Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
Objective To evaluate the clinical and radiographic outcomes of headless compression screws for Lisfranc joint injuries. Methods A retrospective analysis was made on clinical data of 34 patients (36 feet) with Lisfranc joint injuries who underwent open reduction and internal fixation with headless compression screws between January 2006 and January 2012. There were 22 males (24 feet) and 12 females (12 feet), aged 21-73 years (mean, 38.9 years). The causes of injury included traffic accident in 16 cases (17 feet), falling from height in 11 cases (12 feet), crushing in 5 cases (5 feet), and sports in 2 cases (2 feet). Of them, there were 19 cases (20 feet) of closed injury and 15 cases (16 feet) of open injury; there were 7 cases (8 feet) of pure dislocations of tarsometatarsal joints and ligamentous Lisfranc injuries (LD), 22 cases (23 feet) of Lisfranc joint fracture dislocations (LFD), 5 cases (5 feet) of combined Chopart-LFD (CLFD). According to Myerson classification, 5 cases (5 feet) were rated as type A, 7 cases (8 feet) as type B1, 14 cases (15 feet) as type B2, 5 cases (5 feet) as type C1, and 3 cases (3 feet) as type C2. Associated fractures included 12 cases (13 feet) of metatarsal shaft fracture, 4 cases (4 feet) of cuboid fracture, 4 cases (4 feet) of navicular bone fracture, 6 cases (7 feet) of coneiform bone fracture/dislocation, 8 cases (10 feet) of ipsilateral lower limb multiple fracture, and 4 cases (4 feet) of contralateral lower limb multiple fracture. The clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score. Postoperative X-ray films were taken to assess the reduction, internal fixation, and the foot arch height. Results All patients were followed up 1 year to 5 years and 2 months (mean, 3.5 years). X-ray films showed anatomical reduction in 31 cases (33 feet, 91.7%). At last follow-up, AOFAS score and VAS score averaged 80.6 (range, 60-100) and 2.3 (range, 0-6), respectively; the AOFAS score was significantly higher in patients having anatomical reduction than the patients having no anatomical reduction, in patients with LD and LFD than in patients with CLFD, and in patients without cuneiform bone fracture/dislocation than in patients with cuneiform bone fracture/dislocation (P lt; 0.05). There was no significant difference in the talus-first metatarsal angle, the distance between the lateral edge of the base of the first metatarsal bone and the medial edge of the base of the second metatarsal bone, and the arch height between the injured foot and normal foot (P gt; 0.05). Reduction loss was observed in 1 case (1 foot) because of early weight bearing; post-traumatic arthritis developed in 9 patients (10 feet). The incidence of post-traumatic osteoarthritis was higher in the patients with non-anatomic reduction, coneiform bone fracture/dislocation, comminuted intra-articular fractures of Lisfranc joints, the injury types (P lt; 0.05). Conclusion Headless compression screws for fixation of Lisfranc joint injuries can provide satisfactory short- and mid-term clinical and radiographic outcomes. During surgery, the precise anatomic reduction and stable fixation should be paid attention to, especially in patients with CLFD, coneiform bone fracture/dislocation, and comminuted intra-articular fractures of Lisfranc joints so as to control the incidence of the post-traumatic osteoarthritis.
【Abstract】Objective To observe the synthesis of TLR2 protein and its mRNA expression in Kupffer cells (KCs) and sinusoidal endothelial cells(SECs).Methods Thirty-two BALB/c mice divided into two groups (operation group and false operation group) were used to prepare the model of partial hepatic ischemia/reperfusion (I/R) injury. After injury KCs and SECs were isolated with twosteps situ perfusion technique. And these cells were dyed by rat anti-mouse TLR2 IgG and anti-rat IgG2b labeled with flurescein isothiocyanate (FITC). The sysnthesis of TLR2 protein were determined by flow cytometric (FCM) analysis and real time reverse transcription polymerase chain reaction (Real-Time RT-PCR) analysis for gene expression.Results As for KCs: TLR2 expression was significant higher in operation group, compared with false operation group 〔protein expression: （9.19±1.07）% vs （1.52±0.21）%, P＜0.01; gene expression: 0.54±0.77 vs 2.62±2.19, P＜0.05〕. But there were no significant differences with expression in SECs. Conclusion Synthesis of TLR2 protein and its gene expression increased in KCs in the mouse partial hepatic ischemia-reperfusion injury.
Objective To study the effect of Kupffer cell on the liver ischemia/reperfusion injury.Methods The literature in recent years on the liver ischemia/reperfusin injury were reviewed.Results The activated kupffer cell can generate and release a variety of soluble toxic mediators, affect the liver microcirculation directly or indirectly. Conclusion Kupffer cell have important effect on liver ischemia/reperfusion injury.
