2012年 · 第15卷第05期

Abstract：Objective: To evaluate the effect of autograft bone,allograft bone,calcium sulfate bone cement,and calcium phosphate bone cement on the repair of tibial plateau defect in rabbits.Methods: We used autograft bone,allograft bone,calcium sulfate bone cement,and calcium phosphate bone cement to repair tibial plateau defect in rabbits.Gross and histologic observations,X-ray examination,and biomechanical test were conducted at 1,2,4,8 weeks after operation.Results: X-ray examination found that the bone density was evidently reduced in calcium sulfate group at 8 weeks after operation; there were no marked changes in other groups.The maximal load measurements showed that autograft and allograft groups were greater than calcium sulfate and calcium phosphate groups at 1 and 2 weeks after operation.However at 4 and 8 weeks after operation,no significant difference was found among the four groups.In autograft and allograft groups,there was no significant difference in biomechanical intensity at 2,4,and 8 weeks,but it was significantly higher than that at 1 week.In calcium sulfate and calcium phosphate groups,the outcome was ranked in descending order as 1 week＜ 2 week＜ 4 week =8week.Histologic examination found a great amount of new bones at 8 week in both autograft and allograft groups.In calcium sulfate group,calcium sulfate was almost absorbed and there were numerous bone trabeculations.There was a large amount of unabsorbed calcium phosphate in calcium phosphate group.Conclusion: At 1-2 weeks postoperatively,the biomechanical intensity is higher in autograft and allograft groups than calcium sulfate and calcium phosphate groups,but after 4-8 weeks,there is no significant difference among groups.At 1-2 weeks,the biomechanical intensity in all groups is increased,but at 4-8 weeks,there is no significant increase.The rates of absorption and bone formation are quicker in calcium sulfate group than calcium phosphate group。

Abstract：Objective: Focused Abdominal Sonography for Trauma (FAST) is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma (BAT).This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre.Methods: This was a retrospective study of BAT patients over a 6 year period seen in a trauma centre in Hong Kong.FAST findings were compared with laparotomy,abdominal computed tomography or autopsy findings,which served as the gold standard for presence of intrapcritoneal free fluids.The patients who did not have FAST or gold standard confirmatory test performed,had preexisting peritoneal fluid,died at resuscitation or had imcomplete documentation of FAST findings were excluded.The performance of FAST was expressed as sensitivity,specificity,predictive values (PV),likelihood ratios (LR) and accuracy.Results: FAST was performed in 302 patients and 153 of them were included in this analysis.The sensitivity,specificity,positive PV,negative PV,positive LR,negative LR and accuracy for FAST were respectively 50.0 ％,97,3％,87.0％,84.6％,18.8,0.5 and 85.0％.FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients.Conclusion: FAST is a reliable investigation iu the initial assessment of BAT patients.The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use。

Abstract：Objective: To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran.Methods: This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011.The data were from the Fars Forensic Medicine Registry.In 4 923 recorded road traffic accident fatalities,971 deaths were due to pedestrian accidents.The demographic and accident-related information were analyzed by SPSS version 11.5.P value less than 0.05 was considered significant.Results: The mean age of decedents was (47.2±26.2)years,ranging from 6 months to 103 years old.Males accounted for 69.8％ of all deaths.Fatal accidents were most common in September; 56.1％ of the fatal injuries occurred on intracity roads and 33.1％ on extracity roads.Fatal head injuries were present in 60.54％ of cases.Evaluation of the injury site and the cause of death found that they were significantly associated with age,interval between injury and death.Besides,the type of roads played an important role in mortality.Conclusion: Although the clinical management of trauma patients has been improved in our country in the recent decade,decreasing the burden of injuries needs coordination among trauma system organizations。

