Establishment and evaluation of rabbit model of closed tibial fracture / 中国骨伤

OBJECTIVE@#To explore the effect of a modified three-point bending fracture device for establishing a rabbit model of closed tibial fracture.@*METHODS@#The model of closed tibial fracture was established in 40 6-month-old male New Zealand white rabbits with a body weight of 2.5 to 3.0 kg, and the model was verified at 6 weeks after operation. Five rabbits underwent pre modeling without temporary external fixation before modeling, and then were fractured with a modified three-point bending fracture device;35 rabbits underwent formal modeling. Before modeling, needles were inserted, and splints were fixed externally, and then the fracture was performed with a modified three-point bending fracture device. The fracture model and healing process were evaluated by imaging and histopathology at 2 hours, 4 weeks, and 6 weeks after operation.@*RESULTS@#Two hours after modeling, the prefabricated module showed oblique fracture in varying degrees and the broken end shifted significantly;Except for 1 comminuted fracture, 2 curved butterfly fractures and 2 without obvious fracture line, the rest were simple transverse and oblique fractures without obvious displacement in formal modeling group. According to the judgment criteria, the success rate of the model was 85.71%. Four weeks after modeling, the fixed needle and splint of the experimental rabbits were in good position, the fracture alignment was good, the fracture line was blurred, many continuous callus growths could be seen around the fracture end, and the callus density was high. Six weeks after modeling, many thick new bone trabeculae at the fracture, marginal osteoblasts attached, and a small number of macrophages were seen under the microscope. The intramembrane osteogenesis area was in the preparation bone stage, the medullary cavity at the fracture had been partially reopened, the callus was in the absorption plastic stage, and many osteoclasts were visible. The X-ray showed that the fracture line almost disappeared, part of the medullary cavity had been opened, the external callus was reduced around, the callus was in the plastic stage, and the bone cortex was continuous. It suggests that the fracture model showed secondary healing.@*CONCLUSION@#The improved three-point bending fracture device can establish a stable rabbit model of closed tibial fracture, and the operation is simple, which meets the requirements of closed fracture model in basic research related to fracture healing.

Evaluation of left ventricular myocardial systolic function in patients with aortic stenosis by layer-specific strain / 中国医师杂志

Objective:To explore the value of layer-specific strain technique in evaluating the changes of left ventricular myocardial systolic function in patients with aortic stenosis(AS).Methods:From January 2019 to March 2022, 90 AS patients with left ventricular ejection fraction (LVEF) ≥ 50% in Hunan Provincial People's Hospital were selected, including 30 mild AS patients, 30 moderate AS patients, and 30 severe AS patients. In addition, 30 health examinees in the same period were selected as the control group. The normal echocardiographic parameters of the control group and the AS groups with different degrees were compared. The global systolic peak longitudinal strain (GLS) and global circumferential strain (GCS) of the left ventricular three-layer myocardium were measured by the layer-specific strain technique, and the correlation between the strain parameters and the peak systolic velocity (Vmax) of the aortic valve was analyzed.Results:The levels of interventricular septal depth (IVSD), left ventricular posterior wall depth (LVPWD), mean pressure gradient (MPG), and Vmax in mild, moderate and severe AS group were higher than those in the control group (all P<0.05); the GLS of each layer of left ventricle in mild, moderate and severe AS group was lower than those in control group (all P<0.05); the GCS of each layer of left ventricle in moderate and severe AS group was lower than those in control group (all P<0.05). The GLS of left ventricular endocardium in moderate AS group was lower than those in mild AS group (all P<0.05); the GLS and GCS of left ventricular layers in severe AS group were lower than those in mild and moderate AS group (all P<0.05). In AS group, GLS and GCS in endocardium, middle layer and epicardium were negatively correlated with Vmax ( r=-0.716, -0.660, -0.669, P<0.001; r=-0.669, -0.686, -0.598, P<0.001). Conclusions:The layer-specific strain can reflect the changes of left ventricular myocardial function in patients with AS, and has certain application value.

