Objective To study the effect of core decompression combining with autologous cortical sustaining bone and cancellous bone graft in treating osteonecrosis of the femoral head (ONFH). Methods From February 2004 to May 2008, 64 patients (77 hi ps) with ONFH were treated with core decompression combining with autologous cortical sustaining bone and cancellous bone graft, including 45 males and 19 females and aging 23 to 60 years with an average age of 43 years. There were 51 cases of unilateral ONFH and 13 cases of bilateral ONFH. ONFH was caused by alcohol in 39 cases(47 hi ps), by steroid in 21 cases (26 hi ps), and by trauma in 4 cases (4 hi ps). The disease course was 1-12 years. The pain time was 2-14 months (average 7 months). All the cases underwent imageology and postoperation pathology examination to confirm the diagnosis of ONFH. According to Association Research Circulation Osseous (ARCO) international classification of osteonecrosis, 17 cases (23 hips) were classified as stage I A, 2 cases (3 hips) as stage I B, 21 cases (24 hips) as stage II A, 2 cases (2 hips) as stage II B, 4 cases (4 hips) as stage II C, and 18 cases (21 hips) as stage III A. The outcome was evaluated both cl inically by Harris score and radiologically by imageology. Results A total of 59 cases (69 hips) were followed up for 12-62 months with an average of 32.1 months. The Harris score was 87.12 ± 8.68 at 12 months after operation, showing significant difference (P lt; 0.05) when compared with the preoperative one (68.38 ± 14.49). The results were excellent in 39 hips, good in 18 hips, fair in 6 hips, and poor in 6 hip; and the excellent and good rate was 82.6%. Radiographic evaluation was 21 hips (30.4%) of grade I, 42 hips (60.9%) of grade II, and 6 hips (8.7%) of grade III. One case had the compl ication of il ium bone donor site, 21 cases had l ittle pain or numbness, and the other cases had no uncomfortable compl ication. Conclusion The method of core decompression combining with autologous cortical sustaining bone and cancellous bone graft can improve the means of bone grafts, prevent the collapse of the femoral head, and is less traumatic than common procedures. Cl inical effects are obvious and effective.
ObjectiveTo understand the function of trace element and amino acids detection in early diagnosis of breast cancer, and explore the correlation between plasma amino acid and trace element changes. MethodsFifty-five patients with breast cancer and 50 normal controls were included in our study from May 2012 to June 2013. Trace elements were detected by atomic absorption spectrophotometer, and the level of amino acids was detected by Hitachi L-8900 amino acids analyzer. Then, we analyzed the correlation between the two indexes. ResultsCompared with the normal controls, breast cancer patients had a higher level of Cu and Fe (P<0.05), and a lower level of Zn (P<0.05). Seven kinds of amino acids had significant changes (P<0.05), including three kinds of increased amino acids, and four reduced. Amino acids and trace element correlation analysis showed that Mg was negatively correlated with Leu, Tyr, Lys, and His; and Ca was negatively correlated with Lys and His. ConclusionThere are many kinds of changes of plasma amino acids and trace elements in breast cancer patients. Serum trace element and amino acids detection in patients with breast cancer are helpful in the severity judgment and regimen design.
目的 探讨德阳市道路交通伤中人员分布的流行病学特点。 方法 回顾性统计分析德阳市2003年－2005年发生的5 300例道路交通伤资料，总结其中的规律和特点。 结果 在5 300例交通伤中，伤亡人员以男性居多（男︰女= 2.58︰1），其中16～55岁的青壮年占了全部伤亡人员的75.72%；工人、农林牧渔业人员和学生占交通伤的比例最高，达52.73%。步行、二轮摩托车和自行车是造成人员伤亡的最主要三个原因，三者比例达到了59.34%。 结论 加强交通安全意识的教育，加大交通法规的宣传和贯彻力度，加强部门间协作是减少交通伤发生的有效措施。Objective To investigate the epidemiological characteristics of the distrubution of people with trauma due to traffic accidents in Deyang City. Methods The data of 5 300 road traffic accidents from 2003 to 2005 in Deyang were retrospectively analyzed. The rules and characters were summarized. Results More males were injured or dead than females in the 5 300 road traffic accidents (male : female = 2.58︰1 ). The young adults aged from 16 to 55 accounted for 75.72% of all the casualties. The workers, agriculture employees and students had the largest percentage (52.73%) of the injuries. Walking and riding motorcycles and bicycles were the main causes leading to the injury, which occupied 59.34%. Conclusion The effective measures to reduce trauma due to traffic accidents will attribute to enhance the personnel awareness of road safety education, improve the publicity work and enforcement of traffic laws, and strengthen collaboration of different epartments.