Abstract：Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.Methods: In this prospective interventional study,patients presenting with PEA cardiac arrest were randomized into two groups.In Group A,ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity,right ventricle dilation,left ventricle function,pericardial effusion/tamponade and ⅣC size along with the advanced cardiac life support (ACLS) protocol.Patients in Group B solely underwent ACLS protocol without applying echocardiography.The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded.The return of spontaneous circulation (ROSC) and death were evaluated in both groups.Results: One hundred patients with the mean age of (58±6.1) years were enrolled in this study.Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR).Among them,7 patients (14％) had pericardial effusion,11 (22％) had hypovolemia,and 39 (78％) were revealed the presence of MVA.In the pseudo PEA subgroup (presence of MVA),43％ had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA),there was no recorded ROSC (negative predictive value).Among patients in Group B,no reversible etiology was detected.There was no significant difference in resuscitation results between Groups A and B observed (P=0.52).Conclusion: Bedside echocardiography can identify some reversible causes of PEA.However,there are no significant changes in survival outcome between the echo group and those with traditional CPR。

Abstract：Objective: To evaluate the effectiveness of the rigid internal fixation for comminuted and redisplaced zygomatic arch fractures by modified preauricular-temporal approach with the resorbable bone fixation.Methods: Totally twenty patients aged from 14 to 68 years and admitted to our hospital between September 2006 and June 2011 were reviewed,of whom seventeen had a unilateral comminuted zygomatic arch fracture and three redisplaced arch fracture after failed closed reduction.The fracture segments were aligned to restore the preinjury form of the arch by rigid fixation with resorbable plates and screws through a modified preauricular-temporal incision.Results: The fractures were well reduced,preauricular-temporal scar and lateral facial contour were aesthetically satisfying,and no case had limited mouth opening as well as facial palsy.The resorbable plates were not palpated one year after the operation.Conclusion: The rigid internal fixation through the preauricular-temporal approach with the resorbable bone is an effective method for the comminuted and redisplaced zygomatic arch fractures。

Abstract：Objective: To investigate the effect of a new biomaterial combining calcium citrate and recombinant human bone morphogenetic protein-2 (rhBMP-2) on bone regeneration in a bone defect rabbit model.Methods: Totally 30 male New Zealand white rabbits were randomly and equally divided into calcium citraterhBMP-2 (CC-rhBMP-2) group and rhBMP-2 only group.Two 10 mm-long and 5 mm-deep bone defects were respectively created in the left and right femoral condyles of the rabbits.Subsequently 5 pellets of calcium citrate (10 mg)combined with rhBMP-2 (2 mg) or rhBMP-2 alone were implanted into the bone defects and compressed with cotton swab.Bone granules were obtained at 2,4 and 6 weeks after procedure and received histological analysis.LSD t-test and a subsequent t-test were adopted for statistical analysis.Results: Histomorphometric analysis revealed newly formed bones,and calcium citrate has been absorbed in the treatment group.The percent of newly formed bone area in femoral condyle in control group and CC-rhBMP-2 group was respectively 31.73％±1.26％ vs 48.21％±2.37％ at 2 weeks; 43.40％±1.65％ vs 57.32％±1.47％ at 4 weeks,and 51.32％±7.80％ vs 66.74％±4.05％ at 6 weeks (P＜0.05 for all).At 2 weeks,mature cancellous bone was observed to be already formed in the treatment group.Conclusion: From this study,it can be concluded that calcium citrate combined with rhBMP-2 signifcantly enhances bone regeneration in bone defects.This synthetic gelatin matrix stimulates formation of new bone and bone marrow in the defect areas by releasing calcium ions。

Abstract：Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized.Few studies have investigated this presumed association.In this study,wc investigated the incidence of significant associated injuries with scapular fracture and their outcomes.Methods: A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand.All blunt trauma patients were identified.Patients' demographics,injury mechanism,associated injuries,Injury Severity Score (ISS),and survival outcomes were recorded.The management of associated injuries with scapular fracture was reviewed,and the risk factors for mortality were identified.Results: Among the 7 345 trauma patients admitted,scapular fractures occurred in 84 cases (1.1％).The mean age was (37.98±15.21) years.Motorcycle crash was the most frequent mechanism of injury,occurring in 51 cases (60.7％).Seventy-four patients (88.1％) suffering from scapular fractures had associated injuries:5 (6.0％) had significant chest injuries,but none of them had blunt thoracic aortic injury.Two patients (2.4％) with scapular fractures died.Factors determining the likelihood of mortality were:(1) ISS＞25(LR=8.5,P＜0.05); (2) significant associated chest injury (AIS＞3,LR=5.3,P＜0.05) and (3) significant associated abdominal injury (AIS＞3,LR=5.3,P＜0.05).Conclusion: A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury,extremity injury,head injury,etc.If a scapular fracture is found with a high ISS score,high chest or abdomen AIS score,the patient would have a high risk of mortality。

