Augmentative plate fixation for treatment of femoral atrophic nonunions subsequent to intramedullary nailing / 中华创伤杂志

Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.

The treatment of femoral shaft hypertrophic nonunions with exchange nailing versus augmentation plating / 中华骨科杂志

ObjectiveTo compare the outcomes and indications between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for femoral shaft hypertrophic nonunion after femoral nailing. MethodsFrom April 1998 to June 2009, 20 patients with femoral shaft hypertrophic nonunions after femoral nailing were treated with EN (11 patients) and AP (9 patients) respectively. There were no significant differences between the two groups with respect to the patient's age, gender, associated injuries, anatomical location and type of femoral fracture. Patients were evaluated by imaging and clinical function at 1, 2, 3, 4,6, and 12 months after surgery, and then every year postoperatively, to observe the callus and the recovery condition of the affected limb function. Fisher exact test and t'-test were performed to compare the outcome and complications respectively. ResultsAn unpaired t'-test showed no significant differences with respect to follow-up time, operating time, intraoperative blood loss, postoperative drainage, length of stay, time to radiographic union, time to clinical union, and AAOS score between the two groups. The cost of hospitalizations in the EN group was higher than in the AP group(t'=16.4, P=0.013). Four nonunions in the EN group failed to achieve union, which 3 patients were subsequently treated with AP and simultaneous autogenous bone grafting and 1 patient was treated with nail dynamization. All 9 hypertrophic nonunions in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP (χ2=6.01 ,P=0.008). ConclusionEN has been an excellent choice for aseptic isthmal femoral nonunion without a large bone defect subsequent to intramedullary fracture fixation, and AP can be an effective solution in cases of nonisthmal femoral nonunion and bone defect and failed exchange nailing.

Analysis of death causes in 44 patients diagnosed initially as mild to moderate craniocerebral trauma / 中华创伤杂志

Objective To discuss the death causes in patients diagnosed initially as mild to moderate craniocerebral trauma. Methods A retrospective study was done on 44 deaths, who arrived at the emergency department with a mild or moderate craniocerebral trauma from 2004 to 2008. There were 35males and nine females at age range of 19-85 years (average 53 years). There were 17 patients with Glasgow coma score (GCS) 13-15 points and 27 with GCS 9-12 points. The causes of injury included road traffic accidents in 18 patients, tumbling in 18, falling from height in six and unknown factors in two respectively. Of all, 18 patients underwent surgical intervention and 26 received conservative therapy.Results The causes of death were cerebral hernia in 25 patients (57%), various complications in 15(34%), multiple trauma in two (5%) and sudden death in two (5%) respectively. Conclusions The primary death cause is cerebral hernia in the patients with mild to moderate craniocerebral trauma.Attention should be paid to prevention and control of complications and multiple trauma during treatment of primary head injury. The prognosis may be badly affected by human factors.

Application of invasive intracranial pressure monitoring in treatment of traumatic brain injury / 中华创伤杂志

Objective To discuss the effect of invasive intracranial pressure (ICP) monitoring in treating traumatic brain injury (TBI).Methods A total of 116 patients with TBI (including 112 with severe TBI,3 with moderate TBI and 1 with slight TBI) were monitored by using invasive ICP monitoring device in Tiantan Hospital from July 2003 to December 2007.All patients underwent ICP monitoring within first 24 hours after admission and treated with corresponding therapy including drug therapy and surgical treatment.Results Of all,74 patients survived but 42 with severe TBI died.Of 75 patients with GCS 3-5,33 died,with morbidity rate of 44%.Of 37 patieats with GCS 6-8,nine died,with morbidity rate of 24%.Four patients with GCS 9-15 survived.Conclusions Continuous ICP monitoring can help timely understanding of ICP changes for early diagnosis and correct treatment of TBI and is useful for judgment of prognosis.Low GCS and high ICP are predictors for bad outcome.

Combined Therapy of Tension-type Headache after Acute Brain Trauma / 中国康复理论与实践

@#Objective To explore the effect of the combined therapy on tension-type headache after acute brain trauma.Methods Fourteen patients with mild brain trauma and complained severe headache diagnosed as tension-type headache were treated by nerve and pain points block with a mixture of 0.4% lidocaine, triamcinolone acetonide 10 mg accompanied by celecoxib and eperisone. After the block, the degree of pain severity and the duration of headache were observed and recorded. The therapeutic effects were evaluated with visual analogue scale (VAS).Results There was a significant decrease in the degree of pain severity and the duration of headache after treatment ( P<0.01).Conclusion The combined therapy mainly including nerve block has a significant effect on tension-type headache after acute brain trauma.

Operative treatment of complex talar body fracture through approach of internal or external malleolus osteotomy and Absorbable screw for fixation / 中国矫形外科杂志

[Objective]To introduce an operative treatment of complex talar body fracture and discuss the therapeutic effect in the near future.[Method]From March 1999 to January 2003,8 patients of complex talar body fracture in our department were treated.There were 5 males and 3 females with an average age of 28.9 years from 19 years to 46 years.The injuries were caused by fall in 3 cases,traffic accident in 3 cases,crash in 1 case,and on left 5 cases,right 3 cases.Two cases were combined with malleolus fracture and 1 case with open fracture and dislocation.All patients were treated with operation through approach of internal or external malleolus osteotomy and useing Absorbable screw for fixation.[Result]All the patients were followed up 1 to 3 years,average 1.3 year.By the assessment of clinical effects dependingon the complaints,functions and radiological results of the ankle and subtalar joint,4 patients were rated as being excellent,2 patients good,1 fair and 1 poor,the total rate of being excellent and good was 75%.No postoperative avascular necrosis of the talar was seen on radiographies.[Conclusion]Operation through approach of internal or external malleolus osteotomy and Absorbable scrow for fixation is a good method for treatment of complex talar body fracture.

