Effects of mild hypothermia on the expression of high mobility group protein B1 in lung tissues of septic mice / 中国综合临床

Objective:To investigate the effects of naturally occurring mild hypothermia and artificial mild hypothermia on the expression of high mobility group box 1(HMGB1) in lung tissues of septic mice.Methods:One hundred and twenty BALB/C mice (SPF level) were randomly numbered.Twelve mice with integer multiples of 10 were used as the normal control (NC) group, and the remaining 108 mice were chosen as the septic group.The septic mouse model was established by intra abdominal injection of lipopolysaccharide (LPS) 10 mg/kg.The NC group was given the same dose of normal saline.Anal temperature of the septic mice were measured 1 hour after the model was established successfully, and then were divided into naturally occurring mild hypothermia group and non-mild hypothermia group according to T≤36℃ and T>36℃.In the naturally occurring mild hypothermia group, the mice with T<34℃ were eliminated, and the remaining septic mice were randomly divided into the naturally occurring mild hypothermia(NOMH) observation group and the keep normothermia (KN) group.NOMH group was not given preheating intervention, while KN group was placed in an incubator to maintain the anal temperature between 36.0℃ and 37.5℃.Septic mice in the non-mild hypothermia group were randomly divided into the nonhypothermia (NH) observation group and the artificial mild hypothermia (ATMH) group.The NH group was not treated with hypothermia, while the ATMH group was treated with physical hypothermia, so that the anal temperature of the mice were maintained at 34℃-36℃.Four mice in each group were randomly selected at 6 and 12 hours after modeling, and the concentrations of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and HMGB1 in serum were detected by enzyme-linked immunosorbent assay(ELISA). At 12 hours, the survival rate of each group of mice was observed.Then 4 mice of each group were sacrificed and lung tissues were taken.The pathological changes of lung tissues were observed by hematoxylin-eosin (HE) staining, and the expression of HMGB1 in lung tissues was observed by immunohistochemical staining.Real time fluorescence quantitative PCR and Western blot were used to detect the relative expression of HMGB1 at mRNA and protein levels.Results:(1)Twelve hours after modeling, the survival number of NOMH group, ATMH group, KN group and NH group were 36(40), 6(11), 27(40), 4(11), respectively, and there were differences between the four groups (χ 2=32.286, P=0.002). Compared with the other three groups of septic mice, the survival rate was highest in the NOMH group (compared with ATMH group: χ 2=5.222, P=0.022; compared with the KN group: χ 2=6.050, P=0.013; and the NH group: χ 2=11.672, P=0.001), but the differences between the other two groups were not statistically significant (all P>0.05). (2)Compared with the NC group, the concentrations of serum TNF-α, IL-6 and HMGB1 of septic mice in each group were significantly increased at 6 h and 12 h (all P<0.05). Compared with NOMH group, the concentrations of TNF-α, IL-6 and HMGB1 in ATMH group, KN group and NH group were significantly increased at 6 h and 12 h(all P<0.05), and the concentrations of TNF-α, IL-6 and HMGB1 in NH group were the highest at all time points (all P<0.05). The concentrations of TNF-α at 12 h decreased compared with 6 h (all P<0.05), while the concentrations of IL-6 and HMGB1 at 12 h increased compared with 6 h (all P<0.05). (3)HE staining showed that the lung tissue damage were minimal in NOMH group, followed by ATMH group.(4)Immunohistochemical staining showed that the expression of HMGB1 protein was in order of NOMH group, ATMH group, KN group and NH group; (5)The relative expressions of HMGB1 protein in lung tissues of septic mice in NOMH group, ATMH group, KN group, and NH group was 0.280±0.013, 0.320±0.016, 0.340±0.018, and 0.380±0.014, respectively, and the relative expression level of HMGB1 mRNA was 4.86±0.22, 6.02±0.18, 6.26±0.20, and 7.98±0.28, respectively, compared with NC group (HMGB1 protein content was 0.240±0.013, and the relative expression level of HMGB1 mRNA was 2.21±0.12) significantly increased (all P<0.05). Cmpared with NOMH group, the relative expression levels of HMGB1 protein and HMGB1 mRNA in the lung tissues of the ATMH group, KN group and NH group were significantly increased(all P<0.05), with the highest expression level in the NH group(all P<0.05). Conclusion:Mild hypothermia may reduce lung tissue damage by down-regulating the expression of HMGB1 in lung tissues of septic mice, and the improvement of spontaneous mild hypothermia was more significant.

