Objective To evaluate the clinical importance of doublecontrast CTdiagnosis of traumatic anterior shoulder instability. Methods Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. The patients wereexamined by SOMATOM CR Systematic CT. The results of double contrast CT of the 48 patients were divided into Ⅰ, Ⅱ and Ⅲ degree according to the CT results related to their injury history, clinical symptoms, signs and operation findings. Results The patients had no complaint after the CT examination exceptfor 3 patients, who had slight pain within 2 days after CT examination. The results of double contrast CT were as follow:Ⅰ degree: 9 patients, Ⅱ degree: 22 patients, and Ⅲ degree: 17 patients. All patients with Ⅰ degree injuries were treated with rehabilitation program. The patients with Ⅱ degree injuries were mainly treated withrehabilitation program, but took much longer time. The patients with Ⅲ degreeinjuries were suggested to be treated with surgery. Conclusion To divide the results of double contrast CT into Ⅰ，Ⅱ and Ⅲ degree not only reflects the severity of traumatic anterior shoulder instability but provides information for the treatment of the instability.
Objective To review the current status and advances of the correlation between traumatic brain injury (TBI) and fracture healing. Methods The related domestic and abroad literature about the correlation between TBI and fracture healing was extensively reviewed and analyzed. Results There are a variety of studies on the correlation between TBI and fracture healing, which can be divided into two major aspects: revascularization and osteogenesis; the local and systemic changes of the neuropeptide and hormone after TBI. Conclusion TBI facilitates callus formation, the further research is needed to clarify the exact mechanism.
Form April 1991 to August 1994, ten cases of extensive soft tissue injury of the extremities with bone and tendons exposed were treated by emergency transfer of latissimus dorsi myocutaneous flaps. The types of the myocutaneous flap were as follows: with vascular pedicle in 1 case, free latissimus dorsi myocutaneous flap in 8 cases,and transfer of combined bilateral latissimus dorsi myocutaneous flaps in 1 case. There were 8 males and 2 females with the ages ranging from 7 to 44 years (an average of 24.4 years). The operations were all performed within 6 hours after trauma except in 1 case, due to its delayed arrival to our hospital, the operation was carried out 14 days after trauma. The results were as follows: total survival of the flap in 6 cases, necrosis of the distal portion of the skin of the flap in 3 cases and necrosis of a greater portion of the skin in one case who had been subjected the transfer of combined bilateral latissimus dorsi myocutaneous flap. but the deep muscle layerwas intact. However, the result was encouraging. The operative technique and the advantages of emergency coverage of the wound were discussed.
ObjectiveTo explore the diagnostic and therapeutic value of laparoscopy in acute abdomen. MethodsRelated literatures were collected to analyze the advantages, the scope of application, and the effect on the body of laparo-scopy, and to clearly defined the indications of laparoscopy in acute abdomen and related taboos. ResultsMost people could be tolerated for CO2 pneumoperitoneum. Laparoscopic surgery had a certain advantages compared with open surgery in the diagnosis and treatment. It was widely used in the diagnosis and treatment of acute abdomen. ConclusionLaparo-scopic surgery is recommended for acute appendicitis, acute cholecystitis, peptic ulcer perforation, and so on, but it is still controversial in intestinal obstruction, intestinal diverticulum perforation, and the application of abdominal trauma, which need more randomized controlled studies comparing with open operation.
ObjectiveTo explore the effectiveness of vacuum sealing drainage (VSD) combined with open bone graft for tibial traumatic osteomyelitis. MethodsBetween June 2007 and December 2012, 23 cases of tibial traumatic osteomyelitis were treated, including 15 males and 8 females with an average age of 32.5 years (range, 22-48 years). The time from injury to admission was 7-18 months (mean, 8.6 months). There was local bone scarring in 15 cases, the size ranged from 8 cm×4 cm to 15 cm×8 cm. The CT multi-planar reconstruction was carried out preoperatively. Eleven cases had segmental bone sclerosis with a length of 1.5 to 3.8 cm (mean, 2.6 cm); 12 cases had partial bone sclerosis with a range of 1/3 to 2/3 of the bone diameter. On the basis of complete debridement, infection was controlled by VSD; bone defect was repaired by VSD combined with open bone graft. After there was fresh granulation tissue, the wound was repaired by free skin graft or local skin flap transfer. ResultsNail infection occurred in 2 cases, which was cured after the use of antibiotics. The wound healed at the first stage after repairing. All cases were followed up 10-18 months (mean, 13.5 months). In 11 cases of segmental bone sclerosis, the infection control time was 7-14 days (mean, 8.8 days); the bone healing time was 32-40 weeks (mean, 34.4 weeks); and the frequency of VSD was 3-6 times (mean, 4.5 times). In 12 cases of partial bone sclerosis, the infection control time was 7-12 days (mean, 8.3 days); the bone healing time was 24-31 weeks (mean, 27.3 weeks); and the frequency of VSD was 3-5 times (mean, 3.6 times). Infection recurred in 1 case, and the patient gave up the therapy. No infection recurrence was observed in the other patients. ConclusionThe VSD combined with open bone graft is an effective method for the treatment of tibial traumatic osteomyelitis.