Objective To establish a repeatable, simple, and effective model of rat crush injury and crush syndrome (CS) so as to lay a foundation for further study on CS. Methods A total of 42 female Sprague Dawley rats (2-month-old, weighing 160-180 g) were divided randomly into the control group (n=6) and experimental group (n=36). The rats of the experimental group were used to establish the crush injury and CS model in both lower limbs by self-made crush injury mould. The survival rate and hematuria rate were observed after decompression. The biochemical indexes of blood were measured at 2, 4, 8, 12, 24, and 48 hours after decompression. The samples of muscle, kidney, and heart were harvested for morphological observation. There was no treatment in the control group, and the same tests were performed. Results Seven rats died and 15 rats had hematuria during compression in the experimental group. Swelling of the lower limb and muscle tissue was observed in the survival rats after reperfusion. The liver function test results showed that the levels of alanine transaminase and aspartate aminotransferase in the experimental group were significantly higher than those in the control group (P lt; 0.05). The renal function test results showed that blood urea nitrogen level increased significantly after 2 hours of decompression in the experimental group, showing significant difference when compared with that in the control group at 12, 24, and 48 hours after decompression (P lt; 0.05); the creatinine level of the experimental group was higher than that of the control group at 4, 8, 12, and 24 hours, showing significant difference at 8, 12, and 24 hours (P lt; 0.05). The serum K+ concentration of the experimental group was higher than that of the control group at all time, showing significant difference at the other time (P lt; 0.05) except at 2 hours. The creatine kinase level showed an increasing tendency in the experimental group, showing significant difference when compared with the level of the control group at 4, 8, 12, and 24 hours (P lt; 0.05). The histological examination of the experimental group showed that obvious edema and necrosis of the muscle were observed at different time points; glomeruli congestion and swelling, renal tubular epithelial cell degeneration, edema, necrosis, and myoglobin tube type were found in the kidneys; and myocardial structure had no obvious changes. Conclusion The method of the crush injury and CS model by self-made crush injury mould is a simple and effective procedure and the experimental result is stable. It is a simple method to establish an effective model of rats crush injury and CS.
Objective To explore the effectiveness of Colorado 2TM system in the stabil ity reconstruction of sacroil iac joint fracture and dislocation in Tile C pelvic fracture. Methods Between February 2009 and January 2011，8 cases of Tile C pelvic fracture were treated with Colorado 2TM system. There were 3 males and 5 females with an average age of 34.4years (range，22-52 years). Fractures were caused by traffic accident in 3 cases, by fall ing from height in 3 cases，and by crash of heavy object in 2 cases. According to Tile classification, 5 cases were classified as C1-2, 2 cases as C1-3，and 1 case as C2. The time between injury and operation was 5-10 days (mean, 7 days). After skeletal traction reduction, Colorado 2TM system was used to fix sacroil iac joint, and reconstruction plate or external fixation was selectively adopted. Results The postoperative X-ray films showed that the reduction of vertical and rotatory dislocation was satisfactory, posterior pelvic ring achieved effective stabil ity. All the incisions healed by first intention, and no blood vessel or nerve injury occurred. Eight patients were followed up 6-24 months (mean, 12 months). No loosening or breakage of internal fixation was observed and no re-dislocation of sacroil iac joint occurred. The bone heal ing time was 6-12 months (mean, 9 months). According to Majeed’s functional criterion, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case at last follow-up. Conclusion Colorado 2TM system could provide immediate stabil ity of pelvic posterior ring and good maintenance of reduction effect, which is an effective method in the therapy of sacroil iac joint fracture and dislocation in Tile C pelvic fracture.
