2012年 · 第15卷第01期

Abstract：Objective:There are a great number of modified models based on the four-vessel occlusion(4VO)model of Pulsinelli and Brierley which has been used worldwide for brain ischemia research.However,up to now the problems of collateral circulations of 4VO and the difficulty in arranging a surgery to occlude the basilar artery in other models are not satisfactorily solved yet.In this study,an improved 4-vessel occlusion(I4VO)rat model which is easy to handle and able to decrease the effect of collateral circulation is reported.Methods:The common carotid arteries and the beginning of the subclavical arteries of rats were occluded for different time by one-stage apertura thoracis superior approach.Neurological deficit scores defined by the modified Garcia scoring system and histopathological method were used to evaluate the effects of this model up to 7 days after reperfusion.Results:The neurological scores in the 15-min and 25-min groups decreased significantly at 24,48 and 72 hours after reperfusion(P＜0.05),and the histopathologic study showed that there were stable,symmetrical changes of lesions in bilateral hippocampus in all the ischemia samples from two ischemia groups compared with sham operated group(P＜0.05).Conclusion:This modified model is safe,easy,reliable,stable,mini-invasive as well as time-saving in making bilateral hemispheric ischemia,which can effectively decrease collateral circulations and meanwhile lead to stable lesions in hippocampus and cortex。

Abstract：Objective:To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury(TBI)mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews(CDSR).Methods:An exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted.We retrieved such databases as CDSR and Cochrane Injury Group,excluded the duplications,and eventually obtained 20 results,which stand for critical appraisal for as many as 20 different measures for TBI patients.The important data of each systematic review,including total population,intervention,outcome,etc,were collected and presented in a designed table.Besides,we also tried to find out the possible weakness of these clinical trials included in each review.Results:Analysis of these reviews yielded meanfuling observations:(1)The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful,and tranexamic acid,nimodipine and progesterone show a promising effect in bleeding trauma,traumatic subarachnoid hemorrhage,TBI or severe TBI.(2)A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients,largely due to the uncertainty of the effectiveness.(3)The quality of most trials reported in the systematic reviews is more or less questionable.(4)In addition,lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews.Conclusions:For clinical physicians,to translate these conclusions into practice with caution is essential.Basic medication and nursing care deserve additional attention as well and can be beneficial.For researchers,high quality trials with perfect design and comprehensive consideration of various factors are urgently required。

Abstract：Objective:To study the epidemiologic characteristics of traffic injuries among people over 60 years old in the Nan' an district(urban)and Jiangjin district(rural)of Chongqing,and to discuss the corresponding strategies for its prevention and cure.Methods:Records of traffic injuries in people over 60 years old registered by the traffic police between 2000 and 2006 in Nan'an district and Jiangjin district were collected in the Database of Road Traffic Accidents and Traffic Injuries.Epidemiologic characteristics of traffic injuries among the aged people were analyzed and compared.Results:Between the year 2000 and 2006,the average annual incidence of traffic injuries and mortality rate in the aged people in Nan' an district were 124.62/100 000 and 13.85/100 000 respectively,higher than that in Jiangjin district(27.49/100 000,7.13/100 000,P＜0.01).However,the mortality rate for the aged people who were involved in traffic injuries in Jiangjin district was 20.60％,higher than that in Nan'an district(10.00％,P＜0.01).Head injury was the primary cause of death.Totally 76.58％ of casualties were pedestrians.Over 90％ of the traffic accidents occurred in the areas with no traffic signal or traffic control system.Conclusions:The traffic environment is unfavorable to the aged people.It is important to enhance traffic safety consciousness of drivers and the elderly and to strengthen traffic safety system and traffic law,so as to provide a safe road traffic environment for the aged people。

Abstract：Objective:To report the results of repair of skin defects in the extremities with arterialized venous flap harvested from the lateral aspect of the dorsum of the foot.Methods:Six cases of skin and soft tissue defects over the foot and hands were resurfaced by free arterialized venous flaps,including five patients with skin defects of the hands,and one with defects at the dorsum of the foot.The flaps were harvested from the lateral aspect of the dorsum of the foot with the sizes ranging from 2 cm×5.5 cm to 6 cm×11 cm.Two veins at the proximal margin of the flap were retained,one of which was anastomosed to a recipient bed artery to provide arterial inflow and the other was anastomosed to a recipient bed vein for venous outflow.Results:All flaps demonstrated mild edema and survived completely.Blisters appeared on four flaps.Using this technique,we achieved good functional and cosmetic results in this series.Conclusions:Dorsalis pedis arterialized venous flap with rich vascular communications could enhance peripheral perfusion and decrease congestion of venous flaps,thereby improves reliability and utility for extremity reconstruction。

