Comparative study of serum levels of BMP-2 and heterotopic ossification in traumatic brain injury and fractures patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the relationship between serum level of bone morphogenetic proteins-2 (BMP-2) and heterotopic ossification (HO) in traumatic brain injury (TBI) and fractures patients, providing the theoretical evidence for the clinical prevention of HO.</p><p><b>METHODS</b>From December 2007 to January 2009, 145 with trama patients were selected. There were 96 closed primary traumatic brain injury patients, 1 penetrating primary traumatic brain injury, 29 fractures of the radius and ulna, 11 fractures of the humerus, 32 fractures of the tibia and fibula, 27 fractures of the femur. All patients were divided into three groups (i.e., group A, group B and group C) by the type of fracture. Fifty-seven patients in group A (TBI only), including 37 males and 20 females, ranged in the age from 29 to 61 years, with an average age of (43.91 +/- 11.09) years. The disease course was from 13 to 67 d, with an average duration of (18.96 +/- 10.46) d. Forty-eight patients in group B (fractures only), 25 males and 23 females, ranged in age from 31 to 54 years, with an average age of (41.73 +/- 8.41) years. The disease course was from 6 to 48 d, with an average duration of (16.02 +/- 8.71) d. Forty patients in group C (TBI combined with extremities fractures), including 23 males and 17 females, ranged in age from 30 to 60 years, with an average age of (45.87 +/- 14.15) years. The disease course was from 18 to 76 d, with an average of (21.28 +/- 13.02) d. Thirty-one extremities fractures with no significant separations or displacements of fragments were treated with traction reductions, cast immobilization or splint fixations. Sixty-eight fractures with significant separations and displacements of fragments were treated with intramedullary nail fixations or screw internal fixations. Sixty-three TBI patients were treated with open-skull surgeries immediately while 34 TBI patients were treated with stanching bleeding, reducing intracranial pressure and improving cerebral blood circulation. All patients were also divided into two groups (group D and group E) according to the 14-to 16-month follow-up X-ray film results. Seventeen patients in group D (HO had been found), including 11 males and 6 females, ranged in age from 29 to 55 years old, with an average age of (46.88 +/- 7.13) years. The disease course was from 6 to 30 d, with an average of (20.18 +/- 9.78) d. All 128 patients in group E (HO had been not found), including 74 males and 54 females, ranged in age from 33 to 61 years, with an average age of (43.31 +/- 12.94) years. The disease course was from 15 to 76 d, with an average of (18.42 +/- 11.58) d. The 49 subjects in group F (normal controls), 29 males and 20 females, ranged in age from 31 to 60 years, average (43.50 +/- 14.40) years. Peripheral blood samples were taken for the determination of BMP-2 in blood serum on 0.5, 3, 15 d and 30 d after fractures by enzyme-linked immunosorbent assay (ELISA). Analysis of variance and least significant difference test were done with the help of SPSS 13.0 statistic software.</p><p><b>RESULTS</b>The incidence rates of HO between the TBI only patients (21.05%, 12/57) and the fractures only patients(4.17%, 2/48) were significant different (chi2=5.05, P<0.05). Serum levels of BMP-2 at 0.5, 3 d and 15 d between group A and group B were significant different. Serum levels of BMP-2 at 0.5, 3, 15 d and 30 d between group D and group E were significant different. Serum levels of BMP-2 at each time in each group were higher than the control group (51.30 +/- 23.41 ng/L) (P<0.01).</p><p><b>CONCLUSION</b>High serum levels of BMP-2 in TBI only group is one of factors in causing HO. Serum level of BMP-2 at 15 d since fractures may be the obvervational index of HO prevention.</p>

Reverse fasciocutaneous flap pedicled with perforator branch of anterior medial malleolus artery for soft tissue defect on the dorsal side of foot / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the therapeutic effect of reverse fasciocutaneous flap pedicled with perforator branch of anterior medial malleolus artery for soft tissue defect on the dorsal side of foot.</p><p><b>METHODS</b>The perforator branch was located under the guidance of Doppler flowmeter. The flap was designed along the saphenous neurovascular axis. Then the flap was transferred reversely with the perforator branch as rotation point.</p><p><b>RESULTS</b>From Feb. 2002 to Mar. 2008, 12 cases were treated and followed up for 6 - 18 months. All the flaps survived completely. The flap size ranged from 13.5 cm x 3.0 cm to 8 cm x 3 cm. The perforator branch located at 0.5 - 1.5 cm anterior-inferior to the medial malleolus. Both the cosmetic and functional results were satisfactory.</p><p><b>CONCLUSIONS</b>The flap has a reliable blood supply and a flexible design. It is easily performed for soft tissue defect on the dorsal side of foot. It is a new type flap which combined neurocutaneous vascular flap with the perforator flap.</p>