Objective To compare single cell suspension of neural stem cells (NSCs) with neurospheres transplantation for spinal cord injury (SCI) so as to explore the therapeutic effectiveness of two NSCs transplantation methods for SCI. Methods The NSCs were isolated from the spinal cord of adult Sprague Dawley (SD) rats, purified and cultured. At passage 3, the cells were identified by Hoechst33342, Nestin staining, and gl ial fibrillary acidic protein staining for differentiated cells. Sixty adult SD rats (weighing 230-250 g) were made the SCI models at T10 level with modified Allen method and randomlydivided into 3 groups (20 rats in each). The injury sites were treated by injecting 5 μL sal ine (group A), 5 μL single cellssuspensions of NSCs at passage 3 (group B), and 5 μL neurospheres cell suspensions at passage 3 (group C). At preoperation and 3, 7, 14, 21, and 28 days after operation, the locomotor functions of each group were assessed using the Basso, Beattie, and Bresnahan (BBB) rating scale. HE staining was applied to observe the morphology of spinal cord. Subsequently immunofluorescence staining was used to observe microtubule-associated protein 2 (MAP-2). Results The cells cultured were NSCs by morphological observation and immunofluorescence staining. After 3 days of modeling surgery, BBB score significantly decreased when compared with preoperative score, and there was no significant difference among 3 groups at 3 and 7 days (P gt; 0.05). BBB score increased in different degrees with time; at 14, 21, and 28 days, BBB score of groups B and C was better than that of group A, and group C was better than group B, showing significant differences (P lt; 0.05). HE staining showed that spinal cord structure of group C was more clear than that of groups A and B, and had less scar. There was no significant difference in the number of MAP-2 positive cells among 3 groups at 3 and 7 days (P gt; 0.05). At 14, 21, and 28 days, the number of MAP-2 positive cells of groups B and C was significantly more than that of group A, and group C was more than group B, showing significant differences (P lt; 0.05). Conclusion Transplantation of neurospheres suspension compared with single cell can significantly promote NSCsto differentiate into neurons and is conducive to recover the lower extremity function after SCI.
Abstract In case of sciatic nerve injury, there is degeneration of neuron in the corresponding segment of spinal cord. To study whether NGF could protect the dorsal root ganglia in this situation, the following experiments were performed: 72 SD mice were divided into 2 groups. In each mouse, the sciatic nerve was sectioned at the middle of the right thigh, and then,the proximal end of the sciatic nerve was inserted into a one ended silastic tube. The NGF 0.15ml (contain 2.5S NGF 0.15mg) was injected into the tubes of the experimental group, while a equal amount of normal saline was injected into the tubes of the control group. After 1, 3, 5, 9, 20 and 30 days, 6 mice of each groupwere sacrificed respectively, and 5th to 6th lumbar segments of the spinal cords were resected for examination. By histochemical study, the activity of fluoride resistant acid phosphatase (FRAP) of each animal was detected. The results showed: (1) Excision of the sciatic nerve led to decrease of FRAP activity, it suggested that the injury of sciatic nerve could damage the dorsal root ganglia; (2) The use of exogenous NGF could protect the FRAP activity. It was concluded that NGF played an important role in protecting the dorsal root ganglia in peripheral nerve injury, in vivo.
OBJECTIVE Using electrophysiological method to evaluate the severity of incomplete obstetric paralysis brachial plexus injuries, and establish an electrophysiological criteria for selection of operative procedure in the treatment of cases of late stage. METHODS Neurolysis was performed in 16 patients, and during the operation, the neuroma at the upper trunk was discovered. The electrophysiological study was carried out before and during operation to evaluate the conducting function of neuroma. In the follow-up the operative result was analysed by Mallet test. RESULTS The preoperative study showed that the compound muscular active potential (CMAP) amplitude of supraspinatus deltoid and biceps were decreased more than 60% in comparison with that of the healthy side. After external neurolysis of the neuroma, by stimulation of the proximal and distal ends of the neuroma the average decrease of CMAP amplitude of the above three muscles was 37.45% +/- 20.97%, 47.85% +/- 26.23%, 47.05% +/- 21.23%, respectively and no significant improvement was observed in the shoulder and elbow function in all of the 16 cases. CONCLUSION When the preoperative electrophysiological study found that the CMAP amplitude decreased more than 60% in comparison with that of the healthy side, transposition of nerve or nerve grafting was indicated.
