treatment of the seismic patients based on Chinese Trauma Databank, which will be helpful for improvement of future medical rescue in potential disasters.Methods: Based on inpatients' medical records of seismic patients admitted into 11 hospitals, data were registered with Trauma Database System Version 3.0. Patients'general information, causes, clinical characteristics and treatment of injuries were studied.Results: Main causes for seismic injuries were blunt strike (68.2%), crush/burying (18.7%) and slip/falling (11.5%).Slip/falling was the main cause for spinal injuries and accounted for 19.1%, which was higher than the percentage for other body part. Extremity injuries accounted for 54.8%of all injuries. Fractures accounted for 53.1%. Lower extremity fracture accounted for 70.1% of lower extremity injury and spinal fracture accounted for 85.9% of spinal injury.The proportion of spinal injuries with AIS ≥ 4 was higher than that of other injured locations except for the abdomen.Debridement and suturation for single injury and multiple injury patients accounted for 64.7% and 42.9% of their operations respectively.Conclusions: Blunt strike, crush/burying and slip/falling are the main causes for seismic injuries. The most frequently injured site is extremity. The main injury type is fracture, especially for the lower extremities and the spine.Multiple injury patients were mainly treated by operation,including debridement and suturation, closed reduction and external fixation, etc。

Abstract：Objective: To explore the characteristics of susceptibility weighted imaging (SWI) of the intravitreous foreign body of autologous eyelashes in rabbits.Methods: A total of 12 New Zealand white rabbits,either sex, weighing 2.5-3.5 kg, and provided by the Experimental Animal Center of Henan Province were employed in this study. For each rabbit, 5 autologous eyelashes (1 cm in length and 0.2-0.3 mm in diameter) were implanted into the right ocular vitreum, while the left control ocular vitreum received sham operation but nothing was implanted. SWI sequential test was made 2 hours postoperatively. Then the rabbits were killed and the specimens of the vitreous bodies of the rabbits were obtained. Hematoxylin and eosin staining and histological examinations were performed. Results: The autologous eyelashes in 8 ocular vitreums of rabbits showed linear low signal intensity on the magnitude images and susceptibility weighted images, but linear high signal intensity on the phase images. Among the 12experimental rabbits, 5 eyelashes in the right vitreum were completely shown in 3 rabbits, partly shown in 5 rabbits (2eyelashes shown in 3 rabbits and 3 eyelashes shown in 2rabbits), and not shown in 4 rabbits. Conclusions: SWI of the foreign body ofintravitreous autologous eyelashes in rabbits has its own characteristics. The combined application of SWI sequential magnitude images, susceptibility weighted images and phase images is helpful to the detection and diagnosis of intravitreous autologous eyelashes in rabbits。