2013年 · 第16卷第01期

Abstract：Objective:To investigate the protective effect of mouse astrocyte-conditioned medium (ACM)on hypoxic and mechanically injured neurons by a cell model in vitro,and to explore the possible mechanism.Methods:The model of hypoxic neuronal injury was caused by 3％ O2 in three-gas incubator.Neurons were cultured with ordinary medium or 20％ ACM respectively and randomly divided into hypoxic group (hypoxia for 4,8,24 h and marked as H4R0,H8R0,H24R0) and hypoxia reoxygenation group (H4R24,HSR24,H24R24).Mechanical injury model was developed by scratching neurons cultured in 20％ ACM or ordinary medium to different degrees.Neurons in both medium were divided into normal control group,mild,moderate and severe injury groups.The 20％ ACM was added 24 h before hypoxia/reoxygenation or mechanical injury.The morphology and survival of neurons were observed and counted by trypan blue staining.The concentration of NO,lactic dehydrogenase (LDH) and membrane ATPase activity were detected by corresponding kits.Results:It was showed that 20％ ACM can obviously promote the survival rate of hypoxia/reoxygenated neurons and scratched neurons as well The morphology and number of neurons exposed to hypoxia or scratch injury showed great difference between groups with or without ACM treatment.Compared with control group,the concentration of NO and LDH was much lower in hypoxic/reoxygenated neurons treated with 20％ ACM,and the ATPase activity was higher.For the mechanical injury model,neurons with moderate injury also revealed a lower NO and LDH concentration than the control group.All the differences were statistically significant (P＜0.05).Conclusion:ACM can promote the survival and functional recovery of neurons following hypoxia or scratching to a certain degree.The mechanism may be associated with reducing the synthesis and release of NO and LDH as well as increasing the activity of membrane ATPase。

Abstract：Penetrating cerebral injuries caused by foreign bodies are rare in civilian neurosurgical trauma,although there are various reports of blast or gunshot injuries in warfare due to multiple foreign bodies like pellets and nails.In our case,a 30-year-old man presented to neurosurgery clinic with signs and symptoms of right-sided weakness after suicide bomb attack.The skull X-ray showed a single intracranial nail.Small craniotomy was done and the nail was removed with caution to avoid injury to surrounding normal brain tissue.At 6 months' follow-up his right-sided power improved to against gravity。

Abstract：Objective:To analyze the results of clinical and bacteriological examinations in patients with crash syndrome who suffered infectious complications after an earthquake in Sichuan,China.Methods:A total of 313 bacteriological samples among 147 patients with crush syndrome were collected.Infectious complications,results of microbiological examinations,potential risk factors of infection and mortality were analyzed statistically.Results:In the obtained database,112 out of the 147 (75.7％) patients had infectious complications,in which,wound infection,pulmonary infection,and sepsis were most common.The time under the rubble and the time from injury to treatment were related to the occurrence of wound infection (P=0.013,odds ratio 2.25; P=0.017,odds ratio 2.31).Sepsis and wound infection were more common in patients who underwent fasciotomy or amputation than in those who did not (P=0.001).Conclusion:Quick rescue and injury treatment can decrease the infection risk in crush syndrome patients.It is better to obtain microorganic proofs before applying antibiotics,and bacteriological and drug sensitivity data should be taken into account,especially considering that most of these infections are hospital-acquired and drug resistance.Emphasizing the accuracy and efficiency of wound management in emergency situations,cautiously assessing the indications for fasciotomy to avoid open wounds from unnecessary osteofascial compartment decompression incisions may decrease the incidence of infection and ameliorate the prognosis。

