2014年 · 第17卷第04期

Abstract：Objective:To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods:Twenty-eight patients with acute traumatic Rockwood Ⅲ,Ⅳ and Ⅴ dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors.Function was evaluated using the ConstantMurley shoulder score.Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3,6 and 12 months.Results:Two cases with fixation loosening were not included in final statistical analysis.Other patients obtained full joint reposition on immediate postoperative radiographs.Follow-up was performed with an average of 15.6 months (range,12-19).After early range of motion exercises,96.2％ of the patients (25/26) could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months.There was no infection.Average Constant-Murley score was 96.3 points (range,94-100)and mean Taft shoulder rating was 10.7 points (range,8-12) at 12 months.Conclusion:The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation。

Abstract：Objective:Autophagy is involved in several neurodegenerative diseases and recently its role in acute brain injury has won increasing interest.Spinal cord injuries (SCIs) often lead to permanent neurological deficit.Therefore,in this study,we examined the profiles of autophagy-linked proteins (MAP-LC3) after SCI to investigate whether the expression of autophagy contributes to neurological deficit after SCI.Methods:Adult female Sprague-Dawley rats were used and randomly divided into control and SCI groups.All the rates received laminectomy at T8-T10 level.Those in the SCI group received additional exposure of the dorsal surface of the spinal cord,followed by a weightdrop injury.Thereafter we investigated the expression levels of MAP-LC3,beclin-1,Cathepsin D and the beclin-1-binding protein bcl-2 by western blot analysis at 12 h,24 h,3 d,7 d,21 d and 28 d.One-way ANOVA with Tukey post hoc test was used to compare data between groups.Results:We observed significant increase in the level of LC3 (LC3-Ⅱ/LC3-Ⅰ) at 3 d and 7 d after SCI when compared with the sham group.While the level of beclin-1 and ratio of beclin-1/bcl-2 was found to have increased from 12 h to 24 h after injury.Cathepsin D expression was also elevated at 7 d (P＜0.01).Conclusion:Based on the above mentioned data,we proposed that autophagy plays a role in the manifestation of cell injury following SCI。

Abstract：Objective:To evaluate whether the self-blood has influence on the molding process of polymethyl methacrylate (PMMA) bone cement,and to make sure whether it is valuable for the clinical practice.Methods:An in vitro study was performed to evaluate the prolonging-effect of self-blood on PMMA bone cement.The effect of prolonging was evaluated by the dough time (TD) and operable time (To).Moreover,hardness test,squeezing value test and peak temperature test were also conducted to complete the evaluation of this program.Results:The self-blood,especially the plasma,could greatly prolong the handling time of PMMA bone cement without affecting its basic characteristics including hardness,leakage level and peak temperature.On the other hand,we found that in some abnormal conditions,for example with hyperlipemia,self-blood though can also prolong the handling time,would cause some sideeffects.Conclusion:We report a new effective way to prolong the handling time of PMMA bone cement by adding moderate amount of self-blood.But “individualized medicine” should be noticed because some abnormal conditions like hyperlipemia would cause undesired side-effects。

Abstract：Objective:We evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.Methods:Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization.Then,all the patients underwent plain radiography and computerized tomography of the cervical spine.The outcome measure was the presence of traumatic cervical spine injury.Sixty minutes after acetaminophen infusion,posterior midline cervical tendemess was reassessed.Results:Of 1 309 patients,41 had traumatic cervical spine injuries based on imaging.Sixty minutes after infusion,posterior midline cervical tenderness was eliminated in 1 041 patients,none of whom had abnormal imaging.Conclusion:Patients with cervical spine trauma do not need imaging if posterior midline cervical tendemess is eliminated after acetaminophen infusion.This analgesia could be considered as a diagnostic and therapeutic intervention。

Abstract：Objective:To compare efficacy between the modified tension band technique and the parallel titanium cannulated lag screw technique for the transverse patella fracture.Methods:Seventy-two patients were retrospectively analyzed aged 22 to 79 years (mean,55.6 years) with transverse patella fractures,among whom 37 patients underwent the modified tension band and 35 patients received the titanium cannulated lag screw.Patients were followed up for 1-3 years.We analyzed the difference of operation time,complications,fracture reduction,fracture healing time,and the Iowa score for knee function between both groups.Results:In modified tension band group,five patients had skin irritation and seven suffered wire migration,two of whom required a second operation.In comparison,there were no complications in the titanium cannulated lag screw group,which also had a higher fracture reduction rate and less operation time.Conclusion:The parallel titanium cannulated lag screw technique has superior results and should be considered as an alternative method to treat transverse patella fracture。