Orthopaedic Replantation and functional reconstruction of an amputated lower extremity / 中华创伤骨科杂志

Objective@#To evaluate our replantation and functional reconstruction of amputated lower extremities.@*Methods@#From February 2013 to October 2017, 13 patients with an amputated lower extremity were treated at Orthopaedic Department, The 960th Hospital of the PLA Joint Logistics Support Force. They were 10 males and 3 females, aged from 15 to 63 years (average, 39 years). In all the patients, large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage. After desired extension was achieved, the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction. Postoperatively, functions of the knee and ankle joints, sensory recovery of the foot sole, length and appearance of the extremity were observed.@*Results@#All the 13 patients were followed up for 12 to 24 months (average, 16 months). All the limb replants survived well. Of them, 12 were satisfied with their weight-bearing walking and therapeutic outcomes.@*Conclusions@#For an amputated lower extremity, the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

Replantation and functional reconstruction of an amputated lower extremity / 中华创伤骨科杂志

Objective To evaluate our replantation and functional reconstruction of amputated lower extremities.Methods From February 2013 to October 2017,13 patients with an amputated lower extremity were treated at Orthopaedic Department,The 960th Hospital of the PLA Joint Logistics Support Force.They were 10 males and 3 females,aged from 15 to 63 years (average,39 years).In all the patients,large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage.After desired extension was achieved,the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction.Postoperatively,functions of the knee and ankle joints,sensory recovery of the foot sole,length and appearance of the extremity were observed.Results All the 13 patients were followed up for 12 to 24 months (average,16 months).All the limb replants survived well.Of them,12 were satisfied with their weight-bearing walking and therapeutic outcomes.Conclusions For an amputated lower extremity,the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

The anatomic relationship between the thoracic transverse process and adjacent bony structures / 中华创伤骨科杂志

Objective To study the anatomic relationship between the thoracic transverse process and adjacent bony structures and its clinical significance for thoracic screw fixation.Methods The present anatomic measurement used 45 dry cadaveric specimens of the normal adult thoracic vertebrae.We measured the distances from the horizontal midline of the transverse process to the superior,middle and inferior margius of the pedicle,the height of the anterolateral transverse process sheltered by ribs,and the position at the horizontal midline of the transverse process corresponding to the vertebral body.Results The horizontal midlines margius of the transverse processes of T1 to T10 are localized in the plane ranging from the superior to the inferior margins of the pedicle.The midlines of the transverse process are closer at T6 and T7 while more apart at T9 and T10.From T1 to T8,the anterolateral transverse process is totally or mostly sheltered by ribs,but the shelter is much less at T9 and T10.The horizontal midline of the transverse process corresponds to the upper 1/3 or middle 1/3 of the vertebral body.Conclusion Thoracic screw fixation across the transverse process to the vertebral body is safe,reliable and feasible in clinic.

Effects of lung protective ventilation strategy on inflammatory mediators in bronchial alveolar lavage fluid in pulmonary and extrapulmonary acute respiratory distress syndrome / 中国医师进修杂志

Objective To observe the effects of lung protective ventilation strategy (LPVS) on inflammatory mediators in bronchial alveolar lavage fluid (BALF) in pulmonary and extrapulmonary acute respiratory distress syndrome(ARDS).Methods All of 62 extrapulmonary ARDS(ARDSexp) cases and 60 pulmonary ARDS (ARDSp) cases were divided into observation group and control group by table of random digit.ARDSexp and ARDSp observation group were received LPVS treatment [tidal volume 6-8 ml/kg,positive end expiratory pressure (PEEP) 5-15 cm H2O (1 cm H2O =0.098 kPa)],and ARDSexp and ARDSp control group were received the routine ventilation strategy (tidal volume 10-12 ml/kg,PEEP 4-8 cm H2O).All groups were treated with the same conventional therapy of ARDS,same model and parameter of mechanical ventilation.The level of tumor necrosis factor (TNF)-α,interleukin (IL)-6,IL-8 in BALF were tested by enzyme linked immunosorbent assay on the 1st,4th,7th day in each group.The oxygenation index was tested at 8 o'clock each morning.Results There were 4 ARDSexp cases and 6 ARDSp cases who were expelled,because of death within 7 days.ARDSexp observation group was in 28 cases,ARDSexp control group was in 30 cases,ARDSp observation group was in 28 cases,ARDSp control group was in 26 cases.The oxygenation index had no significant difference between ARDSexp and ARDSp observation group and corresponding ARDSexp and ARDSp control group on the 1st and 2nd day (P ＞ 0.05).But the oxygenation index in ARDSexp and ARDSp observation group were significantly higher than that in ARDSexp and ARDSp control group from 3rd to 7th day (P ＜ 0.05).The oxygenation index in ARDSexp observation group was significantly higher than that in ARDSp observation group except 1st day (P ＜0.05).The oxygenation index in ARDSexp and ARDSp observation group were significantly better with the time passing (P ＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp and ARDSp observation group were significantly lower than those in corresponding ARDSexp and ARDSp control group on the 4th and 7th day (P＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp observation group and ARDSexp control group were significantly lower than those in corresponding ARDSp observation group and ARDSp control group (P＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp and ARDSp observation group were decreased significantly with the time passing (P ＜0.05).Conclusion It is more reasonable to decrease the BALF levels of inflammatory mediators,increase oxygenation index for ARDS patients to with LPVS treatment,then for ARDSexp patients obviously.

