Résumé
BACKGROUND:At present,there are some limitations in evaluating the severity of acute spinal cord injury,and a rapid and accurate evaluation method is urgently needed. OBJECTIVE:To analyze the correlation between the expression levels of serum oxidative stress and nerve injury indexes and the severity of the disease in patients with acute spinal cord injury. METHODS:A total of 65 patients were included in the study from August 2020 to May 2022,including 32 patients in the experimental group(acute spinal cord injury)and 33 patients in the control group(simple spinal fracture).American Spinal Injury Association(ASIA)Impairment Scale and neurological function score were evaluated within 8 hours of admission.Meanwhile,serum levels of superoxide dismutase,malondialdehyde,glutathione,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase were detected and compared between the two groups.The correlation between the expression levels of the above serological indicators in serum and ASIA impairment grade and AISA neural function score was analyzed. RESULTS AND CONCLUSION:The average serum levels of superoxide dismutase and glutathione in the experimental group were significantly lower than those of the control group(P<0.001),while the average serum levels of malondialdehyde,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase in the experimental group were higher than those of the control group(P<0.01).The serum levels of superoxide dismutase and glutathione in the experimental group were positively correlated with the damage grade of AISA(r=0.862 4,0.849 3,P<0.01),while the serum levels of malondialdehyde,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with the damage grade of AISA(r=-0.866 1,-0.638 1,-0.746 6,P<0.001),and the serum level of nitric oxide was not significantly correlated with the damage grade of AISA(r=-0.177 5,P>0.05).The serum level of glutathione in the experimental group was positively correlated with AISA sensory function scores(r=0.569 9,P<0.001),while the serum levels of malondialdehyde,glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with AISA sensory function scores(r=-0.574 1,-0.099 2,-0.708 6,P<0.05),and the serum levels of superoxide dismutase and nitric oxide were not significantly correlated with AISA sensory function scores(r=0.230 8,-0.376 2,P>0.05).The serum levels of superoxide dismutase and glutathione in the experimental group were positively correlated with ASIA motor function scores(r=0.380,0.524 7,P<0.05);the serum levels of malondialdehyde,glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with AISA motor function scores(r=-0.577 9,-0.452 2,-0.662 8,P<0.05);and the level of nitric oxide had no significant correlation with AISA motor function scores(r=-0.049 7,P>0.05).To conclude,the serum levels of superoxide dismutase,malondialdehyde,glutathione,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase in serum of patients with acute spinal cord injury are significantly correlated with ASIA impairment grade and ASIA neural function score,which could be used as biomarkers for early clinical assessment of disease severity.
Résumé
Objective To explore the treatment of fracture of ulna coronoid process. Methods Sixty-five patients (66 cases) of fractures of ulna coronoid process were treated between January 1997 and April 2005. There were 54 males and 11 females with an average age of 32 years old (range, 8-76 years old). 29 fractures occurred on the left extremity, 35 on the right and 1 on the bilateral. The mechanism of injury was fall in 23 sides, traffic injury in 16, wringer injury in 14, fall from a height in 10 and other trauma in 3. 60 cases were fresh fractures, 6 old fractures and 7 open fractures. 38 patient suffered multiple fractures in ipsilateral elbow. According to Regan-Morrey classification, there were 22 type Ⅰ, 30 type Ⅱ and 8 type Ⅲ. In addition, there were 6 cases with a sagittal fracture line which we defined them as "type Ⅳ". In this series, immobilization of the elbow in flexion or extension with a long arm plaster splint or cast were applied in 37 sides, open reduction and internal fixation in 23 sides, resection of fragments in 5 sides and reconstruction of coronoid process in 1. Results 43 cases(44 sides) were followed up for an average 15 months (range, 7-32 months). All the fractures healed well, and the averaged union time was 12.2 weeks with a range of 6-16 weeks. The clinical results were evaluated according to Morrey's scale, 25 sides (56.8%) were rated as excellent, 9 (20.5%) as good, 6 (13.6%) as fair and 4(9.1%) as poor. No deep infection, loosening or breakage of the internal fixators and other severe complications occurred except for 2 cases with subluxation of elbow joint and 2 cases with myositis ossificans. Conclusion For type I and some cases with a stable typeⅡand Ⅳ which have no or mildly displaced fragment of the coronoid process, conservative treatment are applicable. Open reduction and internal fixation are suitable for all type Ⅲ and some cases with an unstable typeⅡ and Ⅳ which have a obviously displaced fragment of the coronoid process.