Biomechanical effect of major extremity vessels in choosing repair methods for peripheral artery injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the biomechanical effect of major extremity vessels to choose appropriate repair methods for vascular injuries of the extremities.</p><p><b>METHODS</b>The data of 385 patients (337 males and 48 females, aged 18-71 years, mean=32.6 years) including 403 injured vessels, who suffered from vascular injuries of the extremities and were treated in our hospital from October 1960 to August 2005, were studied retrospectively in this article. We compared the results of different repair methods for the defect of vessels and evaluated different injured vessels for repairing arterial injuries with anastomosis and venous graft, respectively.</p><p><b>RESULTS</b>A significant difference was found between the defect lengths of the arteries repaired with anastomosis and venous graft (P less than 0.0001). The upper limits of the confidence interval in the defect lengths of the brachial artery, the femoral artery and the popliteal artery were 3.43 cm, 2.38 cm and 2.42 cm, respectively, when repaired with anastomosis. The lower limits were 2.16 cm, 2.16 cm and 1.63 cm, respectively, when repaired with venous graft. The defect length of each artery repaired with venous graft had linear correlation with the graft length.</p><p><b>CONCLUSION</b>Because of the longitudinal biomechanical difference of human peripheral vessels, different options of repair are necessary for different arterial injuries.</p>

Orthopedic trauma of limbs associated with vascular injuries / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the treatment for patients with major vascular injuries associated with traumatic orthopedic injuries.</p><p><b>METHODS</b>A total of 196 patients, aged from 4-67 years with the mean age of 29.88 years, had major vascular injuries associated with traumatic orthopedic injuries and were treated in our hospital in a period of 44 years. The most common mechanism of trauma was blunt trauma (67.3%), open injuries accounted for 32.4% and 54.5% of the injuries were located in the lower extremities. The vascular injury frequently happened in the femoral artery (26.7%) and popliteal artery (20.3%). The treatment principle consisted of aggressive resuscitation, Doppler imaging and stable bone internal fixation with subsequent vascular repair and debridement. The vascular repair for injuries included end-to-end anastomosis (80 cases, 39.6%), interpositional vein graft (94, 46.5%), vascular decompression through fracture distraction (18, 8.9%), arterial ligation (6, 3.0%), vein patch (2, 1.0%), bypass graft (2, 1.0%), venous repair including autogenous vein graft (9, 24.3%) and ligation (28, 75.7%) and prophylactical fasciotomy (15, 7.4%). Postoperative amputation was performed in 16 cases (16.3%).</p><p><b>RESULTS</b>No intraoperative death was observed and all fractures united within 6 months. Limbs were salvaged in 180 patients (91.8%). Among these patients, early complications were found in 19 patients (9.7%) and late complications were observed in 8 patients (4.1%).</p><p><b>CONCLUSIONS</b>A well-organized approach, based on a specific treatment principle, not only improves clinical outcome but also does good to excellent functional recovery for patients with severe orthopedic injuries and concomitant vascular lesion.</p>

Morphological changes of roof of subacromial bursa in patients with rotator cuff tear / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the morphological changes of the roof of the subacromial bursa (SAB) and its involvement extent after rotator cuff tear.</p><p><b>METHODS</b>In the experimental group, the roof of SAB was obtained from 30 cases of rotator cuff tear both at the tear site and a site 2.5-3.0 cm distal to the tear site during rotator cuff repair. In the control group, the roof of SAB was obtained from the exposed site of recurrently dislocated shoulder or fractured humeral shaft of 8 cases. The specimens were stained with hematoxylin and eosin and observed under a transmission electron microscope. The cell number was quantitated through counting the blue-stained nucleus in SAB with a computer image analysis system.</p><p><b>RESULTS</b>The number of cells increased significantly in the roof of SAB in the experimental group compared with that of the control group. However, no difference of the bursal reaction was found among the type of rotator cuff tear, the bursa thickness and the presence of fluid in the bursa. The great majority of cells were type B cells observed under the transmission electron microscope.</p><p><b>CONCLUSIONS</b>The increase in cell number in the roof of SAB in the experimental group is a reactive increase rather than an inflammatory process and the involvement of SAB is not limited in extent. The change of the roof of SAB is a secondary reaction to the rotator cuff tear.</p>

Treatment of adult developmental dysplasia of hip (DDH) through total hip replacement / 中华创伤骨科杂志

When adult developmental dysplasia of hip (DDH) patients have developed secondary os- teoarthritis of hip (OAH) with serious clinical symptoms,total hip replacement (THR) is their first choice of treatment.The anatomic structures of the acetabulum and femur in these patients are ahnormal and special,such as small and shallow cup,small femoral head,and narrow medullary cavity at proximal femoral shaft.As a result,the THR for DDH patients is quite different from the conventional ones and is thus highly difficult.We review in this paper the clinical classification of DDH,which is important for its treatment,the difficulties we will have in THR, especially in acetabular reconstruction and femoral prosthesis placement,and also strategies to resolve them.

Expression of adenovirus-mediated neurotrophin-3 gene in Schwann cells of sciatic nerve in rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the expression of neurotrophin-3 (NT-3) gene in Schwann cells of rat sciatic nerve introduced by an adenovirus vector in vivo.</p><p><b>METHODS</b>A recombinant adenovirus vector for NT-3 (Ad-NT-3) was propagated in 293 packaging cells and titered with tissue culture infectious dose(50) (TCID(50)). Ad-NT-3 was injected directly into the rat sciatic nerve after transection and immediate repair. Immunohistochemical staining was employed to determine the expression of NT-3 in Schwann cells in rat sciatic nerve and the expressive intensity of the tissue slices of the sciatic nerve was measured with LEICA M550 image analysis system.</p><p><b>RESULTS</b>On the 2nd day after injection of Ad-NT-3, positive stain in the Schwann cells was apparent in the vicinity of anastomosis. NT-3 expression increased significantly on the 7th day (P<0.01) and then decreased 14-28 days after injection (P<0.01). There was no significant difference of NT-3 expression between the 14th and 28th day groups (P<0.05). Compared with the 2nd day group, the 14th and 28th day groups still maintained a relatively high level of NT-3 (P<0.01). Intact and repaired nerves, which were injected with adenovirus encoding LacZ genes (Ad-LacZ) or physiological saline served as controls, showed no NT-3-positive Schwann cells.</p><p><b>CONCLUSIONS</b>An adenovirus vector can be used to induce efficiently the expression of NT-3 gene in Schwann cells of rat peripheral nerves following nerve injury and repair, which suggests that neurotrophic factors can be introduced into Schwann cells with an adenovirus vector to promote peripheral nerve regeneration.</p>