Use of cross-leg fibula flap for difficult reconstruction of extensive injuries in the lower extremities / 中华骨科杂志

Objective To study clinical outcomes of cross-leg fibula flap for difficult reconstruction of an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects combined with vascular injury.Methods From September 2004 to September 2008,8 cases with an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects with vascular injury,were retrospectively analyzed,including 6 males and 2 females with an average age of 36 years (range,19-55 years).The course of disease ranged from 2 weeks to 3 months (average,2 months).The bone defect length ranged from 8 to 20 cm (average,13 cm),and the skin defect area varied from 10 cm×7 cm to 22 cm×12 cm.After thorough debridement,cross-leg fibula flap was used to repair the tibial defect and concomitant soft tissue defect.The pedicles were divided at 4-6 weeks after the initial surgery.The important technical considerations were outlined.Results All 8 patients were followed up for 6 to 36 months (average,24 months).The flaps survived in all 8 patients,and no infection and osteomyelitis happened.The flap transplantations healed at two weeks after operation with good shape.The fractures healed in all of patients with an average period of 11 months (range,6-15 months).All of patients recovered to walk without aid.According to Edwards classification of tibial fractures,4 cases were classified as good,2 as acceptable,and 2 as poor.Conclusion The cross-leg fibula flap is relatively simple,liable for the treatment of an extensive injury in the lower extremity.

Application of 3％ hypertonic saline in patients with severe craniocerebral injury after operation / 中国医师进修杂志

Objective To study the application of 3％ hypertonic saline (HS) in patients with severe craniocerebral injury after operation.Methods Sixty-eight cases with severe craniocerebral injury after operation were divided by random digits table method into HS group and control group with 34 cases each.The patients in control group were treated with 125 ml 20％ mannitol every 6 hours or 8 hours.The patients in HS group were given conventional mannitol and added with 130 ml 3％ HS every 12 hours or 8 hours through fast intravenous drip altemated with mannitol.The levels of intracranial pressure (ICP),mean arterial pressure (MAP),central venous pressure (CVP) were recorded within 6 hours,12 hours,24 hours of the 1st day,24 hours of the 2nd day,24 hours of the 3rd day,24 hours of the 5th day.The Na+ level of blood serum and the plasma osmotic pressure were recorded and calculated within 12 hours,24 hours of the 1st day,24 hours of the 2nd day,24 hours of the 3rd day,24 hours of the 5th day.The Glasgow coma scale( CCS) score was accounted within 24 hours of the 1 st day,24 hours of the 3rd day,24 hours of the 5th day.Results Compared with control group,the level of ICP in HS group decreased at every time point (P ＜ 0.05).The tendency of ICP in two groups was not significant on the 1st and 2rid day (P ＞ 0.05 ),but the level of ICP within 24 hours of the 3rd and 5th day obviously increased compared with those of the 1st and 2nd day (P＜0.05).The levels of MAP and CVP in HS group were significantly higher than those in control group within 6 hours,12 hours and 24 hours of the 1 st day and 24 hours of the 2nd day [ ( 87.98 ± 5.03 ),(88.56 ± 5.36),(87.04 ±6.90),(90.03 ±5.19) mm Hg (1 mm Hg =0.133 kPa) vs.(77.98 ±5.09),(79.98 ±6.09),(80.98 ± 5.27),(81.98 ± 4.32) mm Hg and (9.23 ± 1.24),(9.67 ± 1.35),( 10.21 ± 1.38 ),( 10.56 ± 1.96)mm Hg vs.(7.15 ± 2.01 ),(8.32 ± 1.53),(8.67 ± 1.89),(9.22 ± 2.03) mm Hg] (P ＜ 0.05),but the values within 24 hours of the 3rd and 5th day between two groups had no significant differences (P＞ 0.05 ).The Na+ level of blood serum and the plasma osmotic pressure in HS group at every time point was obviously higher than that in control group (P＜ 0.05).The GCS scores within 24 hours of the 1st,3rd and 5th day in HS group were (4.21 ± 2.31 ),(5.44 ± 2.46 ),(7.23 ± 1.64 ) scores,respectively,while the scores in control group were (4.14 ± 2.10),(5.15 ± 2.31 ),(7.31 ± 2.12) scores,respectively ;the score within 24 hours of the 5th day in two groups was obviously higher than that of the 1st day respectively (P＜ 0.05 ),but the scores between two groups had no statistical significance (P＞ 0.05 ).Conclusions Adding 3％ HS is more effective to decrease ICP,improve the brain perfusion and reduce the adverse reactions.3％ HS can be used as the first-line therapy for patients with severe craniocerebral injury after operation.