Abstract：Objective:To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue.Methods:We retrospectively investigated 944 patients sustaining limb fractures,including 891 in Wenchuan earthquake and 53 in Yushu earthquake,who were admitted to West China Hospital (WCH) of Sichuan University.Results:In Wenchuan earthquake,WCH met its three peaks of limb fracture patients influx,on post-earthquake day (PED) 2,8 and 14 respectively.Between PED 3-14,585 patients were transferred from WCH to other hospitals outside the Sichuan Province.In Yushu earthquake,the maximum influx of limb fracture patients happened on PED 3,and no one was shifted to other hospitals.Both in Wenchuan and Yushu earthquakes,most limb fractures were caused by blunt strike and crash/burying.In Wenchuan earthquake,there were 396 (396/942,42.0％) open limb fractures,including 28 Gustilo Ⅰ,201 Gustilo Ⅱ and 167 Gustilo Ⅲ injuries.But in Yushu earthquake,the incidence of open limb fracture was much lower (6/61,9.8％).The percent of patients with acute complications in Wenchuan earthquake (167/891,18.7％) was much higher than that in Yushu earthquake (5/53,3.8％).In Wenchuan earthquake rescue,1 018 surgeries were done,composed of debridement in 376,internal fixation in 283,external fixation in 119,and vacuum sealing drainage in 117,etc.While among the 64 surgeries in Yushu earthquake rescue,the internal fixation for limb fracture was mostly adopted.All patients received proper treatment and survived except one who died due to multiple organs failure in Wenchuan earthquake.Conclusion:Provision of suitable and sufficient medical care in a catastrophe can only be achieved by construction of sophisticated national disaster medical system,prediction of the injury types and number of injuries,and confirmation of participating hospitals' exact role.Based on the valuable rescue experiences after Wenchuan earthquake,the rescue was faster,more orderly and effective in Yushu earthquake.Nevertheless,there is still a long way to go in the development of a stronger emergent response to the disasters。

Abstract：Objective:To present our experience in treatment of difficult ununited long bone fractures with locking plate.Methods:Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done.Fixation was done with locking plate for femoral shaft fracture (3 patients),supracondylar fracture of femur (gap nonunion),fracture of clavicle,fracture of both forearm bones (radius and ulna) fracture of ulna,fracture of shaft of humerus,fracture of tibial diaphysis and supracondylar fracture of humerus (one patient each).Five fractures had more than one previous failed internal fixation.One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks.Seven fractures were atrophic,two were oligotrophic,and one was hypertrophic.Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients.Results:Minimum follow-up was 6 months (range,6 months to 2.5 years).Average rime for union was 3.4 months (range 2.5 to 6 months).None of the patients had platerelated complications or postoperative wound infections.Conclusion:Along with achieving stability with locking compression plate,meticulous soft tissue dissection,acceptable reduction,good fixation technique and bone grafting can help achieve union in difficult nonunion cases.Though locking plate does not by itself ensure bony union,we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions。

Abstract：Objective:To observe the therapeutic effect of absorbable screw in medial malleolus fracture and discuss its clinical application in orthopedics.Methods:A total of 129 patients with simple medial malleolus fracture were studied.Among them,64 patients were treated with poly-D,L-lactic acid (PDLLA) absorbable screws,while the others were treated with metal screws.All the patients were followed up for 12-20 months (averaged 18.4 months) and the therapeutic effect was evaluated according to the American Orthopaedic Foot and Ankle Society clinical rating systems.Results:In absorbable screw group,we obtained excellent and good results in 62 cases (96.88％); in steel screw group,61 cases (93.85％) achieved excellent and good results.There was no significant difference between the two groups.Conclusion:In the treatment of malleolus fracture,absorbable screw can achieve the same result compared with metal screw fixation.Absorbable screw is preferred due to its advantages of safety,cleanliness and avoiding the removal procedure associated with metallic implants。

Abstract：Objective:The main treatment method used for thoracolumbar fractures is open reduction and internal fixation.Commonly there are three surgical approaches:anterior,posterior and paraspinal.We attempt to compare the three approaches based on our clinical data analysis.Methods:A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study.These patients were treated by anterior-,posterior-or paraspinal-approach reduction with or without decompression.The fracture was fixed with titanium mesh and Z-plate via anterior approach (24 patients),screw and rod system via posterior approach (38 patients) or paraspinal approach (32 patients).Clinical evaluations included operation duration,blood loss,incision length,preoperative and postoperative Oswestry disability index (ODI).Results:The average operation duration (94.1 min±13.7min),blood loss (86.7 ml±20.0 ml),length of incision (9.3mm± 0.7 mm) and postoperative ODI (6±0.5) were significandy lower (P＜0.05) in paraspinal approach group than in traditional posterior approach group (operation duration 94.1 min±13.7 min,blood loss 143.3 ml±28.3 ml,length of incision 15.4 cm±2.1 cm and ODI 12±0.7) and anterior approach group (operation duration 176.3 min±20.7 min,blood loss 255.1 m1±38.4 ml,length of incision 18.6 cm±2.4 cm and OD113±2.4).There was not statistical difference in terms of Cobb angle on radiographs among the three approaches.Conclusion:The anterior approach surgery is convenient for resection of the vertebrae and reconstruction of vertebral height,but it is more complicated and traumatic.Hence it is mostly used for severe Denis type B fracture.The posterior approach is commonly applied to most thoracolumbar fractures and has fewer complications compared with the anterior approach,but it has some shortcomings as well.The paraspinal approach has great advantages compared with the other two approaches.It is in accordance with the concept of minimally invasive surgery and can replace most posterior approach operations。

