[Improvement effect of estrogen on flap reperfusion injury and blood supply].

OBJECTIVE: To study the effect of various doses of estrogen on tissue injury, blood supply and survival area of skin flap and to investigate its mechanism. METHODS: Thirty New Zealand white rabbits aged 3-4 months old and weighing 1.5-2.2 kg (male or female) were used. Random pattern skin flap (12 cm x 3 cm in size) taking the central line of the rabbit dorsum as axis and with the pedicle attached at the proximal end was prepared, and the flap pedicle division was performed 7 days after operation. The rabbits were divided randomly into three groups (n = 10 rabbits per group). At 2, 4, and 6 days after operation, the proximal edge of flap in group A and B received 100 microg/kg and 50 microg/kg subcutaneous injection of estradiol benzoate, respectively, while group C received no further treatment serving as control group. General condition of the rabbits was observed after injection, gross observation was performed 3 and 7 days after injection, survival area of the skin flap was measured 7 days after injection, contents of malondialdehyde (MDA) and nitric oxide (NO) were tested 5 days after injection, and the flaps were harvested 4 and 7 days after injection to receive histology and immunohistochemistry observation, neutrophil (NEU) counting and VEGF scoring. RESULTS: All rabbits survived to the end of the experiment except 3 rabbits (1 rabbit per group) dying from anesthesia overdose. After operation the distal edge of flap in each group all demonstrated different degrees of darkening and hardening, especially group C, and no exudation was observed. Skin temperature of the flaps was close to that of normal skin 3 days after injection. The survival area of the skin flap 7 days after injection was (13.71 +/- 2.91) cm in group A, (12.80 +/- 1.99) cm2 in group B, and (10.12 +/- 1.43) cm2 in group C; at 5 days after injection, the MDA content was (4.02 +/- 0.85) nmol/mL in group A, (3.99 +/- 0.77) nmol/mL in group B, and (4.89 +/- 0.75) nmol/mL in group C, and the NO content was (89.36 +/- 14.82) micromol/L in group A, (88.37 +/- 24.81) micromol/L in group B, and (65.78 +/- 19.04) micromol/L in group C. Significant difference was evident when comparing group A or B with group C in terms of the above parameters (P < 0.05), and no significant difference was noted between group A and group B (P > 0.05). The NEU counts 4 days after injection were (18.20 +/- 6.24) cells/HP in group A, (21.27 +/- 5.34) cells/HP in group B, and (28.78 +/- 7.92) cells/HP in group C, and at 7 days after injection, there were (15.16 +/- 7.02) cells/HP in group A, (18.12 +/- 6.44) cells/HP in group B, and (29.67 +/- 9.12) cells/HP in group C. The VEGF score 4 days after injection was (4.02 +/- 0.48) points in group A, (4.19 +/- 0.66) points in group B and (3.67 +/- 0.49) points in group C, and at 7 day after injection, it was (4.96 +/- 0.69) points in group A, (5.12 +/- 0.77) points in group B, and (3.81 +/- 0.54) points in group C. Significant difference was evident between 4 days and 7 days after injection in group A or B in terms of NEU counts and VEGF score (P < 0.05), and difference between 4 days and 7 days after injection in group C was not significant (P > 0.05), and the differences among 3 groups were significant (P < 0.05). CONCLUSION: Estrogen injection can increase VEGF expression and NO content of flap, decrease MDA content and NEU infiltration of flat, and improve survival area of flap.

[Autologous bone marrow integrating artificial bone and ilium periosteum transplantation for treatment of bone nonunion].

OBJECTIVE: To evaluate the initial clinical effect of the autologous bone marrow integrating artificial bone and ilium periosteum transplantation in treatment of problematic nonunion. METHODS: From January 2004 to July 2006, 12 patients (13 limbs)with problematic nonunion were treated with autologous bone marrow integrating artificial bone and ilium periosteum. There were 8 males and 4 females, aged 17-58 years old. The position of nonunion were the tibia in 7 limbs, the femur in 3 limbs, the humerus in 2 limbs. The operated number was 1-4, mean 2.5. The time from injury to therapy was 13 months to 9 years, mean 47.6 months. The bone defect distance was 6-30 mm (mean 15 mm) through 1 : 1 X-rays before operation. Eleven limbs were treated by internal fixation (10 limbs by the bone nail and 1 limb by the limited contact-dynamic compression plate), 2 limbs were treated by the external fixation. The X-ray films were taken at 1 day, 1, 3, 6, 9, 12 months after operation to observe fracture union. RESULTS: All patients were followed up for 12-26 months (mean 17.5 months) and achieved union within 4-7 months (mean 6 months). No deformity of rotation, angulation and crispation occurred in 13 limbs, but functional impairment occurred in 6 limbs after union of fracture. CONCLUSION: Autologous bone marrow integrating artificial bone and ilium periosteum transplantation for treatment of problematic nonunion has the satisfactory result.

[Surgical treatment for rotationally and vertically unstable pelvis fracture].

OBJECTIVE: To study the clinical results of surgery for rotationally and vertically unstable pelvis fracture. METHODS: Thirty-four patients with rotationally and vertically unstable pelvis fractures were treated. There were 23 male and 11 female,with the average age of 36 years ranging from 13 to 56 years. There were 9 cases of type APC III, 14 cases of type LC III, and 11 cases of type VS according to Young-Burgess Classifiction. All patients' pelvis were treated with temporary external fixation after hospitalization, and were treated with open reduction and internal fixation through anterior approach after stabilization of body condition. RESULTS: All patients were followed up for 12 to 48 months (average 21 months). All the incisions healed well, and the fractures got union for 3 to 6 months. According to the Majeed evaluation, the results were excellent in 21 cases, good in 10, fair in 3. All patients were not remained deformity of rotation and dislocation. But 3 patients remained lameness, 4 remained low back pain, 3 remained both leg and feet numbness. CONCLUSION: In the management of the rotationally and vertically unstable pelvis fractures, a stable pelvis can be reconstructed by effective open reduction and internal fixation through the anterior approaches, so that further sequelae can be reduced.