Role of scapholunate interosseous ligament in flexion-extension motion of scaphoid and lunate / 中华创伤杂志

Objective To observe the resection of the scapholunate interosseous ligament (SLIL)and its subregions on the three-dimensional(3-D)movement of the scaphoid and lunate so as to discuss the role of SLIL in the 3D flexion-extension motion of the scaphoid and lunate.Methods Twelve upper extremities(six left extremities and six right extremities)from adult cadaver were used in this study and divided into five groups:normal group,proximal subregion resection group,proximal subregion plus dorsal subregion resection group,proximal subregion plus palmar subregion resection group and whole SLIL resection group.The 3-D laser scan and reconstruction technique were used for meusure ment of the 3-D flexion-extension motion of the scaphoid and lunate.Results In the normal group,the scaphoid and lunate flexed and the radial deviated at the same direction during wrist flexion-extension motion.At the same time,there was minimal scaphoid and lunate pronation-supination during wrist flexionextension.After resection of the proximal and palmar(or dorsal)subregions of the SLIL,some different movements were found compared with the normal specimen.Whole SLIL resection resulted in increase of the flexion motion of the scaphoid but decrease of the palmar flexion of the lunate.Conclusions 3-D laser scanning and image reconstruction techniques can accurately measure the 3D motion of the scaphoid and lunate.Partial or whole resection of SLIL may exert significant effect on the flexion-extension motion of the scaphoid and lunate.However,the proximal subregion of SLIL has no prominent effect on the motion of the scaphoid and lunate.

Distal pedical fibular osteoseptocutaneous flap transfer for the lateral forefoot defect / 中华显微外科杂志

Objective The anterior-lateral defect of foot that lost one of the three supporting point of foot can lead to collapse of the lateral longitudinal arch, overload of the first metatarsal heads, and painful callus formation. It is meaningful to investigate the effect of reconstructing the lateral forefoot defect with pedical fibular osteoseptocutaneous flap. Methods From March 1989 to June 2008, there were 38 patients with anterior-lateral defect of foot were constructed. The supporting point with the local distal based pedical fibular osteoseptocutaneous flap was constracted. Results All the 38 flaps survived. All 38 patients had been followed up from 6 months to 10 years (mean 23.5 months) postoperatively. The constructed supporting point of the foot was functional. The patients could walk freely with no pain, and was satisfied with the operation. Assessed with the rating system for foot and ankle established by the American Orthopaedic Foot And Anke Society, 8 patients got a score above 85, 23 patients between 75 to 85, 7 patients between 60 to 75. Conclusion It is effective that transferring local distal based pedical fibular osteoseptocutaneous flap to repair the anterior-lateral defect of foot.

