Research on the expression of some immune markers after reamed and unreamed femoral nailing / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate on the expression of some cytokines and other immunity makers right after the operation, the effect of femoral nailing on systemic immunity and sought to differentiate any differences between reamed and unreamed IMN.</p><p><b>METHODS</b>Fifty-nine patients presenting with acute femoral fractured including 55 male and 4 female, 32.1 years old on average, are divided into 2 group depend on ISS. All patients were treated by close reduction and intramedullary nail for fixation. In group 1, 23 reamed and 23 unreamed; in group 2, 7 reamed and 6 unreamed. Venous blood samples were taken at 24 hr pre-operationally, and 1 hr, 24 hr, 48 hr post operationally. Serum TNF, IL-6, IL-8, IL-10 were measured by enzyme-linked immunosorbent assay. CRP was measured by protein assay apparatus. We also collected venous samples from 22 healthy uninjured volunteers, which formed control group.</p><p><b>RESULTS</b>All immune marks were elevated post operation, for IL-6, IL-8, IL-10, this elevation began at 1 hr after operation, reached to the peak at 24 hr, and then down but never to the normal at 48 hr. For TNF and CRP, the level were raised at 24 hr, and then fallen at 48 hr. All mediators were raised significantly above the control group (< 0.05). Between reamed and unreamed patients both in group 1 and group 2, Although there was a trend towards higher levels of TNF, IL-6, IL-8, IL-10 and CRP in RFN than in the URFN, no significant difference was found except that there was a greater release of serum IL-10 in RFN than in URFN at 24 hr post operation (P = 0.047). Two patients have become SIRS, but the markers have shown no significant difference with those that have no SIRS symptoms.</p><p><b>CONCLUSIONS</b>To the patient not injured severely, using IMN for treatment will make the inflammatory mediators re-released on higher level than normal, which will be balanced by immunity itself soon, so IMN won't make any damage severely. And no significant difference were found between reamed and unreamed nail. But the changing of IL-10 show us that after IMN, especially the reamed nailing, the level of anti-inflammatory mediators will show the difference more apparently between RFN and URFN while the patient got injured more severely. Under this condition, the RFN will aggravate the restrain of immunity.</p>

Surgical treatment of shotgun injuries of the sciatic nerve / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve.</p><p><b>METHODS</b>From 1996 to 2000, 19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds, the gluteal wound was in 2 cases, thigh wound in 15 cases, and knee wound in 2 cases. The firing distance was between 0.5-9 m. According to Shermen classification of shotgun injury, 4 cases belonged to type I injury, 11 cases type II, 4 cases type III. The time from injury to admission was between 2 months-14 months except 1 patient who underwent emergency operation 4 hours after injury, and 1 patient was treated with debridement and epineurial neurorrhaphy, 7 cases with nerve trunk grafting, 6 cases with nerve cable grafting, 4 cases with neurolysis, 1 case with arthrodesis of ankle.</p><p><b>RESULTS</b>Nineteen cases were followed-up for 0.8-3.5 years (mean, 19 months). The excellent and good nerve functional recovery was found in 52.6% according to MCRR.</p><p><b>CONCLUSIONS</b>Shotgun injuries of the sciatic nerve are very severe and complicated, and injuries in most patients were usually complicated by open fracture, vascular injury, soft-tissue loss and infection; the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve, but outcome is poor; the recovery of the sciatic nerve should be observed continually after injury; selecting correct initial treatment after injury, strict minimally invasive surgical procedure, physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.</p>