2014年 · 第17卷第03期

Abstract：Objective:To investigate the expression pattern of resistin (RSTN) in skeletal muscle tissue and its influence on glycometabolism in rats with traumatic brain injury (TBI).Methods:Seventy-eight SD rats were randomly divided into traumatic group (n=36),RSTN group (n=36) and sham operation group (n=6).Fluid percussion TBI model was developed in traumatic and RSTN groups and the latter received additional 1 mg RSTN antibody treatment for each rat.At respectively 12 h,24 h,72 h,1 w,2 w,and 4 w after operation,venous blood was collected and the right hind leg skeletal muscle tissue was sampled.We used real-time PCR to determine mRNA expression of RSTN in skeletal muscles,western blot to determine RSTN protein expression and ELISA to assess serum insulin as well as fasting blood glucose (FBG) levels.Calculation of the quantitative insulin sensitivity check index (Q value) was also conducted.The above mentioned indicators and their correction were statistically analyzed.Results:Compared with sham operation group,the RSTN expression in the skeletal muscle as well as serum insulin and FBG levels revealed significant elevation (P＜0.05),and reduced Q value (P＜0.05) in traumatic group.Single factor linear correlation analysis showed a significant negative correlation between RSTN expression and Q values (P＜0.001) in traumatic group.Conclusion:The expression of RSTN has been greatly increased in the muscular tissue of TBI rats and it was closely related to the index of glycometabolism.RSTN may play an important role in the process of insulin resistance after TBI。

Abstract：Objective:To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children.Methods:We prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years.The most common mechanism of trauma was fall while playing (n=23),followed by fall from height (n=20),road traffic accidents (n=5) and fall from standing height (n=2).In 2 cases,mode of injury was not available.The mean follow-up was 12 months and patients were assessed according to Flynn's criteria.Results:Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases.Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation.Majority of patients regained full range of motion within 6 weeks of pin removal.Two patients had postoperative ulnar nerve injuries that resolved after pin removal.The common late complication of cubitus varus was not seen in any patient.Delayed presentation to the emergency department,repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients.Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics.No deep infection occurred.A detailed clinical examination and radiographic analysis was done at final follow-up.They included measurement of carrying angle and range of movements of both operated and normal sides,and radiographs of both upper limbs for comparison.According to Flynn's criteria,90.4％ patients showed satisfactory results.Conclusion:Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward,ensuring anatomical reduction and excellent function.The approach is easy and familiar to most orthopedic surgeons in our setup。

Abstract：Objective:To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis.Methods:Between November 2009 and June 2012,28 patients with ankle arthritis were treated,among whom 11 had obvious foot varus deformity,and 17 were almost normal in appearance.There were 13 males and 15 females with an average age of 49.4 years (range,23-67 years).The main symptoms included swelling,pain,and a limited range of motion of the ankles.The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) preoperatively and at 1 year follow-up.Results:Twenty-eight patients were followed up for 19.8 months on average (range,1-2 years).Superficial wound infection occurred in 3 cases,and was cured after debridement; the other incisions healed by first intention without complications.All ankles were fused at 1 year follow-up after operation.The symptom was relieved completely in all patients at last follow-up without complication of implant failure,or nonunion.The postoperative AOFAS ankle and hindfoot score was 83.13±3.76,showing significant difference when compared with the preoperative score (45.38±3.21,P＜0.01).VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up (P＜0.05).Conclusion:Modified Blair ankle fusion has the advantages of high feasiblity,less cost and rigid fixation.It shows high reliability in pain relief and may obtain a good clinical effectiveness。

Abstract：Objective:The treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving.This study attempts to revisit and compare extramedullary vs.intramedullary devices in relatively young population.Methods:Thirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment.Results:The mean age of patients was 37.53 years.Most were males between 21-40 years.The dominant mode of injury was traffic accidents (66％).Fractures were classified according to Russell-Taylor classification.Forty percent were Russell-Taylor type ⅠA,37％ type ⅠB and 23％ type ⅡA.Average time to surgery was 3.6 days from the time of admission to hospital.Mean duration of surgery was 45 minutes for intramedullary device (group A) and 105 minutes for extramedullary device (group B).Average blood loss was 100 ml in group A and 200ml in group B.Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B,while average duration of hospital stay was 12 days and 16 days respectively.Excellent results were seen in 47％ of cases in group A and 33％ of cases in group B.Conclusion:Intramedullary device is a reliable implant for subtrochanteric fractures.It has high rates of union with minimal soft-tissue damage.Intramedullary fixation has biological and biomechanical advantages,but surgery is technically demanding.Gradual leaming and patience is needed to make this method truly rewarding。

Abstract：Objective:The use of fibrin adhesives has a broad background in nerve repair.Currently the suboptimal physical properties of singledonor fibrin adhesives have restricted their usage.The present experiment studies the performance and physical characteristics of a modified fibrin glue prepared from single-donor human plasma in the repair of posterior tibial nerve of rat.Methods:Forty Wistar rats were divided into 5 groups; in the control group,tibial nerve was completely transected and no treatment was done,while in the four experimental groups the nerve stumps were reconnected by one suture,three sutures,one suture with fibrin glue and fibrin glue alone respectively.During 8 weeks of follow-up,Tibial Function Index was measured weekly and adhesive strength,inflammation and scar formation were assessed at the end of the study.Results:Nerve stumps dehiscence rate and adhesive strength were similar in all experimental groups and significantly differed from control group (P＜0.05).By the end of the eighth follow-up week,functional recovery of one and three sutures groups were significantly higher than groups in which fibrin glue was used for repair (P＜0.05).The amount of inflammation and scar tissue formation was similar among all groups.Conclusion:The study results show that the prepared single-donor fibrin adhesive has acceptable mechanical properties which could provide required adhesiveness and hold nerve stumps in the long term; yet,we acknowledge that more studies are needed to improve functional outcome of single donor fibrin adhesive repair。