Treatment of humerus nonunion using lilac bone graft limited internal fixation combined with external fixation in 13 cases / 中国组织工程研究

BACKGROUND: There is lack of effective method for treating humerus nonunion, lilac plate can maintain the compact contact between fracture end and bone graft, accelerate bone union, as well as provide stability for bone union. OBJECTIVE: To evaluate the clinical effects of treating humerus nonunion by using lilac bone graft as plate combined with the external fixation.METHODS: Thirteen patients with nonunion of the humorous at Department of Orthopedic Trauma Surgery, Jinan Command General Hospital of Chinese PLA were selected, including 11 males and 2 females, aged 20 51 years, mean aged 35.5 years. All the patients were treated with Uiac bone graft and screws combined with the mono lateral external fixation. The bone healing was observed by X-ray film. Shoulder function and complications were measured by Neer score.RESULTS AND CONCLUSION: All patients were followed up for 7-64 months, mean 38 months. Bony union was achieved in all patients within 6-10 months (mean 8.1 months). The activity function of shoulder and elbow was normal; and Neer scores were 71-96 (mean 87 scores). No infection, pain, prevalent fracture or nonunion occurred. The results demonstrated that using lilac bone graft as plate combined with the mono lateral external fixation is a good salvage operation for nonunion of the humerus.

Finite element analysis of thoracolumbar fracture following varying fixations / 中国组织工程研究

BACKGROUND:A selection of treatment for thoracolumbar fracture is very important.OBJECTIVE:To develop and validate three-dimensional finite element models of human thoracolumbar fracture using varying fixation methods,and to compare biomechanical characteristics of fixation method.DESIGN TIME AND SETTING:A contrast observation was performed at the Mechanical Experiment Center of Tongji University from August to October 2008.MATERIALS:64-slice spiral CT (Siemens,Germany) was used to scan T_(11)-L_1 segments of an adult male,and the slice thickness was 0.6 mm.based on Boolean operation,the lower half of T_(12) segment was resected,and the structure of posterior part was reserved to establish finite element model of thoracolumbar fracture.METHODS:There were five groups in this study,including 4 pedicle screws+2 rods (group 1),5 pedicle screws+2 rods at one side (group 2),6 pedicle screws+2 rods at both sides (group 3),anterior fixation (group 4),and anterior plus posterior fixation (group 5).Forces of axial compressive,anterior bending,posterior extension,left bending,and right rotation were loaded to compare the biochemical characteristics.MAIN OUTCOM MEASURES:vonMises stress and displacement at different directions.RESULTS:The stresses of all the fixation screws increased from the anterior part to posterior part in all movement tests,and the strongest stress was measured in the joint position.The stress of proximal screw was stronger than that of the distal screw.Additionally,the stress in group 1 was significantly stronger than in groups 2,3,and 5 (P<0.01).The group 5 was the most stable,but the group 1 was the poorest.CONCLUSION:T_(12) bursting fracture models were established using varying fixation methods,and the results verified that short segment plus fracture vertebral segmental fixation has more superior biomechanics.

Mechanical features of screw internal fixation technique for acetabular anterior column fracture:Quantitative anatomic observation / 中国组织工程研究

BACKGROUND:Recently,open reduction and internal fixation has become an important therapy for pelvic and acetabular fracture. However,screw penetration sometimes occurs,which damage vessels or nerves in the pelvic cavity. OBJECTIVE:To measure the best entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique. DESIGN,TIME AND SETTING:Measurement experiment was performed at the Department of Anatomy,Medical School of Shandong University from June to October 2008. MATERIALS:A total of 20 semi-pelvic specimens of adult male cadavers were used to make serial cross-sections of the acetabular anterior column. METHODS:In single screw technique,the horizontal distance OP and vertical distance PQ from entry point O to apex of greater sciatic notch Q were measured,and screw length was measured. In double screw technique,the horizontal distance O1P1,O2P2 and vertical distance P1Q,P2Q from entry point O1 of the inner screw and entry point O2 of the outer screw,respectively to apex of greater sciatic notch Q were measured. The length of inner screw and outer screw were measured respectively. Angle ? on sagittal plane and the angle ? on coronal plane of the screw were determined. All data were put into software SPSS 10.0 for statistical analysis. MAIN OUTCOME MEASURES:The entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique RESULTS:Single screw technique:the length of OP and PQ was (23.5?2.2) mm and (16.8?1.6) mm respectively; the length of lag screw was (84.9?4.7) mm. Double screw technique:the length of O1P1 and P1Q was (26.3?2.3) mm and (13.6?1.4) mm,respectively,and the length of medial lag screw was (69.8?4.1) mm; the length of O2P2 and P2Q was (20.7?2.1) mm and (20.1?1.8) mm,and the length of lateral lag screw was (61.2?3.7) mm. Angle ? was (123.4 ? 4.1)? and angle ? (62.2 ? 5.8)?. CONCLUSION:The entry point of single screw technique lies in the summit of greater sciatic notch 17 mm outward,vertical to the medial margin of the posterior column,24 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 85 mm. The entry point of medial screw in double screw technique lies in 14 mm outward,vertical to the medial margin of the posterior column,and 26 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 70 mm. The entry point of lateral screw in double screw technique lies in 20 mm outward,vertical to the medial margin of the posterior column,and 21 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 61 mm. The angle of lag screw with respect to the parallel line of the medial margin of the posterior column is 123?,and the angle lag screw with respect to the vertical line of the medial margin of the posterior column is 62?. The position of the lag screw must be confined by intraoperative fluoroscopy in multiple projections.