Internal fixation with elastic intramedullary nail versus plate-screw system for treatment of fibular diaphyseal fracture / 中华创伤骨科杂志

Objective To compare elastic intramedullary nail (EIN) and plate-screw (P+S) system in the treatment of fibular diaphyseal fractures. Methods From January 2014 to April 2017, 48 tibiofibular fractures were treated with internal fixation using EIN (21 cases) or plate-screw (27 cases). The 2 groups were compared in terms of intraoperative blood loss, operative time, fibular healing time, fibular union rate, ankle function and postoperative complications.Results All the patients were followed up for 3 to 24 months (average, 14.0 months). The intraoperative blood loss (17.9 ± 4.9 mL), operative time (23.2 ± 5.8 min) and fibular healing time(10.3 ± 1.8 weeks)for the EIN group were significantly less than those for the plate-screw group (28.9 ± 9.6 mL, 30.0 ± 10.7 min and 11.6 ± 2.0 weeks)(P <0.05). There were no significant differences be-tween the 2 groups in fibular union rate(95.2% versus 92.6%) or incision infection(0 versus 7.4%)(P> 0.05) . The AOFAS ankle-hindfoot scoring revealed 12 excellent, 8 good and one fair cases (91.0 ± 5.3 points on aver-age) in the EIN group, and 14 excellent, 10 good and 3 fair cases(90.1 ± 6.1 points on average) in the plate-screw group, showing no significant difference between the 2 groups(P=0.594). Conclusions Compared with plate-screw system, elastic intramedullary nail for fibular diaphyseal fractures may be in line with the biome-chanical characteristics of the fibula and with the basic principles of minimally invasive surgery. It may be ad-vantageous in blood loss, operative time and fracture healing but not in fibular union rate or functional recovery of the ankle. An appropriate way of internal fixation for a fibular diaphyseal fracture should be chosen according to the specific conditions of the patient.

Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice.</p><p><b>METHODS</b>From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20-65 years). The causes of the fractures included traffic accidents (13 cases), falls from a height (four cases), heavy lifting injuries (three cases), and sport injury (one case). All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction.</p><p><b>RESULTS</b>The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36-76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%.</p><p><b>CONCLUSION</b>The mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient's joint function and quality of life.</p>

Early and mid-term results of transarticular external fixation in the treatment of supination-external rotation type IV equivalent ankle fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To investigate the early and mid-term results of open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B 3.1) and provide evidence for clinical practice.</p><p><b>METHODS</b>This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014. There were 13 males and 9 females, mean age 38.9 years (range, 17-73 years). Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents (11 cases), falling from height (6 cases) and sports injuries (5 cases). The mean period of hospitalization was 9.8 days (range, 6-14 days). For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400, the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058. Patients' main complaints about inconvenience of daily life were also recorded.</p><p><b>RESULTS</b>All the 22 patients were followed up for 24-63 months (mean, 33.6 months). None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 ± 5.096, 79.59 ± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data (t = 26.221, p < 0.001; t = 11.910, p < 0.001; t = 11.571, p < 0.001). The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases).</p><p><b>CONCLUSION</b>In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satisfactory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.</p>

Analysis of the axial stretching force of the small splint fixation system / 中国骨伤

<p><b>OBJECTIVE</b>To measure the axial stretching force produced by the small splint fixation system in the treatment of the fracture.</p><p><b>METHODS</b>Dumbbell shaped plexiglass was machined to model the bone shaft with expanded two ends. Force transducer was set at the model fracture site to measure the stretching force produced by fracture fixation of the small splint with cloth aqueous bag that simulated the muscles and other soft tissue underneath.</p><p><b>RESULTS</b>There was positive relationship between the axial stretching force produced at the model fracture site and the transverse pressing force exerted by the external plates. The ratio of which was 1/10.</p><p><b>CONCLUSIONS</b>Muscle enwrapped with fascia is similar to the cloth aqueous bag system in mechanical structure. From this article, axial stretching force exists at the bone shaft fracture site when fixed by small splint which exerts the force transversely from the outside of the extrimity.</p>

Perioperative treatment of femoral neck fracture with deep venous thrombosis: A case report / 中华创伤杂志(英文版)

Deep venous thrombosis (DVT) is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.