In extensive frictionavulsion injuries, part of the injuried skin was still viable, so that total excision of the avulsed skin should be avoided. After debridememt, sutured the avulsed skin flap in situ temporarily and took a split-thickness graft from it. If bleeding occurred from the splitted surface of the dermis which was meant that part of the skin was alive. Along the border between the bleeding and nonbleeding area, the nonbleeding area of skin was excised. This could preserve the viable skin to the maximal extent. From July 1991 to May 1992, the viability of the skin in 8 avulsion injuries was judged. The maximal avul sed area was 13% and the minimal was 6% of the total body surface. After the treatment, 90% of the avulsed skin was alive. The appearance was satisfactory.
To investigate the protective effect of propofol on ischemia/reperfusion induced spinal cord injury in rabbits and its influence on excitatory amino acid (EAA). Methods Sixty New Zealand white rabbits weighing 2.0-2.5 kg, half males and half females, were selected. The infrarenal circumaortic clamping model was used. And 6 mL/kg different fluids were continuously infused through a catheter into the aorta distal to the clamping site at a speed of 12 mL/(kg?h) during the 30 minutes ischemia period. According to the different infusing l iquids, the rabbits were randomized into 6 groups(n=10 per group): group A, normal sal ine; group B, 10% intral ipid; group C, propofol 30 mg/kg; group D, propofol 40 mg/kg; group E, propofol 50 mg/kg; group F, propofol 60 mg/kg. At 0, 6, 24, and 48 hours after reperfusion, neurologic outcomes were scored on a Tarlov scale system. At 48 hours after reperfusion, the number of normal neurons in the anterior spinal cord was counted, and concentration of EAA in the lumbar spinal cord was measured by high performance l iquid chromatography. Results The neuroethological score was better in groups C, D, E and F than that of groups A and B (P lt; 0.05), the score of group E was the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). The number of normal neurons in the anterior spinal cord of groups C, D, E and F was greater than that of groups A and B (P lt; 0.05), and group E was greater than groups C, D and F (P lt; 0.05). The concentration of EAA in groups A, B, C, D, E and F was greater than that of normal tissue, the group E was the lowest (P lt; 0.05), the groups A and B were the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). Concentrations of glutamate and aspartic acid were negatively correlated to normal neuron numbers in the anterior spinal cord and neuroethological scores 48 hours after reperfusion, and the corresponding correlation coefficient was — 0.613, — 0.536, — 0.874 and — 0.813, respectively (P lt; 0.01). Conclusion Propofol can significantly inhibit the accumulation of EAA in spinal cord and provide a protective effect against the ischemia/reperfusion injury induced spinal cord in rabbits.
Objective To investigate the influence of Nogo extracellular peptide residues 1-40 (NEP1-40) gene modification on the survival and differentiation of the neural stem cells (NSCs) after transplantation. Methods NSCs were isolated from the cortex tissue of rat embryo at the age of 18 days and identified by Nestin immunofluorescence. The lentiviruses were transduced to NSCs to construct NEP1-40 gene modified NSCs. The spinal cords of 30 Sprague Dawley rats were hemisected at T9 level. The rats were randomly assigned to 3 groups: group B (spinal cord injury, SCI), group C (NSCs), and group D (NEP1-40 gene modified NSCs). Cell culture medium, NSCs, and NEP1-40 gene modified NSCs were transplanted into the lesion site in groups B, C, and D, respectively at 7 days after injury. An additional 10 rats served as sham-operation group (group A), which only received laminectomy. At 8 weeks of transplantation, the survival and differentiation of transplanted cells were detected with counting neurofilament 200 (NF-200), glial fibrillary acidic portein (GFAP), and myelin basic protein (MBP) positive cells via immunohistochemical method; the quantity of horseradish peroxidase (HRP) positive nerve fiber was detected via HRP neural tracer technology. Results At 8 weeks after transplantation, HRP nerve trace showed the number of HRP-positive nerve fibers of group A (85.17 ± 6.97) was significantly more than that of group D (59.25 ± 7.75), group C (33.58 ± 5.47), and group B (12.17 ± 2.79) (P lt; 0.01); the number of groups C and D were significantly higher than that of group B, and the number of group D was significantly higher than that of group C (P lt; 0.01). Immunofluorescent staining for Nestin showed no obvious fluorescence signal in group A, a few scattered fluorescent signal in group B, and b fluorescence signal in groups C and D. The number of NF-200-positive cells and MBP integral absorbance value from high to low can be arranged as an order of group A, group D, group C, and group B (P lt; 0.05); the order of GFAP-positive cells from high to low was group B, group D, group C, and group A (P lt; 0.05); no significant difference was found in the percentage of NF-200, MBP, and GFAP-positive cells between group C and group D (P gt; 0.05). Conclusion NEP1-40 gene modification can significantly improve the survival and differentiation of NSCs after transplantation, but has no induction on cell differentiation. It can provide a new idea and reliable experimental base for the study of NSCs transplantation for SCI.