Objective To summarize the cl inical characteristics of 596 patients with fracture in Wenchuan earthquake and to investigate the therapeutic methods and effects of early treatment. Methods From May 12th 2008 to May 21st 2008, 596 patients with fracture caused by Wenchuan earthquake were treated, including 283 males and 313 females aged1.9-102 years (median 43 years). The time from injury to hospital ization varied from 12 minutes to 4 days. There were 132 cases of upper extremity fracture, 496 cases lower extremity fracture, 10 cases clavicular fracture, 16 cases scapular fracture, 23 cases pelvis fracture, and 59 cases spinal fracture. Among them, 183 cases were open fracture and 413 cases were closed fracture. And 214 cases had multiple fracture (35.9%) and 68 cases had crush injury in l imbs which scored (6.84 ± 2.48) points according to the mangled extremity severity score (MESS). Thirty-six cases were combined with neurovascular injury. The wound of the open fracture was contaminated at different degrees, but no gas gangrene was observed. Open fracture was treated with suturing or no suturing after debridement, open reduction and internal or external fixation. Closed fracture was fixed with spl ints, cast and traction. Forty-nine patients whom were highly suspected as osseous fascia compartment syndrome received incision decompression timely, and 34 patients whose MESS were above 7.0 points or suffering from crush injury of l ifethreatening systemic symptoms received amputation. Results Apart from 34 patients receiving amputation, 460 patients achieved functional reduction of fracture after manipulative reduction and 102 cases got satisfactory reduction after surgery. Postoperatively, 289 patients were transferred to other hospitals. Among the rest 307 patients, 34 with severe wound infection were healed after multiple debridement, anti-infection, and skin flap transplantation (16 cases healed by first intention and 18 cases healed by second intention), 42 cases with crush syndrome were treated with open decompression and amputation, and nodeep venous thrombosis of lower l imb, stress ulcer and death were observed after operation (29 cases healed by first intention and 13 cases healed by second intention). Conclusion By aiming at the features of fracture caused by earthquake, the prompt and professional treatment can achieve good therapeutic effects.
Objective To retrospectively analyze the 420 fractured inpatients in the People’s Hospital of Deyang city seven days after the Wenchuan earthquake, so as to provide reference for the improvement of emergency plans earthquakes and the subsequent treatment of fracture patients. Methods The analysis was based on the data provided by the Department of Orthopedics of the Hospital up until July 18,2008. The software Microsoft EXCEL was used for data input, and SPSS 13.0 was used for statistical analysis. Results Up to July 18 420 cases from the disaster area have been treated in the department of orthopedics, including 176 men (41.9%) and 244 women (58.1%), the age was from 1 to 102 years and a median age of 43 years (2 761) among the inpatients. Most patients(328 cases) were sent to the hospital within the first three days after the quake (78.1%), and the number of inpatients were 92 4-7 days after the quake. The wounded were mainly from Mianzhu,Shifang , and Guanghan. The admission fracture diagnoses were tibial fractures (18.8%), fibular fractures (16.6%), and femoral fractures (14.9%). The major treatments were splinting, plaster fixation, or traction for closed fractures (301 cases), internal fixation or external fixation for malreduction (85 cases), and debridement suture and plaster fixation for open fractures (78 cases). Conclusion It is a vital to develop an emergent plan for fracture patients after an earthquake disaster and to strengthen the reserve of medical supplies, personnel training, and individual therapy.
ObjectiveTo compare the biomechanical properties between the proximal femoral locking plate and Gamma3 for fixing stable intertrochanteric fracture so as to provide a theoretical basis for selecting internal fixation in the clinical application. MethodsFive pairs of antiseptic femur specimens were selected. Specimens of each pair of matching were randomly divided into groups A and B (n=5). All specimens were made the intertrochanteric fracture of 31A1.1 type according to AO/Association for the Study of Internal Fixation (AO/ASIF) classification. Fracture was fixed with Gamma3 in group A and with proximal femoral locking plate in group B. The axial compression, destruction, and torsion tests were carried out on the mechanical testing machine. ResultsAxial compression test:The load-displacement curve of groups A and B was basically a straight line; axial stiffness of groups A and B was (621.00±36.48) N/mm and (542.55±46.94) N/mm respectively, showing significant difference (t=3.648, P=0.036). Destruction test:The maximum yield load of groups A and B was (4 394.82±450.37) N and (2 987.54±112.14) N respectively, showing significant difference (t=5.433, P=0.032). After loading maximum yield load, femoral fracture occurred again, and internal fixation and bone interface loosening were observed in group A; bending and breaking of proximal locking screw for internal fixation were found in group B, but loosening of internal fixation and bone interface was more obvious in group A than in group B. Torsion test:The torque of specimens in 2 groups increased with the increase of torsion angle (P < 0.05), the torque corresponding to the torsion angle in group B was larger than that in group A, but the difference was not significant (P > 0.05). The torsional stiffness of groups A and B was (1.78±0.16) N·mm/deg and (2.01±0.08) N·mm/deg respectively, showing no significant difference (t=-3.833, P=0.162). ConclusionProximal femoral locking plate and Gamma3 in the treatment of stable intertrochanteric fracture have good biomechanical properties, which can meet the requirements of minimal invasion, strong internal fixation, and early activity.