Expression of Bone Morphogenetic Protein-2 in Gunshot Fracture Healing Detected with Real Time Fluorescence Quantitative Reverse Transcript Polymerase Chain Reaction / 中国康复理论与实践

@#ObjectiveTo detect the levels of bone morphogenetic protein-2(BMP-2) mRNA in gunshot fracture healing of the rabbits.MethodsA model of primary treating gunshot fracture of the rabbit with external fixator and the real time fluorescence quantitative reverse transcription polymerase chain reaction(FQ-RT-PCR) technology with SYBR Green I were established.The levels of BMP-2 mRNA 1,2,3 and 4 weeks after operation were detected with FQ-RT-PCR respectively.ResultsIn the control group,BMP-2 mRNA of the bone tissue began to rise at the first week after fracture and the peak of mRNA expression appeared at the second week.The expression returned to normal at the forth week.In the experimental group,the BMP-2 mRNA rose more slowly that it arrived peak stage at the third week and was significantly lower in experimental group than that in control group at the same phases.ConclusionReal time FQ-RT-PCR is a good method for measuring the levels of BMP-2 mRNA during gunshot fracture healing.The mRNA expression rose more slowly and was significantly lower in gunshot fracture than in common fracture at the same phases.

Post-traumatic osteomyelitis / 中国矫形外科杂志

Post-traumatic osteomyelitis is painful and challenging disease.High success rate of antimicrobial therapy in most cases has not been achieved in skeleton due to its physiological and anatomical characteristics.The key to successful management is early diagnosis and treatment.Different types of post-traumatic osteomyelitis require different medication and different surgical therapeutic strategies.Post-traumatic osteomyelitis is associated with avascular necrosis of bone and formation of sequestrum(dead bone).Surgical debridement is necessary in addition to antibiotic therapy.Generally,multidisciplinary techniques are required,including orthopaedic surgery,plastic surgery,as well as vascular surgery,especially for complex cases with soft-tissue defect.

Use of an articulated and spanning external fixator for Pilon fractures / 中华创伤骨科杂志

Objective To introduce our experience of treating Pilon fractures with an articulated and spanning external fixator. Methods From February 2002 to June 2004, 19 patients with high energy Pilon fractures (21 sides) were treated with a T- shaped unilateral articulated and spanning external fixator in our department. The fixators were placed medial1y across the ankle joint, and the fixation of fracture was enhanced by a combined use of limited internal fixation. The main causes of injury were traffic accidents and high altitude falling. The distal 2 pins were inserted into the talus and the tuberosity of calcaneus so that the subtalar joint was treated as an axis during ankle movement. At approximately postoperative 2 or 3 weeks, the articular hinge was released and the patient began ankle exercises. The clinical outcomes and complications were investigated and the postoperative X- ray examinations of the ankle were also evaluated. Results 19 patients were followed up for a mean period of 13 months. No infection of wound or pin site, no neurovascular complication or no nonunion was found. According to Baird & Jackson ankle joint scoring system, their functional evaluation of the ankle scored from 72 to 98 (averaging 92). Clinical results were excellent in 4, good in 12, fair in 3 and poor in 2. Reduction of the articular surface was anatomic in 16, fair in 3 and poor in 2 according to Burwell & Charnley classification. Conclusions External fixation with an articulated and spanning fixator combined with limited internal fixation is a satisfying technique to treat Pilon fractures. This technique can restore anatomical articular surface, allow early ankle joint motion, effectively decrease complications of both wound and bone healing, and prevent ankle joint stiffness after fixation.