Early surgery for acute injuries of cervical spinal cord / 中华创伤骨科杂志

Objective To study the clinical results of early surgery for acute cervical spinal cord injury. Methods 24 cases of acute cervical spinal cord injury were treated with early surgery in our hospital from 1999 to 2002. The average interval from injury to surgery was 67 hours. The injured cervical segments were reduced, decompressed and fixed through anterior approach, posterior approach or anterior posterior approach. Results 22 cases got follow ups of 12 to 38 months (mean 18 months), but 2 cases were lost. 2 cases of the 11 patients of ASIA Grade A did not experience any restoration, but all the other patients got significant restoration and an average improvement of 1.8 ASIA grades. Conclusion Operation should be performed as soon as possible for acute cervical spinal cord injury, for good results can be achieved by early surgery.

Pathological observation of brain arteries and spontaneous aneurysms in hypertensive rats / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the role of hypertension in the pathogenesis of cerebral aneurysms in rats.</p><p><b>METHODS</b>Twenty spontaneous hypertensive rats (SHR) and 10 Wistar-Kyoto rats (WKY) were included in this observational study. Animals were fed with normal diet and drinking water. No experimental modifications were undertaken in either group. They were sacrificed at one year of age, the bifurcations of the circle of Willis were dissected and longitudinal serial sections were prepared for light microscopic and transmission electron microscopic study.</p><p><b>RESULTS</b>In the SHR group, 2 of the 20 rats formed an aneurysm respectively at the bifurcations of the basilar artery. As revealed by electron microscopy, injury at the bifurcation of the artery first occurred on the steeper side of the intimal pad. Furthermore, loss of endothelial cells, small depressions on the intima, disruptive internal elastic lamina and lymphocytes or red blood cells infiltration were noted at the steeper side of the intimal pad. No significant changes were observed in WKY group.</p><p><b>CONCLUSIONS</b>Cerebral aneurysms can form spontaneously in SHR without ligation of the common carotid artery and without a diet containing beta-aminoproprionitrile. Long-standing systemic arterial hypertension is one of the etiological factors that contributes to aneurysm formation in SHR rats.</p>

Changes of cerebra flow under monitoring of transcranial Dopple in posterior retroperitoneoscopic surgery / 医学研究生学报

Objective:To explore the changes of cerebra flow in retroperitoneoscopic surgery.Methods: Twenty-two patients undergoing retroperitoneoscopic surgery were selected.We measured Vm、Delt and PI with transcranial Dopple(TCD),and measured endothelin(ET),neurol peptide Y(NPY),Calcitonin gene-related peptide(CGRP) in plasma before CO2 insufflation,after CO2 insufflation,and after CO2 deflation.Results:Vm and Delt increased significantly at 30 min after pneumoperitonenum,and reached the peak at 90 min after pneumoperitonenum.PI decreased significantly 90 min after pneumoperitonenum.The plasma concentrations of ET and NPY increased significantly 60 min after pneumoperitonenum. Conclusion:Cerebra flow changes significantly in patients undergoing retroperitoneoscopic surgery,which is correlated to the changes of plasma CO2 and vascular bioactive substances.

Surgical treatment of severe lower cervical fracture by one stage anterior and posterior approach / 中华创伤骨科杂志

Objective To evaluate the clinical results of one stage ante rior and posterior approach in the treatment of severe lower cervical injury. Me thod 8 cases of severe lower cervical injury underwent reduction, decompression and fixation through one stage anterior and posterior approach. 6 cases had fra cture and dislocation of cervical spine, and 2 cases cervical spine burst fractu re with cervical stenosis. Their clinical and radiographic records were reviewed retrospectively. Results Follow-ups of a mean period of 14 months showed that satisfactory recovery of neurological function was achieved. The Frankel Grade w as A in 7 cases and B in 1 case before operation, but D in 2 cases, C in 3 cases , and B in 1 case after operation except in 2 cases who had no improvement and r emained A. X-ray film demonstrated satisfactory stabilization of the fracture a nd dislocation, complete fusion of autograft, and preservation of the normal int ervertebral height and cervical lordosis. Conclusion One stage anterior and post erior approach operation is essential, safe and effective when radiographs demon strate that lower cervical canal is compressed from both anterior and posterior directions and clinical symptoms show severe neurological defects.

Surgical treatment of complicated Pilon fractures / 中华创伤骨科杂志

10?) and delayed union of tibia in 4 sides. Conclusion Many factors can affect the prognosis of tibial Pilon fracture, but the key points for a successful operation are right procedure and timing of surgery.

Study on hemodynamic changes of the ophthalmic artery with color Doppler ultrasonography after strabismus surgery / 中华超声影像学杂志

0.05).②The ophthalmic artery showed a significant increase in Vs and PI,RI 1 week postoperatively(P 0.05).Conclusions Two horizontal rectus muscle operations do cause significant hemodynamic changes in the ophthalmic artery 1 week postoperatively,but these changes in the ophthalmic artery revive normal 1 month postoperatively.