Application of CO2 laser and self-made laryngeal dilator in the treatment of the laryngeal stenosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the treatment effect of CO2 laser and self-made laryngeal dilator on the laryngeal stenosis.@*METHOD@#Twenty-five patients with laryngeal stenosis were treated with CO2 laser and self-made laryngeal dilator. The laryngeal cavity scar was resected as much as possible by using CO2 laser and the laryngeal cavity was exposed by placing laryngeal dilator under general anesthesia.@*RESULT@#The 24 cases of all were successfully decanulated 1 to 12 months after operation and could breathe freely. One case had second operation and was successfully decanulated 9 months after operation. The follow-up for 1 to 2 years showed all cases speaking well and 3 cases recurrence.@*CONCLUSION@#The method for treating laryngeal stenosis using CO2 laser and self-mande laryngeal dilator is effective, fewer complication, less invasive, and faster recovery. The laryngeal dilator is made simply and conveniently.

Regeneration and functional recovery of rabbit knee joint after osteotomy under control of external artificial joint / 医用生物力学

Objective To discuss the possibility for regeneration of knee joint with normal function under bionics biomechanical environment. Methods Seven normal rabbits with two metal frames respectively mounted on their femur and tibia of single (right) side leg by two threading pins of 1.5 mm diameter were used. Then the external artificial joints, containing two four-bar-linkage inside and outside of the knee to simulate motion trajectory of the joint in sagital plane were connected with the two preset fixed frames before osteotomy. The arthro-cartilage of the knee joint, crucial ligaments, semi-lunar fibro-cartilages, and partial under-cartilage-osseous intra articular capsule were cut off during osteotomy, with the patella, sesamoid bones remained intact. Insertion sites of muscle tendons were not invaded as far as possible, and capsules with ligaments outside were kept complete when the incision wound was closed by suture. The rabbits could move freely after osteotomy. The range of motion (ROM) of the knees in sagital plane and bony gap between the femur and tibia were measured by X-Ray films during the fracture healing after osteotomy. Results External artificial knee joints were successfully installed on right legs of 6 rabbits among the seven. The rabbits moved freely after osteotomy under the control of minimal invasive external artificial joint in bionics trajectory. The average angles between femoral shaft and tibial shaft at the 1st week after osteotomy were from (144.7±15.62)° in extremely flexed position to (44.2±25.77)° in extremely extended position, with ROM of (100.5±29.03)°. At the 12th week, the average angles were from (139.4 ± 12.92)° in extremely flexed position to (40.4±22.04)° in extremely extended position, with ROM of (99.0±23.39)°. No significant differences were displayed in flexed/extended position and ROM between the 1st and 12th week, with the bony gaps of the knees still existed but decreased significantly from (4.03±1.84) mm at the 1st week to (2.32±1.05) mm at the 12th week. In contrast, bony gaps of the opposite knees were not changed significantly, which were (1.27±0.22) mm on average. At the end of 16th week after osteotomy, the external artificial joints were removed. Newly born cartilage, with white color and smooth surface, were covered at lower end of the femur and upper end of the tibia. Typical trochlear surface appeared at the front side of regenerated cartilage corresponding to the posterior surface of the patella. And the regenerated fibro-bundle linkage similar with ligament, which started from bony structure of regenerated lower end of the femur and inserted into regenerated upper end of the tibia, was observed in each rabbit. At the 25th week, the average angles between femoral shaft and tibial shaft were from (148.3 ± 4.75)° in extremely flexed position to (48.30±17.57)° in extremely extended position, with ROM of (100.0±20.80)°. In the opposite (left) leg, the average angles between femoral shaft and tibial shaft were from (148.3±7.5)° in extremely flexed position to (21.6±9.09)° in extremely extended position, with ROM of (126.7±6.88)°, and the average bony gap of the knees after osteotomy was (1.4±0.59) mm, while that of the opposite (left) knees was (0.92±0.35) mm. Conclusions The external artificial joint with bionics trajectory could reserve the space for regeneration of rabbit knee joint by providing motion modeling environment, and proved the stress adaption during fracture healing. The present results indicated that regeneration of the knee joint after intra-capsular osteotomy in bionics biomechanical environment was possible.