Abstract：Myositis ossificans is defined as formation of bone at the site of injured muscle.It is one of the rare complications of supracondylar fracture of humerus in children.Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion,but complete ankylosis is rare.To the best of our knowledge,this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica.In this case,a six-year-old child presented to the casualty department with pain in the right elbow after a fall on outstretched hand during play,After surgical excision through the anterior approach,the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last followup of one year after surgery。

Abstract：Elbow dislocation with concomitant diaphyseal fractures of radius and ulna has been reported rarely.This injury could be included in Monteggia equivalent lesions based on the mechanism of injury,radiographic pattern and method of treatment as described by Bado.We report a rare case of Monteggia equivalent lesion in an adult with unclear mechanism of injury.The possible mechanism of injury,its management and the follow-up results were described.An attempt to solve the controversy regarding whether labeling it as type 1 or type 2 was made。

Abstract：A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg.It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm×4 cm.Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis.The anterior tibial artery was patent.Three weeks after injury,the left anterolateral thigh muscle flap was harvested and transplanted to the right medial malleolus defect area for repair of the soft tissue defect,and an end-to-side anastomosis was performed between the posterior tibial vessel of the contralateral leg and the muscle flap's vascular pedicle.A split thickness free skin graft was used to cover the muscle flap and around the flap's vascular pedicle.The vascular pedicle was cut off after 28 days and the muscle flap survived completely.After 3-year follow-up postoperatively,the right tibia and fibula fractures were confirmed healing radiologically.The posterior tibial artery of contralateral leg was patent by clinical and Doppler examinations.This technique can be used to preserve the flow and patency of recipient arteries。

Abstract：Since 1980s,the rapid development of tissue engineering and stem cell research has pushed regenerative medicine to a new fastigium,and regenerative medicine has become a noticeable research field in the international biology and medicine.In China,about 100 million patients need repair and regeneration treatment every year,while the number is much larger in the world.Regenerative medicine could provide effective salvation for these patients.Both Chinese Academy of Sciences and Chinese Academy of Engineering have made roadmaps of 2010-2050 and 2011-2030 for regenerative medicine.The final goal of the two roadmaps is to make China go up to leading position in most research aspects of regenerative medicine.In accord with this strategy,the government and some enterprises have invested 3-5 billion RMB (0.5-0.8 billion USD)for the research on regenerative medicine.In order to push the translation of regenerative medicine forward - from bench to bedside,a strategic alliance has been established.and it includes 27 top-level research institutes,medical institutes,colleges,universities and enterprises in the field of stem cell and regeneration medicine.Recently the journal,Science,has published a special issue-Regenerative Medicine in China,consisting of 35 papers dealing with stem cell and regeneration,tissue engineering and regeneration,trauma and regeneration and bases for tissue repair and regenerative medicine.It is predicated that a greater breakthrough in theory and practice of regenerative medicine will be achieved in the near future (20 to 30 years)。

Abstract：Avascular necrosis of the femoral head is a known complication of femoral neck fracture but on the contrary,femoral neck fracture in a case of preexisting avascular necrosis is a very rare phenomenon.We present a case study of a 47 year old Iraqi male who developed spontaneous ipsilateral subcapital femoral neck fracture under the condition of preexisting sickle cell disease and avascular necrosis of the femoral head.The fracture was unnoticed for a few months.The patient was managed successfully by uncemented total hip arthroplasty.Postoperative recovery was uneventful and he was discharged 4 days after surgery.At 1 year's follow-up,the patient had normal gait and hip function,with no sign of loosening or any other complications on radiograph。