A quantitative anatomic study of plate-screw fixation of the acetabular anterior column through an anterior approach.

BACKGROUND: Screw penetration of the hip joint is a serious complication during plate-screw internal fixation of acetabular anterior column or anterior wall fractures through an anterior approach. The purpose of the cadaveric study is to determine safe paths for screw placement on the anterior column of the acetabulum. METHODS: A total of 46 hemipelvises (24 male, 22 female) were utilized in this study. These hemipelvises were sectioned, and formed cross-sections anterior endpoint (AEP), anterior quarter point (AQP), midpoint (MP), posterior quarter point (PQP) and posterior endpoint (PEP), respectively. Positions at distances of 0.5-, 1.0-, and 1.5-cm lateral to the pelvic brim on cross-section AQP, MP and PQP were marked, respectively. The nearest distance from entry points of the anterior column to the hip joint, the average medial angulation of cortical screws at 0.5-, 1.0-, and 1.5-cm entry points on cross-section AQP, MP and PQP were measured. RESULTS: The nearest distance from 0.5-, 1.0-, and 1.5-cm entry points to the hip joint is 15.6 +/- 1.5, 13.1 +/- 1.2, and 11.2 +/- 1.4 mm, respectively. The maximum medial angulation to provide safe cortical screw placement at 0.5-, 1.0-, and 1.5-cm entry points is 8.2 +/- 2.2 degrees, 14.9 +/- 3.4 degrees, and 26.1 +/- 4.5 degrees, respectively. CONCLUSIONS: During the operation of plate-screw fixation of the anterior column on the acetabulum, there are three ways to avoid screw penetration of the hip joint. The first one is to use the long screw. Its entry point is placed as close to pelvic brim as possible, and the entry direction is parallel to the quadrilateral surface. The second one is to use the short screws whose lengths are 14, 12 and 10 mm and locate them in the region between the pelvis brim and 0.5-cm entry point, between 0.5- and 1.0-cm entry point, between 1.0- and 1.5-cm entry point, respectively, regardless of the direction of the screw placement. The third one is to take quadrilateral surface as a reference plane, and adjust the medial angulation of the screw placement according to different target locations, i.e., in the coronal plane ranges from 0 degrees to 10 degrees in the region between pelvis brim and 0.5-cm entry point, 10 degrees-20 degrees in the region between 0.5- and 1.0-cm entry point, and 20 degrees-30 degrees in the region between 1.0- and 1.5-cm entry point.

Clinical anatomic study of internal fixation of acetabular posterior column plate technique / 中华外科杂志

<p><b>OBJECTIVES</b>To study the best entry points, direction and length of screw in acetabular posterior column plate technique, and to prevent the serious complications of screw penetrating the joint surface.</p><p><b>METHODS</b>February to July 2008 20 male cadaveric adult semi-pelvic specimen were taken.Serial cross-sections of the acetabular posterior column were determined and made. The safe angle of screw entry and the length on all entry points of each cross-section were measured. And put all data into software SPSS 10.0 for statistics process.</p><p><b>RESULTS</b>On margin of acetabulum, lateral-middle 1/4 point, midpoint, medial-middle 1/4 point and medial margin of posterior column of each cross-section, safe entry angle of inclination was 39 degrees , 57 degrees , 74 degrees , 90 degrees and 106 degrees respectively, the length of the screw was 39, 57, 74, 90 and 106 mm respectively.</p><p><b>CONCLUSION</b>On lateral 1/4 region, lateral-middle 1/4 region, medial-middle 1/4 region and medial 1/4 region, screw posterior column angle is 40 degrees to 60 degrees , 60 degrees to 75 degrees , 75 degrees to 90 degrees , 90 degrees to parallel to the quadrilateral plate, and the length of the screw is 30 mm.</p>

Effects on the survival of rat's abdominal axial skin flap after the combination of VEGF gene therapy and skin flap delay / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of VEGF (vascular endothelial growth factor) gene therapy and skin flap delay on the survival of rat's abdominal axial skin flap.</p><p><b>METHODS</b>In 48 Wistar rats, the model of a abdominal axial skin flap supplied by right superficial epigastric vessel was created. The rats were divided into six groups. The group was treated with subcutaneous injection of pcDNA4-VEGF165, skin flap delay or VEGF injection combined with skin flap delay. 7 days later, the survival rate of the skin flap was measured; specimens were harvested from the skin flap for histological investigation of the microvessels and for immunohistochemical staining to observe the expression of VEGF.</p><p><b>RESULTS</b>Every treated group was significantly higher than blank group in the average survival rate of the skin flap and group V (gene injection when delayed) has the highest one. The average number of the microvessels in group II, III, V, VI was significantly higher than group IV and blank group. Group IV > group V, VI > group II, III > blank group in lumen diameter of the microvessels. Immunohistochemical staining documented more deposition of VEGF DNA in group II, III, V, VI than group IV and blank group.</p><p><b>CONCLUSIONS</b>Both administration of pcDNA4-VEGF165 and skin flap delay can improve the survival of rat's abdominal axial skin flap, but the mechanisms of the effect were different. The combination of the two ways has stronger effect.</p>

Effects of early Xuebijing injection(血必净注射液) treatment on the change of prognosis in patients with multiple traumas / 中国中西医结合急救杂志

15 scores were randomly divided into therapeutic group (30 cases)and control group(30 cases).The two groups were treated with the same conventional therapy. From the 1st day of admission,Xuebijing injection 80 ml was given by intravenous drip once for every 12 hours for 7 days to the therapeutic group.The level of tumor necrosis factor-?(TNF-?),interleukin-1?(IL-1?),IL-6,IL-10,and APACHEⅡscore were tested on 1,3,5 and 7 days after admission.The case fatality and incidences rates of sepsis and MODS in both groups were recorded.Results Compared with the control group,APACHEⅡscore,TNF-?,IL-1?,IL-6 and IL-10 of the therapeutic group were lower significantly on the 3rd day after admission,especially on the 5th day(all P