The key points to the successful repair of cerebrospinal fluid rhinorrhea / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize the clinical experience of endoscopic repair for cerebrospinal fluid (CSF) rhinorrhea in our department in the last 4 years.@*METHOD@#Clinical data of 16 patients with CSF rhinorrhea who underwent nasal endoscopic repair was analyzed retrospectively. The effect of etiology, image data, location of CSF leaks and surgical techniques on treatment were discussed.@*RESULT@#Among the 16 patients, 10 were diagnosed with spontaneous CSF rhinorrhea, 2 were diagnosed with traumatic CSF rhinorrhea, 3 were diagnosed with CSF rhinorrhea after catching cold and 1 was diagnosed with meningo-encephalocele in with CSF rhinorrhea. The leak was located by CT scan in 11 cases, by MRI in 7 cases. The common locations of the defect were the frontal sinus (3 cases), cribriform roof (3 cases), sphenoid sinus (6 cases) and the nasal cavity top (4 cases). All the cases were successfully cured after the first nasal endoscopic repair with autologous materials. None of patients had a reoccurrence during 10 to 42 months follow-up time.@*CONCLUSION@#The application of CT and MRC before surgery which could make an accurate diagnosis of the location and the size of the defect. The correct selection of repair materials, processing planting bed around the leakage and complete contacting leakage with graft bed are the key points to the successful surgery of CSF rhinorrhea.

Biomechanical test in vivo on reduction fixator for treating distal radius fractures / 医用生物力学

Objective To investigate the regular pattern of traction forces during the treatment of distal radius fracture by reduction fixator with pins. Methods A self-designed pin-lock style force transducer instead of two original pin locks in the distal of reduction fixator was adopted to conduct continuous testing on six cases of unstable distal radius fracture of forearms treated by reduction fixator in vivo. The value of static traction force and the added value of traction force in fist clenching at the postoperative 1st, 5th, 14th, 21st, 28th, 35th, 42nd, 49th day, was recorded respectively. Results The maximum and minimum static traction force was 9.93 kg and 2.26 kg, respectively, with mean value of (4.93±1.79) kg. The maximum and minimum traction force increment in fist clenching was 10.40 kg and 0.13 kg, respectively, with mean value of (3.17±2.42) kg. Conclusions Larger axial forces can be generated in muscles of the forearm, by both static tension and dynamic contraction, which might be a serious negative factor in healing unstable distal radius fractures.

A retrospective analysis of 163 cases with intractable epistaxis managed by nasal endoscopic surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical characteristics of intractable epistaxis and the application of nasal endoscopic surgery as the treatment.@*METHOD@#The clinical data of 163 patients with intractable epistaxis were retrospectively analyzed.@*RESULT@#The bleeding points were found in the following different sites, superior wall of inferior nasal meatus (31.3%, 51/163), olfactory cleft area (21.5%, 35/163), postero-inferior wall of nasal septum (20.8%, 34/163), middle nasal meatus (10.4%, 17/163) and Little area (8.6%, 14/163). The results showed that the bleeding points had correlation with age. According to the frequency of nasal bleeding, patients under the age of forty in turn occurred in superior wall of inferior nasal meatus, olfactory cleft area, Little area, postero-inferior wall of nasal septum and middle nasal meatus; patients over the age of forty occurred in superior wall of inferior nasal meatus, postero-inferior wall of nasal septum, olfactory cleft area, middle nasal meatus and Little area. There was a significant difference between the two groups (P < 0.05). All cases stopped bleeding after 1 time of treatment, and there was no complication during a followed-up for 3 months after management. Seven cases reoccurred bleeding in half a year, but they were finally cured under nasal endoscopic surgery.@*CONCLUSION@#The results indicate that we should pay attention to different bleeding points in different age groups. In addition, nasal endoscopic treatment is a reliable, convenient and effective method for intractable epistaxis and is the first choice after failed nasal packing.