Abstract：Objective:Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital.Treatment of these patients is still a major problem in health care system.The aim of current study was to assess the epidemiology of livestock-related injuries in a major trauma center in Iran from 2006 to 2011.Methods:In a prospective study,patients with livestock-related injuries who were consecutively admitted to the trauma center in Kashan,Iran between 2006 and 2011 were evaluated.The data collected included patient's demographics,place and nature of accident,damaged organ,educational level,transport and outcome.Data were expressed as mean±standard deviation.Results:A total of 129 patients were included in this study,accounting for 0.3％ of all trauma admission (40 273cases).The mean age was (55.27±14.45) years.Men were affected four times more than women.Falling down from livestock is the main mechanism of trauma in all groups.Upper and lower extremities were most frequently injured (n=72),followed by the head,neck and spine (n=33 for each).There was one death resulting from livestock-related injury in this study.Conclusion:Despite the low incidence,livestock-related injuries can damage major organs of human body and therefore appropriate training program to increase the safety awareness in home and outdoor is very important。

Abstract：Objective:Surgical management options for femoral shaft fracture and ipsilateral proximal femur fracture vary from single-implant to double-implant fixation.Cephalomedullary fixation in such fractures has relative advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation.However,the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation.The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture.Methods:Sixteen cases (10 males and 6 females with a mean age of 41.8 years) ofipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India.The fractures were classified according to AO classification.An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients.ResuRs:The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients.The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients.Four of the AO B2.1 and 2 of the AO B2.3 fractures required open reduction with Watson-Jones approach.The mean operative time was around 78 minutes,which tended to decrease as the surgical experience increased.There was only one case of malreduction,which required revision surgery.Conclusion:Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult fracture pattern for trauma surgeons.Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications.Surgery is technically demanding with a definite learning curve.Nevertheless,a majority of these fractures can be surgically managed by singleimplant cephaiomedullary fixation by following basic surgical principles that have been summarized in this article。

Abstract：Objective:Falls are one of the life events leading to injury and in serious cases cause high morbidity and mortality.This research was conducted to determine the fall incidence among female population of Kashan city from the years 2005 to 2008.Methods:This was a retrospective research using existing data from the data bank of trauma center of Kashan University of Medical Sciences.Records of all the female patients treated at local hospitals with complete hospitalisation kept at the center were examined for 4 consecutive years from 2005 to 2008.Results:A total of 2 094 female patients' records were examined.A significantly higher incidence of injuy occurred in 2008 compared to 2005 (P＜0.0001).In addition,the highest frequency of injury occurred in age group above 65 years (31.9％)and in group with elementary education level (42.8％).Conclusion:The results showed that fall incidences occurred in the old age group above 65 years.Fall injuries at this age may cause disability.Therefore,preventive measures should be taken,such as increasing the awareness of the aging population about the seriousness of fall incidence and encouraging the aged individuals to get involved in fitness program to remain physical fit and healthy。

Abstract：Penile amputation and successful replantation is very uncommon,and there is no routine standardized procedures for dealing with this medical condition.Here we report two cases of penile amputation and replantation involving different degrees of vascular insult leading to different pathogenesis,clinical presentation,surgical approach and prognosis.This report described the microsurgical procedure and postoperative care using bipedicled scrotal flap to achieve successful engraftment and function.A review of the published data and future methods to increase success of such surgical procedures is provided。

Abstract：T-condylar fracture is rare in paediatric age group,especially in skeletally immature children less than 9 years old,with very few cases reported in available literature.We present such a case in a 5 year old child that was initially managed as a supracondylar fracture at another centre before referral to us,10 days after the injury.The child was diagnosed as having a displaced T-condylar fracture on plain radiograph.Open reduction and internal fixation with K-wires was performed.At 2 years follow-up,the child had good range of motion at elbow with 5°of cubitus varus.With this background we discuss the pertinent principles of management of T-condylar fractures in skeletally immature children。