Abstract：Objective:The rapid expansion of knowledge regarding the functional anatomy of hand and wrist,increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner.The purpose of our study was to evaluate the difference in patients function among those treated by 1) closed reduction and Plaster of Paris cast,2) distractor application,or 3) open reduction and internal fixation with a volar plate,and to assess the treatment choice for each particular fracture type.Methods:A prospective study was carried out on 60 patients with fractures of the distal end radius.Fractures were classified according to the AO classification into type A (extra-articular),type B (partial articular) and type C (complete articular).After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years.Results:Anatomical results were evaluated according to the Sarmiento's modification of Lindstrom Criteria,which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique.Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification,which was revealed to relate with the type of treatment techniques.Conclusion:There is no customized solution for all the fractures of the distal radius.The choice of treatment should be based on the fracture type,the patient's characteristics,the patient's demands and the treating surgeon's experience and preference。

Abstract：Objective:To compare the value of Glasgow coma scale (GCS) and cerebral state index (CSI)on predicting hospital discharge status of acute braininjured patients.Methods:In 60 brain-injured patients who did not receive sedatives,GCS and CSI were measured daily during the first 10 days of hospitalization.The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic (ROC) curve regarding the time of admission and third day of hospitalization.Sensitivity,specificity and other predictive values for both indices were calculated.Results:Of the 60 assessed patients,14 patients had mild,13 patients had moderate and 33 patients had severe injuries.During the course of the study,17 patients (28.3％) deteriorated in their situation and died.The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital.GCS＜4.5 and CSI＜64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients.For the first day of hospitalization,the area under ROC curve was 0.947 for GCS and 0.732 for CSI.Conclusion:GCS score at ICU admission is a good predictor of in-hospital mortality.GCS＜4.5 and CSI＜64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients。

Abstract：Objective:To assess the accuracy of the clinically estimated blood loss (EBL) when compared with the actual blood loss (ABL) in replacement surgeries.Methods:This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013.Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits.Exclusion criteria were intake of antiplatelet drug or anti-coagulant,bleeding disorders,thrombotic episode,and haematological disorders.There were 65 men and 75 women.In this study,the consultants were free to use any clinical method to estimate the blood loss,including counting the blood-soaked mops and gauze pieces (estimating the volume of blood carded in all the mops and gauzes),measuring blood lost to suction bottles and blood in and around the operative field.The ABL was calculated based on a modification of the Gross's formula using haematocrit values.Results:In 42 of the 140 cases,the EBL exceeded the ABL.These cases had a negative difference in blood loss (or DIFF-BL＜0) and were included in the overestimation group,which accounted for 30％ of the study population.Of the remaining 98 cases (70％),the ABL exceeded the EBL.Therefore they were put into the underestimation group who had a positive difference in blood loss (DIFF-BL＞0).We found that when the average blood loss was small,the accuracy of estimation was high.But when the average blood loss exceeded 500 ml,the accuracy rate decreased significantly.This suggested that clinical estimation is inaccurate with the increase of blood loss.Conclusion:This study has shown that using clinical estimation alone to guide blood transfusion is inadequate.In this study,70％ of patients had their blood loss underestimated,proving that surgeons often underestimate blood loss in replacement surgeries。

Abstract：Objective:To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods:Literature reports in both Chinese and English languages were retrieved (from the earliest available records to October 1,2013) from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials (RCTs) to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results:A total of 12 randomized controlled trials,comprising 985 patients (475 in the unreamed group and 510 in the reamed group),were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection (RR=0.64; 95％CI,0.39 to 1.07;P=0.09),compartment syndrome (RR=1.44; 95％CI,0.8to 2.41; P=0.16),thrombosis (RR=1.29; 95％CI,0.43to 3.87; P=0.64),time to union (WMD=5.01; 95％CI,-1.78 to 11.80; P=0.15),delayed union (nonunion)(RR=1.56; 95％CI,0.97 to 2.49; P=0.06),malunion (RR=1.75; 95％CI,1.00 to 3.08; P=0.05) and knee pain (RR=0.94; 95％CI,0.73 to 1.22; P=0.66).But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group (RR=4.29; 95％CI,2.58to 7.14; P＜0.00001).Conclusion:There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate。

Abstract：Objective:Trauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care expenditures.Although spine-related injuries constitute a small proportion of trauma cases,they need special consideration due to poor functional outcomes and substantial burden.Despite relatively extensive previous studies on traumatic spinal injuries,there is still obscurity in some aspects of the issue.The purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation registry.Methods:This is a prospective case series study,including all patients with acute traumatic spine lesions admitted to a regional multicenter since 2014.Data is extracted based upon a form developed by Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences,Tehran,Iran.Novel electronic data entry software is initiated and data will be entered to the software.Information remains confidential and security considerations will be taken based on standards of data entry systems.Results:The results of this study will include age and gender distribution of the patients,causes of injury,location of pain and neurological deficit,the American Spinal Injury Association score and Frankel grade on admission,at discharge,after 6 and 12 months and at the latest annual follow-up,radiologic findings,details of operative procedures and methods of external fixation.Conclusion:This study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment methods.It can lead to a considerable improvement in patient care and will have a great national and transnational impact。