Abstract：Objective:Head injury (HI) is the leading cause of mortality and life-long disability in infants.Infants have different anatomical and pathophysiological brain structures from other age groups.The aim of this study was to survey infant HI patients admitted to Shahid Behest Hospital in Kashan,Iran from 2004 to 2010,and to identify the causes of His in this age group.Methods:In this retrospective study,all HI patients under the age of two who were hospitalized for more than 24 hours between January 2004 and January 2010 were enrolled in the study.Demographic,etiologic,and injury data were collected and a descriptive analysis was performed.Results:Infants comprised 20.8％ of all children (under 15 years old) with His and 65.1％ of the injuries occurred in the home.Falls were the most common cause of injury (63.4％).In hospital mortality was 6.6 per 100 000 infants.A decreasing trend was seen in home events,but His caused by traffic accidents were increasing during the study period.The amount of HI infants resulting from car accidents has tripled from the years 2004 to 2010.Conclusion:Although home events and falling are the main causes of infant HIs and need attention,our study showed an increase of HIs caused by road traffic accidents,especially by car accidents,thus legislation for the implementation of protective equipment such as child safety seats and programs is urgently needed。

Abstract：Objective:Paraplegia due to traumatic spinal cord injuries is one of the devastating effects of dorsolumbar vertebral fractures.Treatment modalities for such fractures,such as stabilization,have no effect on the neurological recovery.Thus,various pharmacological and biological treatment modalities have been used.The more recent trend of using autologous stem cells from the iliac crest has been used in some clinical trials with varying success.Thus,more clinical studies are required to study the effect of this novel approach Methods:This is a prospective hospital-based cohort study (level IV).The study was conducted in the Dept.of Orthopaedics,University College of Medical Sciences and GTB Hospital,Delhi from November 2010 to March 2012.Ten patients who had sustained traumatic dorsolumbar vertebral fractures with complete paraplegia were recruited for this study.Under suitable anaesthesia,at the beginning of surgery,100 ml of bone marrow was aspirated.This was centrifuged and buffy coat isolated and then transferred into a sterile tube and sent to the operating room on ice packs.After surgical decompression and stabilization,the buffy coat isolate was injected into the dural sleeve at the site of the injury using a 21G needle.All the patients were evaluated for neurological improvement using the American Spinal Injury Association (ASIA) score and Frankel grade at 6 weeks and 3 months postoperatively.Results:The evaluation at 6 weeks showed some improvement in terms of the ASIA scores in 2 patients but no improvements in their Frankel Grade.The other 8 patients showed no improvements in their ASIA scores or their Frankel Grades.The current pilot study has shown that there has been no improvement in most of the recipients of the transplant (n=8).Some patients (n=2) who did show some improvement in their sensory scores proved to be of no significant functional value as depicted by no change in their Frankel Grades.Conclusion:The outcome of current study shows that although this modality of treatment is safe for the patients,it provides no additional benefits on improvement of quality of life among these patients。

Abstract：Objectives:To review the calendar,mortality and morbidity of Iraq-Iran chemical war among Iranians based on researchers' reports.Methods:We used national and international databanks such as PubMed,ISI,Scopus,Irandoc and Iranmedex and studied 350 articles related to chemical agents and their effects on different organs.The main criteria for qualification of articles were relevancy orientation and being published in approved medical journals.Results:The Iraqi army invaded to west and southwest Iran using chemical weapons such as nerve agents (NAs) and sulfur mustard (SM).Most victims were civilians including women and children.These attacks had imposed more than 150 types of diseases and complications on Iranians and the frequency of death was 2％-3％.Most reports were about respiratory problems and a few were in the domain of socio-economic damages.Conclusion:At present,25 years after the end of war,the victims are faced with different complications induced by chemical agents and it is estimated that they will be continuously troubled by these problems in future。

Abstract：Gunshot injuries are rather serious but uncommon type of trauma in India.A 45-year-old male was presented with gunshot (pellets) embedded in the maxillofacial area for 22 years.There is no consensus in the literature whether to attempt their removal or leave them in situ.Our patient had no long-term sequela like infection,fistula formation,carcinogenesis or metal poisoning to date except for chill feeling on cold days.Management of this patient presented a dilemma in treatment in view of the effects of foreign bodies in the maxillofacial area。

Abstract：We accidentally found an unusual case of a middle aged Tibetan woman who had eight metallic foreign bodies (eight needles) in her head,chest and abdomen.These needles were not related to any surgical intervention or trauma.The diagnosis "metallic foreign bodies" cannot usually be made in an acute setting.Some patients may present chronic symptoms,such as infection or pain.However,in some cases,the patients do not have any symptoms。

Abstract：Neurapraxia frequently occurs following traction injury to the nerve intraoperatively,leading to radial nerve palsy which usually recovers in 5-30 weeks.In our case,we had operated a distal one-third of humeral shaft fracture and fixed it with 4.5 mm limited contact dynamic compression plate.The distal neurovascular status of the limb was assessed postoperatively in the recovery room and was found to be intact and all the sensory-motor functions of the radial nerve were normal.On the second postoperative day,following the suction drain removal and dressing,patient developed immediate radial nerve palsy along with wrist drop.We reviewed the literature and found no obvious cause for the nerve palsy and concluded that it was due to traction injury to the radial nerve while removing the suction drain in negative pressure。