Taking Wistar rats and pigs as models, the basic fibroblast growth factor (bFGF) was studied on wound healing. Five rats and five pigs were used in the experiment. Each rat had 2 roundshapedwound (1.8cm in diameter) and each pig had 4 wounds of the same size as that ofthe rat. One wound of each rat and 2 wound of each pig were dressed with bFGF saline (60U/cm2). While the other wounds of the rats and pigs were dressed with normal saline as control. The wounds treated with bFGF were completely covered with granulation tissue on the 7th day after injury, and in 14 days the wounds were almost completely covered by epithelium. The bFGF would enhance the growth of theepithelial cells, reepithelization of the wound and the tensile strength of thetissue. It was concluded that the bFGF could promote skin regeneration, whichmight be the direct action of bFGF on the bFGF receptors in the basic cells of skin.
Fifteen rabbits were given a second degree scald on the back, then a large amount of fluid were given rapidly. In this way an acute diluted hyponatremia and a brain edema model were produced. In one group, the magnetotherapy was instituted immediately following the acut injury, while in the other group, it was started after the brain edema being developed. After giving a large quantity of fluid, the Na~+, CI~-, and K~+ concentrations in the blood were decreased and the quantity of water in the brain tissue was increased evidentely. The phenomena of neuron edema and widening of the perivascular space were also found. It was proved that the model of experimental brain edema could be produced on animals and the treatment and the prevention for brain edema could be obtained to advantage to certaiin degree. Also,it was better to use the magnetotherapy in brain edema as early as possidle.
Abstract For the purpose of studying the effects on wound healing of three new bioelectret composites (BC) which are composed ofcollagen polyvinyl alcohol and epidermal growth factor (EGF), 30 rabbits were divided into 5 groups. Three wounds in round shape (1.8 cm in diameter) were made in each side of the back of the rabbits. The wounds of 1～3 groups were treated by one of the three BC respectively, group 4 treated by SDAg, and group 5 were treated by Normal saline as control. From observation of the growth of the granulation tissue, the reepithelization and the pathological assessment, it was shown that the quality of wound healing in all BC treated wounds was better than that in SDAg or the control. It indicated that the BC benefited the wound healing, and this might also be due to its bioelectric effects and the direct effects from growth factor.
Objective To compare the effectiveness between the myo-periosteal fibular bone bridging and traditional transtibial amputation in the treatment of amputation below knee so as to provide theoretical basis for choosing transtibial amputation in clinical application. Methods Between November 2001 and November 2011, 38 patients with mangled lower extremity were treated by transtibial amputation. Among 38 patients, 17 (group A) underwent myo-periosteal fibular bone bridging (the operation techniques of an attached peroneal muscle myo-periosteal fibular strut bridge between the end of the tibia and fibula below knee amputation), and other 21 (group B) underwent traditional transtibial amputation. There was no significant difference in age, gender, injury cause, amputation cause, side, and disease duration between 2 groups (P gt; 0.05). The quality of life (QOL) was analyzed using 36-item short form health survey (SF-36), and prosthesis satisfaction by Trinity amputation and prosthesis experience scale (TAPES). Results Healing of incision by first intention was obtained in all patients of 2 groups; no necrosis, infection, or poor stumps was observed. The mean follow-up time was 22 months (range, 14-30 months) in group A, and 26 months (range, 15-30 months) in group B. The patients achieved good healing of bone bridging, no bone nonunion occurred. The healing time was (5.1 ± 1.1) months in group A and (3.3 ± 0.6) months in group B, showing significant difference between 2 groups (t=9.82, P=0.00). Spur occurred at the distal fibula in an 11-year-old boy of group B after 2 years of operation, which blocked use of prosthesis; prosthesis was well used in the other patients. After 12 months of operation, SF-36 score was 55.84 ± 14.01 in group A and 49.93 ± 12.78 in group B, showing significant difference (P lt; 0. 05); the physical functioning, social functioning, role-physical, vitality, body pain, general health scores in group A were significantly higher than those in group B (P lt; 0.05), but no significant difference was found in role-emotional and mental health scores between 2 groups (P gt; 0.05). TAPES score was 12.12 ± 2.23 in group A and 10.10 ± 2.00 in group B, showing significant difference (t=2.891, P=0.006). Conclusion It is a very effective method to treat traumatic amputation using an attached myo-periosteal fibular bone bridging between the end of the tibia and fibula below knee, which can afford better quality of life and prosthesis satisfaction.