Comparison of prediction performance of PAHs carcinogenicity between a BALB/c-E6E7 cell transformation assay and a BALB/c 3T3 cell transformation assay / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To predict the carcinogenicity of polycyclic aromatic hydrocarbons (PAHs) by cell transformation assay using BALB/c 3T3 cells and HPV16-E6E7-transfected BALB/c 3T3 cells (BALB/c-E6E7 cells).</p><p><b>METHODS</b>The cell transformation assays induced by PAHs using BALB-E6E7 cells and BALB/c 3T3 cells.</p><p><b>RESULTS</b>The initiating and promoting activities of PAHs examined in a BALB-E6E7 cell transformation assay were similar to in a BALB/c 3T3 cell transformation assay, which was up to the standard of agents classified by the IARC. There were much more transformed foci appeared and much shorter time consumed to accomplish phenotypic alterations in the BALB/c-E6E7 cell transformation assay than in the BALB/c 3T3 cell transformation assay. The BALB/c-E6E7 cell transformation assay was superior to the BALB/c 3T3 cell transformation assay in cost and labor performance, the sensitivity of transformation response.</p><p><b>CONCLUSION</b>The BALB/c-E6E7 cell transformation assay, with a satisfied prediction performance of initiating activity and promoting activity, would improve the overall process of safety and risk assessment of carcinogenicity.</p>

Percutaneous screw fixation for pelvic fractures with fluoroscopy-based navigation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the applications of fluoroscopy-based navigation in pelvic fractures and related surgical considerations.</p><p><b>METHODS</b>From May 2010 to December, 16 patients with pelvic fractures were treated with computerized navigation. There were 12 males and 4 females with an average age of 37 years (ranged from 20 to 54 years). Fractures were caused by traffic accident in 5 cases, crush injury in 5 cases and falling from height in 6 cases. Based on the Tile classification, there were 15 cases of Tile C type and 1 case of Tile B type. In these patients, 4 patients were treated with sacroiliac screw fixation; 2 patients were treated with sacroiliac screw fixation, screw fixation for pubic symphysis diastasis and pubic fractures; 8 patients were treated with sacroiliac screw fixation and screw fixation for pubic fractures; 2 patients were treated with screw fixation for pubic fractures. The index such as screw inserting time, accurance of inserting screws, intra-operative blood losing, injuries of nerve, vascular and other organs, reduction conditions were observed.</p><p><b>RESULTS</b>A total of 36 screws were inserted. The average time was 20 min for each screw placement. The blood loss ranged from 10 to 20 ml. There were no wound infections, neurovascualr injuries and other organ injuries. The postoperative pelvic X-ray and three-dimensional CT showed that the fractures had good reduction and all the screws had good position.</p><p><b>CONCLUSION</b>Percutaneous screw fixation of pelvic fractures with fluoroscopy-based navigation have advantages such as little trauma, less blood loss, little complication, reliable fixation and no blood transfusion, which can reconstruct the stability of the pelvic ring, but need adequate preoperative reperation and high requirements for the surgeon.</p>

Pretreatment methods of urine proteomics in children with primary nephrotic syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To optimize a pretreatment method of urine proteomics in children with primary nephrotic syndrome.</p><p><b>METHODS</b>Urine from children with primary nephrotic syndrome was treated in different pH and isolated by cold acetone precipitation for different durations. Then the amounts and kinds of proteins were compared by quantify, SDS-polyacrylamide gel electrophoresis (SDS-PAGE) and two-dimensional electrophoresis (2-DE) in order to optimize a way to deal with urine protein.</p><p><b>RESULTS</b>Most proteins were obtained at pH 2.7. The amounts of protein precipitated by acetone for 0.5 hr was obviously less than those precipitated for 1 and 2 hrs (P<0.05), while there was no significant difference between the amount of protein precipitated for 1 and for 2 hrs. Protein precipitated by cold acetone for 1 hr at pH 2.7 was selected as the best pretreatment method. Satisfactory 2-DE maps can be acquired.</p><p><b>CONCLUSIONS</b>Urine protein can be best obtained at pH 2.7 and precipitated by cold acetone for 1 hr.</p>

Using radiographs to analyze equivalent weakest transverse interface of fracture healing / 医用生物力学