Abstract：Objective:Radiation is an important cause of delayed wound healing,and there still exist many questions regarding the patterns and mechanisms of wound healing.This study investigated the characteristics of wound healing after varying doses of local radiation and explored possible causes of the delay in healing caused by radiation.Methods:A full-thickness dorsal longitudinal skin tissue,2 cm in diameter,was excised after local irradiation on one side of the back of swine,and the other side was wounded as a control.The size of the wound area was recorded every two days after injury.Pathological changes,proliferating cell nuclear antigen(PCNA,immunohistochemistry)and apoptosis levels(TUNEL assay)were measured at different time points after wounding.Results:The course of wound healing can be divided into four phases,namely:the arresting phase,the healing priming phase,the fast healing phase,and the healed phase.Although the total wound healing time was closely correlated to the dose of irradiation(R2=0.9758),it was more dependent on the length of the arresting phase(R2=0.9903)because once the arresting phase ended,the wound healed at a similar speed regardless of radiation doses.Pathological analysis showed that compared with the control side there were more necrotic tissues,slower epithelial crawling,as well as fewer blood vessels and cellular components in the irradiated side at the arresting phase,while other phases revealed no significant difference concerning these measurements.Immunohistochemistry showed that the irradiated wounds had significantly less PCNA-positive and more TUNEL-positive labeling of cells in the arresting phase than in other phases.Moreover,the changes were positively related to the radiation doses,but there was no obvious difference in cell proliferation or apoptosis among the healing priming phase,fast healing phase or healed phase,whether on the control side or on the irradiated side.Conclusions:After local irradiation,the length of the arresting phase determines the wound healing time.Increased apoptosis and decreased cell proliferation might be an important reason for the formation of the arresting phase。

Abstract：Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility.In this case report,we describe the successful outcome of a case of double thoracic impalement by two steed tors,of which one steel tor had impaled two patients simultaneously.The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened under controlled environment at the trauma centre itself,till the definitive management of the impaled thoracic objects.Thoracic impalement injuries are dramatic and appear very challenging.However presence of mind of the managing team,coordinated team effort and availability of adequate facilities can lead to a successful outcome。

Abstract：There is a dearth of case reports describing simultaneous bilateral patellar tendon ruptures in the medical literature.These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use.The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar tendon ruptures without any history of systemic disease or steroidal medication.We repaired and reattached the ruptured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement.One year after operation,the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag.The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event。

Abstract：Bronchobiliary fistula(BBF)is a rare condition in which there is a nonnatural communication between the biliary tract and the bronchial trees.It is usually aroused by the complications of hepatic hydatidosis,hepatic amebic,biliary obstruction,trauma,neoplasm and hepatic abscess formation.In this paper,we described a patient suffering from BBF that is secondary to trauma or surgery.Especially,BBF was detected in the left lung.Finally,we managed this case successfully without an open surgery。

Abstract：Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event.Scapulothoracic dissociation though has been reported,usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury,etc.Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition.Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature.It is a distinct clinical entity and needs to be differentiated from other similar conditions.Here,we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a l0 years old girl.The patient had a recurrence of the dislocation before presenting to us.But she did not have any pre-existing condition for scapular dislocation。

Abstract：Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including neck pain,headache,weakness and parasthesisas.According to previous and recent clinical researches,we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio.The mean sagittal diameter of cervical spinal canal at C1 to C7 ranges from 15.33 mm to 20.46 mm,the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96.With respect to narrow cervical spinal canal,the following charaterstics are found:firstly,extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly,females sustain cervical spinal canal narrowing more easily than males;finally,the consistent narrowest cervical canal level is at C4 for all ethnicity,but there is a slight variation in the sagittal diameter of cervical spinal stenosis(≤ 14 mm in Whites,≤12 mm in Japanese,≤ 13.7 mm in Chinese).Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic,degenerative and inflammatory conditions and is related with extension of cervical spine,gender,as well as ethnicity.It is hoped that this review will be helpful in diagnosing spinal cord and neurological injuries with the geometric parameters of cervical spine in the future。

Abstract：Hip trauma has been a leading cause of death in senile patients for more than a centenary.Although the mortality decreased due to the advanced technique in medication,surgery and nursing,the increasing mortality should not be neglected in elders after orthopedic operation nowadays.Many factors are considered to influence the causes of death after trauma,such as age,gender,personal customs,comorbidities,types of fracture,timing of surgery,procedure,anesthesia,complications,medical treatment,activity of daily living,or even marriage status.This article reviews these causes from the aspects of patient's own factors,iatrogenic factors,medical treatment and other factors and provides some clues for further clinical application according to the recent foreign and domestic researches.According to the present research,it is essential for surgeons to perform a comprehensive estimation for patients suffering from hip trauma。

Since the new century,stem cell research has become a hot field in medicine and life science.Scientists in Harvard Plans Stem Cell Center in 2004 have dreamed that one day they can lead stem cells to grow into tissues and even organs in the lab,which can be used to replace the damaged tissues or organs in severe injuries or applied in diseases at the end stage(incurable diseases)in order to prolong the life time and improve the life quality of patients.But this is a long way full of difficulties! Nevertheless,the stem cell research has helped our mankind to understand how single cells grow and develop into tissues as well as organs,and how healthy cells replace the damaged cells in adult body and so on,which induces us to explore the way of treating diseases on cell levels(repairing or regeneration medicine as we usually say)because gene therapies have many unsolved problems。

Abstract：Objective:To introduce the posterolateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases.Methods:This study consisted of 32 cases,22 males and 10 females with the mean age of 48 years(range,21-63years),suffering from posterior malleolar fracture.All cases were treated with the posterolateral surgical approach to the ankle.The average follow-up period was 28 months (range,24-35 months).The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle (OMA)score and plain radiographs.Results:All cases showed radiological evidence of bony union at follow-up.The average OMA score was 82 points; 21 cases had excellent scores(90-100 points),9 good (61-90 points),and 2 fair(31-60 points).The excellent-togood rate was 93.8％.Although most cases did not show any wound dehiscence or necrosis,one patient had a superficial infection which healed after using antibiotic dressing and one had sural cutaneous nerve injury that underwent spontaneous remission without any treatment after three months.In addition,one presented with mild symptoms of peroneal tendonitis that disappeared after plateremoval.Conclusion:The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments。