2013年 · 第16卷第04期

Abstract：Objective:To investigate the diagnostic and therapeutic effect ofbronchofiberscopy in the management of severe thoracic trauma.Methods:Aretrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012.During the period,488 bronchofiberscopies and lavages were done.The bronchofiberscope was inserted through tracheal incision (282),nasal cavity (149) and oral cavity (57).Intensive SaO2 monitoring as well as blood gas analysis were performed pre-,intra-and postoperatively.Simultaneously oxygen therapy or ventilatory support was given.Sputum culture was done intraoperatively.Results:Diagnosis in 207 cases was confirmed by bronchofiberscopy.The result of sputum culture was positive in 78 cases.Lavage was performed on 156 cases.SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery (both P＜0.05).Heart rate and respiratory rate decreased.There was no bronchofiberscopy-related death.Conclusion:Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma,which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body,secretion,blood and sputum crust in the airway,manage obstructive atelectasis and pneumonia,and significantly improve respiratory function and treatment outcome。

To the editor:We appreciate Raju Vaishya's proposal.Actually,we made an inapposite expression in conclusion of the abstract.There were no evidences to prove that tranexamic acid (TA) could reduce deep vein thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA).In the text,we also mentioned that concerning the occasional thromboembolic events,most of doctors are reluctant to use TA in TKA.1

Abstract：With rapid advancement in surgical techniques and improvement in implant materials,rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased.Among various modes of implant failure,screw/plate breakage and loosening are common complications following unstable fixation.Migration of loose screws into the urinary bladder has been reported as an extremely uncommon complication of pubic symphyseal plating.Here we present a case report of a 52-year-old female who presented with asymptomatic passage of screws in her urine following migration into the bladder,2 years after symphyseal plating for pubic diastasis in an anteroposterior compression pelvic ring injury。

To the editor:I congratulate the authors for conducting a meta-analysis of randomized controlled trials to investigate the efficacy and safety of the intravenous use of tranexamic acid (TA)in total knee arthroplasty (TKA).1 We do agree with them that TA effectively reduces blood loss and transfusion rate as well as transfusion volume after TKA and does not apparently increase the risk of deep vein thrombosis (DVT) or pulmonary embolism (PE).2

Abstract：Objective:The treatment offrontobasilar fractures is a demanding aspect of craniofacial fracture management.A sequel of inadequate or improper fracture management presents cosmetic and functional problems which are very difficult to correct.The aim of this manuscript was to examine a group of growing patients treated for frontobasilar fractures and provide clinicians a possible therapeutic option for the treatment of these challenging fractures.Methods:In this investigation,12 patients under the age of 16 years treated for severe injuries to the frontobasilar region were included.Their records were reviewed to evaluate the clinical diagnosis,preoperative findings,hospital course,postoperative results,and long-term follow-up.Preoperative and postoperative CT scans were performed in all children treated.Postoperative complications were reviewed in detail.Surgical procedures were evaluated for type and location of fixation.All complications and treatments were recorded.Results:Three of the patients presented with a cerebrospinal fluid (CSF) leak and required pericranial flaps.Only 3 patients underwent removal of plates and screws due to palpability in 1 patient,loose hardware in 1 patient,and limited disturbance on growth in the rest patient.Seven patients underwent open reduction and internal fixation with resorbable plates,4 patients with titanium plates,and 1 parent with a combination.Follow-up ranged from 6 months to 5 years.No patients with a preoperative CSF leak developed any recurrence of the leak.Conclusion:According to basic craniofacial principles,reducing and stabilizing the fractures should reconstruct the anterior cranial base.However,the treatment of paediatric maxillofacial trauma requires the evaluation of several factors.The facial skeleton of a child is constantly evolving and its growth depends on the balance of basal bone and soft tissues。

Abstract：Objective:To analyze the management of high-voltage electrical burn injury of the scalp in our hospital.Methods:This study involved 10 patients who suffered from high-voltage electrical burn injury of the scalp.Scalp reconstruction was done by different modalities according to the size and location of the defect.Results:Complete flap viability was achieved in all the cases.We had one case of gapped wound which was managed only by dressing.Widening of the scar was found in 2 cases.Conclusion:Rotation,advancement and transposition scalp flaps are used for reconstructing scalp defects caused by electrical burn.The choice of ideal flaps for reconstruction depends upon the size and site of scalp defect。

Abstract：Objective:The treatment of multifragmentary,intraarticular fractures of the distal humerus is difficult,even in young patients with bone of good quality.Small distal fragment,diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic.The anatomically preshaped locking plates allow angular stable fixation for these complex fractures.We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal humerns fractures.Methods:Forty-three consecutive patients with articular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates.Forty patients were available for the final outcome analysis.According to AO/ASIF classification,there were 2 cases of type A2,4 cases of type A3,1 case of type B1,1 case of type B2,14 cases of type C1,7 cases of type C2 and 11 cases of type C3.Open reduction with triceps splitting technique was used in all patients.The clinical and radiographic follow-up was performed and outcome measures included pain assessment,range of motion,and Mayo elbow performance score.Results:Forty patients were available for the final outcome analysis.There were 29 males and 11 females with an average age of 38.4 years (18-73 years).Clinical and radiological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks).The average follow-up was 12 months (10-18 months).Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5％).One patient had superficial infection,and 4 had myositis ossificans.There were no cases of primary malposition or secondary displacement,implant failure or ulnar neuropathy.Conclusion:Anatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early postoperative rehabilitation.The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation。

Abstract：Objective:To report a case series of six neglected cervical spine dislocations without neurological deficit,which were managed operatively.Methods:The study was conducted fromAugust 2010 to December 2011 and cases were selected from the out-patient department of Postgraduate Institute of Medical Education and Research,India.The patients were in the age group of 30 to 50 years.All patients were operated via both anterior and posterior approaches.Results:During the immediate postoperative period,five (83.33％) patients had normal neurological status.One (16.67％) patient who had C5-C6 subluxation developed neurological deficit with sensory loss below C6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C6 level.Conclusion:There is no role of skull traction in neglected distractive flexion injuries to cervical spine delayed for more than 3 weeks.Posterior followed by anterior approach saves much time.If both approaches are to be done in the same sitting,there is no need for instrumentation posteriorly.But if staged procedure is planed,posterior stabilization is recommended,as there is a risk of deterioration in neurological status。

Abstract：Objective:Management of Rockwood type 3 acromioclavicular disruptions is a matter of debate.Should we adopt conservative or operative measures at first presentation? It is not clear but most of the evidences are in favour of conservative management.We present our experience in managing these patients surgically.Methods:We present a prospective series of eight cases of chronic Rockwood type 3 acromioclavicular joint disruptions treated surgically.Anatomical reconstruction of the coracoclavicular ligament was done by artificial braided polyester ligament prosthesis.Results:All the patients were able to perform daily activities from an average of the 14th postoperative day.All patients felt an improvement in pain,with decrease in average visual analogue scale from preoperative 6.5 points (range 3-9 points) to 2.0 points (range 0-5 points),Constant score from 59％ to 91％ and American Shoulder and Elbow Surgeons shoulder score from 65 to 93 points postoperatively.These results improved or at least remained stationary on midterm follow-up,and no deterioration was recorded at an average follow-up of 46 months.Conclusion:This midterm outcome analysis of the artificial ligament prosthesis is the first such follow-up study with prosthesis.Our results are encouraging and justify the further use and evaluation of this relatively new and easily reproducible technique。

Abstract：Objective:The management of secondary normal pressure hydrocephalus (sNPH) is controversial.Many factors may affect the surgery effect.The purpose of this study was to identify the possible factors influencing prognosis and provide theoretical basis for clinical treatment of sNPH.Methods:A retrospective study was carried out to investigate the results of 31 patients with sNPH who underwent ventriculoperitoneal shunt surgery from January 2007 to December 2011.We processed the potential influencing factors by univariate analysis and the result further by multivariate logistic regression analysis.Results:Factors including age,disease duration and Glasgow coma scale (GCS) score before surgery significantly influenced the prognosis of sNPH (P＜0.05).Further logistic regression analysis showed that all the three factors are independent influencing factors.Conclusion:Age,disease duration and GCS score before surgery have positive predictive value in estimating favorable response to surgical treatment for sNPH。

Abstract：Objective:To study the role and effect of Schwann cells (SCs) remyelination in contused spinal cord.Methods:Green fluorescence protein expressing-SCs were transplanted into the epicenter,rostral and caudal tissues of the injury site at 1 week after the spinal cords were contused.At 6 weeks,the spinal cords were removed for cryosections,semithin sections and ultrathin sections,and then immunocytochemical staining of myelin basic protein (MBP),P0 protein (P0) and S 100 protein (S100) was carried out on the cryosections.Qualitative and semiquantitative analyses were performed on the cryosections and semithin sections.Ultrastructure ofmyelinated fibers was observed on the ultrathin sections under electron microscope.Results:Transplanted SCs and myelinated fibers immunocytochemically labeled by MBP,P0 as well as S100 distributed in whole injured area.The quantity of myelinated fibers labeled by the three myelin proteins showed no statistical difference,however,which was significantly larger than that of controls.On the semithin sections,the experimental group demonstrated more myelinated fibers in the injured area than the controls,but the fibers had smaller diameter and thinner myelin sheath under electron microscope.Conclusion:SCs can promote regeneration of injured nerve fibers and enhance remyelination,which may be histological basis of SCs-mediated functional repair of injured spinal cords。

Abstract：Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures.Arterial injury following the operative fixation is a rare but serious event.We present a patient who developed pseudoaneurysm of profunda femoris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw.The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization。

Abstract：Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS).Breakage of a guide wire during operation is a very rare condition.We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type Ⅳ fracture of the right femoral neck.The distal end of the guide wire broke and was entrapped in the fractured femoral neck.We tried to get the broken part out by a cannulated drill.Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope.A bone curette was used to get the broken wire out but failed,so we had to use the cannuated drill to dredge this bone tunnel.Finally the broken wire end was taken out,mixed with blood and bone fragments.Through the existing drilling channel,DHS fixation was easily finished.The patient had an uneventful recovery without avascular necrosis of femoral head or nonunion of the fracture at one year's follow-up.A few methods can be adopted to deal with the broken guide wire.The way used in our case is less invasive but technically challenging.When the guide wire is properly positioned,this method is very practical and useful。

Abstract：Simultaneous fracture/dislocation of the thumb carpometacarpal (CMC)joint and dislocation of the metacarpophalangeal (MCP)joint is considered as a rare injury pattern.We report an unusual case of dorsal dislocation of MCP joint of the thumb associated with extraarticular fracture of the base of the first metacarpal in a 28-year-old man.The dislocation of MCP joint had been missed during initial presentation at a peripheral centre.The patient made an uneventful recovery following open reduction and fixation with 1.25 mm Kirschner wire of the MCP joint along with repair of the ulnar collateral ligament.This injury pattern has not been previously reported to the best of our knowledge in the English-language based medical literature。