Objective An effective but simple method for quantifying the fracture healing progress was provided to obtain more information on fracture healing mechanics from plain X-ray film. Method Twelve rabbits were used for experimentally osteotomy at the middle tibiae, each of which was fixed by the sliding fixator with four pins of 1.5 mm diameter, with mini transducer of displacement measuring the sliding micro movement between the fractured bone fragments, denoted as ΔL. The bending rigidity, denoted as K=P/ ΔL, of the rabbits’ tibia (with sliding fixator together) were recorded by computer data assembling system once a week, where P was the load on the fracture site from anterior of the tibia by manual operation of a loading transducer. The anterior posterior and lateral radiographs were also taken every week by digitally upgraded X-ray radioscope. The effective weakest transverse curved interfaces were found, and the equivalent bending moments of inertia were calculated from the radiographs automatically, by gray scan along the longitudinal axis of the tibia upon the image programs edited in Delphi programming environment. And they were used for quantitative description of the rigidity of the healing bone. Results The sliding fixators were removed in 29~41 days after the osteotomy. Ratios of the minimum to the maximum of equivalent bending moments of inertia for each fracture bone were calculated. And they were found to increase via the healing time. The means of the ratios of all twelve rabbits calculated from lateral radiographs were (0.31±0.17) for the first week, (0.34±0.13) for the second week，(0.43±0.20) for the third week, and (0.56±0.23) for the fourth week after the osteotomy, respectively. From anterior posterior radiographs, the means of the ratios were (0.40±0.19), (0.47±0.16)， (0.56±0.20), and (0.66±0.11), respectively. These ratios were significantly correlated with the bending rigidity K of the fracture tibia of the rabbits. The means of K value was （3.976±4.986）N•μm-1 before the operation，and （0.679±1.026）N•μm-1 for the first week，（2.115±3.233）N•μm-1 for the second week，（3.459±4.723）N•μm-1 for the third week and （4.788±4.831）N•μm-1 for the fourth week after the operation, respectively. Conclusions The growth of external callus has its own rules. It can be distinguished from plain radiographs easily, and it grows from either side of the fracture site and meets together gradually, filling up the gap at the fracture site at last. The methods described in this paper could reflect the feeling when reading the radiographs.

Effects of tension relaxation by small needle knife on muscle tension and nerve endings after compression of gracilis muscle in rats / 中国骨伤

<p><b>OBJECTIVE</b>To determine the effect of tension relaxation by small needle knife on the muscle tension and morphology changes of nerve terminals when sustained pressure was applied to muscular tissue.</p><p><b>METHODS</b>Rat gracilis muscles were exposed to pressure in vivo at 70 kPa for 2 hours. Sixty rats were divided into three groups: normal, control and experiment group respectively. In all rats except the six normal ones, the lower legs were considered as the control group, and the right left as experiment group. At day 1, 2 and 3, 9 rats from the two groups were randomly selected and sacrificed in order to determine the muscle tension change. At the same time, muscle histology and morphology changes of nerve terminals were observed.</p><p><b>RESULTS</b>Abnormal tension increased in muscles under compression of 70 kPa. At the 1st and 2nd days, there were no significant differences between the two groups. Compared with control group, the tension was lower in experiment group, and there was statistically significant difference (P < 0.01) between the two groups. Exposure of striated muscle tissue to intensive and prolonged compression may pathologically alter its microstructure. Histological evaluation showed that this stiffening accompanied extensive necrotic damage. The changes could not be found in the nerve terminals.</p><p><b>CONCLUSION</b>Deep muscle tissue that undergoes prolonged compression may significantly increase its stiffness during acute injury. Tension relaxation applied by small needle knife can effectively reduce the mechanical load which is harmful to the whole tissue.</p>

Long-term effects of vascularized pisiform transfer for Kienb(o)ck's disease / 中华骨科杂志