Treatment of open tibial fractures of type ⅢB with unreamed locking intramedullary nails and skin flap grafting / 中华创伤骨科杂志

Objective To investigate the methods for emergency treatment of open tibial fractures of type ⅢB. Methods From February 1999 to February 2002, 16 cases of open tibial fractures of type ⅢB (age range: 19 47 years; average age: 27 years; the skin defect area: 4.5cm ?3cm-14cm ?6cm) were treated with administration of antibiotics, debridement, stabilization by unreamed locking intramedullary nails, and finally transfer or transplantation of cutaneous or musculo cutaneous flaps. Autografting from the iliac crest was done for 4 cases with bone defects. Results The follow ups averaged 9 months (ranging from 6 months to 14 months). The survival rate of flaps was 100%and all were free of deep infection. All fractures healed within 6 months in 14 patients and within 10 months in 2 patients. According to the Johner Wruchs method, the functions of ankle and knee were excellent in 14 cases, and good in 2 cases. Conclusion Emergency management of open tibial fractures of type ⅢB with unreamed locking intramedullary nails and skin flap grafting results in good outcome.

STRESS ANALYSIS OF THREE-DIMENSIONAL FINITE ELEMENT MODEL OF CALCANEUS WITH COMPRESSION OF POSTERIOR FACET AFTER FACTURE AND TALUS DURING GAIT / 解放军医学杂志

Objective To analyze the stress distribution of calcaneus and talus with posterior facet after compression fracture during gait by finite element method. Methods A wedge was resected to simulate the malunion calcaneus with compression fracture of posterior facet. The Bo?hler’s angle was reduced from 35? to 10?. The calcaneus and talus malunion were used to simulate for three phases of the stance during the gait (heel strike, midstance, push off). A finite element solver to calculate. The results were compared with normal condition. Results The stress distribution within the bone in condition of malunion was obtained, and sites of enhanced stresses for three phases were located. The results were significantly different from that of normal condition. Conclusion The results revealed the importance of reconstruction of calcaneal structure and helped us understand the cause of sequela of calcaneal fractures

Three-dimensional finite element model of calcaneus and talus during different gait phases / 第二军医大学学报

Objective:To establish a 3 dimensional finite element model of calcaneus and talus for analysing their stress distribution during different gait phases. Methods: CT scanning and computer image processing system were used to establish the model to simulate the situation of calcaneus and talus for 3 phases (heel strike, midstance, push off) during the gait. A finite element solver was used to calculate stress. Results: A three dimensional finite element model of calcaneus and talus was established. And the stress distribution within the bone was obtained and regions with elevated stress at 3 phases were located. The stress distributions of 3 phases were significantly different. The stress increased gradually from heel strike to push off. Conclusion:The model can be used to study biomechanics of calcaneus and talus. The regions of elevated stress of calcaneus and talus are important, which provide an insight into the factors contributing to the fractures and arthritis.

EFFECTS OF TRANSPOSITION OF FLAPS TO THE EXPRESSION OF bFGF IN CONCUSSION AREAS OF GUNSHOT INJURY / 解放军医学杂志

Flap pedicled with the arteria epigastrica superficialis was transposed to primarily repair firearm wound after the rabbit's posterior limb was shotted. Recovery of the wound was observed and the content of bFGF mRNA in myoideum of the concussion area was measured by reverse transcroption polymerase chain reaction(RT PCR). All wounds repaired with transposition of fascia flaps attained primary healing and the content of bFGF mRNA in myoideum of the concussion area was higher than that in the control group. The result suggests that transposition of arterialized fascia flaps could primarily repair firearm wounds successfully and the high expression of bFGF is one of the causes.

Separating cultivating and osteogeneric identifying of bone marrow stromal cells in rabbit / 中华显微外科杂志

Objective To search a kind of ideal seeded cell of bone tissue engineering. Methods Bone marrow tissue was fetched from rabbit,got bone marrow stromal cells by the method of density centrifuge,observed the conformation,growing feature and osteogeneric capability of the cells during culture in vitro by light microscope,transmission electron microscope and measure of osteogeneric capability. Results Most of the cultivated bone marrow stromal cells were triangle-like or shuttle-like cells. They growed and breeded rapidly,and had osteogeneric capability. They were easy to differentiate to osteoblasts. Conclusion The cultivated bone marrow stromal cells are matured ones,and could become the more ideal seeded cells for bone tissue engineering.