Objective To evaluate the long-term efficacy of vascularized pisiform transfer for patients with Kienb(o)ck's disease in Lichtman stages Ⅲ-Ⅳ. Methods Eleven patients were reviewed to analyze results after lunate resection and vascularized pisiform transfer for Lichtman stages Ⅲ and Ⅳ. There were six men and five women. Age ranged from 20 to 67 years with a average of 41.0±14.3 years. According to Lichtman stage. There were 4 cases in stage Ⅲa, 5 cases in stage Ⅲb, and 2 cases in stage Ⅳ. Assessment criteria included subjective assessment of pain, visual analogue scale (VAS), range of motion (ROM), grip power,Cooney wrist score and radiographic changes on each follow-up visit. The radiographic changes including pis iform bone location, shape, sclerosis change, osteoarthritis, carpal height ratio, Nattrass index, Radioscaphoid angle and ulnar variance were recorded. Results The follow-up periods of all of cases were 61-202 months,with an average of 104.1 months. Pain had improved in 10 patients and disappeared in 7 cases. The VAS score was 2.2±1.9 at follow-up visit. Range of motion of injured wristw as only 65.3% of opposite side. Grip power was 84.3% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 7cases, fair in 2 cases and poor in 1 case, with the excellent and good rate of 72.7%. Radiologically, 8 cases had normal position of the pisiform bone, 2 had volar displacement and 1 had ulnar displacement which leaded to widen scaphopisiform space. Six pisiform bones had normal trabecular structure, three had degenerative changes. Bone sclerosis was seen in 2 cases and osteoarthritis was found in 3 patients. Compared with radiographic parameter before surgery, carpal height ratio and Nattrass index significantly lowered and radioscaphoid angle significantly increased. Conclusion Lunate resection and vascularized pisiform transfer is an effective method for Kienb(o)k′s disease in stages Ⅲ-Ⅳ. Although carpal collapse appeared postoperatively,the results show high patient satisfaction and good function after vascularized bone transplantation.

Comparison of lentivirus and adenovirus vector mediated gene transfer into cultured spiral ganglion cells / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#We aimed to compare the characteristics between lentivirus and adenovirus vector mediated gene transfer into cultured spiral ganglion cells (SGCs).@*METHOD@#SGCs from newborn rats were cultured and exposed to lentivirus-GFP and adenovirus-GFP vectors. GFP expression and the cell morphology were evaluated under epi-fluorescence microscope at 3 days and 7 days after exposure. Survival number of SGCs was counted, and the average percentage of SGCs with GFP expression was calculated, and axon length was measured by ImageJ software.@*RESULT@#Cultured SGCs were transfected by either adenovirus or lentivirus vector successfully. The adenovirus vector presented an instant and efficient transfection. However, the expression of GFP went down after 7 days. In lentivirus-GFP group, GFP expression was detected at 7 days after exposure, and the number of cells with GFP expression increased gradually in the following days. Statistical analysis revealed that there were no differences in survival number of SGCs and average axon length among lentivirus-GFP group, adenovirus-GFP group and control group.@*CONCLUSION@#Cultured SGCs can be transfected by either lentivirus vector or adenovirus vector safely and efficiently. SGCs are more susceptible to adenovirus vector, but GFP persists for a longer period after the lentivirus-mediated gene transfer.

Influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by earthquake / 中南大学学报(医学版)

Objective To determine the influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by Wenchuan earthquake,to discuss the clinical symptom and to improve the clinical treatment. Methods The clinical symptom, drug therapy, limb incision decompression, hemodialysis, and limb salvage of hyperpotassemia caused by earthquake were analyzed by logistic regression. Results All the 37 patients received drug therapy: 9 patients received incision and decompression singlely,8 received hemodialysis singlely,and the other 20 received decompression and hemodialysis simultaneously. The concentration of potassium decreased from (6.25 ± 0.91) mmol/L to (4.47±0.65) mmol/L,with significant difference (P＜0.05).Five patients with Gustilo III grade open injury received amputation at the concentration of potassium of (6.13±(0.78)) mmol/L, while the concentration of potassium for the other 32 patients was (6.25±0.31) (mmol/L). There was no significant difference between them(P>0.05). Logistic regression analysis found the time of compression, the time before incision and decompression, and the time before hemodialysis were the main factors to affect limb salvage. The OR value of these factors was 4.394, 3.793 and 5.432;while the P value was 0.013, 0.047, and 0.015, respectively. Conclusion Decreasing the time of compression, appropriate incision and decompression, and hemodialysis help improve the result of limb salvage in hyperpotassemia patients with bone fracture caused by earthquake.