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ObjectiveTo discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.ResultsThe mean time of operations was 290 min(range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.ConclusionThe effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer.
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Objective To compare the effect of calcium sulfate pellets made by different methods in repair of segmental radial defect of rabbits. Methods Eighty white New Zealand rabbits were sub-jected to defects of middle part of the left radial bone and divided into four groups according to repair ma-terials: control group (Group A, implanted with no artificial bone substitute), uncoated pressed calcium sulfate pellets (Group B), coated pressed calcium sulfate pellets (Group C) and coated pressed calcium sulfate pellets combined with rhBMP-2 (Group D). Histologic examination and biological test were done at 4, 8 and 12 weeks after operation. The data were processed with mono-factor variance analysis. Re-sults New bone formation was found on the defected bone in Group D and Group C, with better in Group D. The bone strength test showed that the anti-bending strength was (39.6±1.7) % in Group C and (47.5±2.1) % in Group D, which were higher than (21.3±2.7) % in Group A and (23.6±3.3) % in Group B, with higher anti-bending strength in Group D than that in Group C (F = 125.3 ,P <0.01). Conclusions For restoration of segmental bone defects, chitosan-coated pressed calcium sulfate pellet shows relatively high density and slightly slow resorption, which closely coincides with the growth rate of new bone. The coated pellet combined with rhBMP-2 can enhance its osteogeneais in restoring segmental Done defects.
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BACKGROUND: An effective preservation method must preserve the integrity of tissue structure. OBJECTIVE: To compare the effects of vitrification and cryopreservation method on the artery morphology and mechanical properties. DESIGN, TIME AND SETTING: The randomized controlled animal experiment was done at the Department of Orthopedics, General Hospital of Chinese PLA, between September 2001 and August 2004. MATERIALS: Eighteen New Zealand rabbits were randomly divided into vitrified artery group, cryopreserved artery group and fresh artery group, with 6 rabbits in each group. METHODS: Femoral arteries were removed from rabbits and put in balanced solution. Arteries in the vitrified artery group were immersed in the 25%, 50% and 100% gradient vitrified solution at 4 ℃ and then were put in liquid nitrogen. Arteries in the cryopreserved artery group were cooled from normal temperature to 0, -20, -70 ℃, and balanced for 60 minutes, then were put in liquid nitrogen. Samples were preserved in liquid nitrogen for more than 14 days. MAIN OUTCOME MEASURES: The morphology changes of preserved arteries observed through naked eye and microscope; hysteresis loop; stress relaxation; breaking strength. RESULTS: Artery structures were all preserved well in the three groups, the integrity rate of vitrified artery group was 91.67%, which was significantly better than 54.17% of cryopreserved artery group (P 0.05). CONCLUSION: There influences of vitrification and cryoprsesrvation on the artery morphology and mechanical properties were not significant, while arteries preserved by vitrification had less tissue ruptures, so vitrification is suitable for preserving long vessels.
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0.05).The maximum relaxant forces of vitrification and fresh arteries groups were greater than the freezing group(P 0.05).The arteries of three groups began obvious relaxant responses when sodium nitroprusside was 10-7 mol/L, and nearly reached their maximal relaxant responses when sodium nitroprusside was 10-4 mol/L.CONCLUSION:The vitrification could preserve more active smooth muscle cells of arteries than the freezing method.The norepinephrine has better effect on contraction ability of artery, which preserved in the vitrification group than the freezing group;however, there is no difference in relaxation of sodium nitroferricyanide.
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[Objeetive]To report the repairing offect of cancellous bone defect with calcium sulphate.[Method]A defect 5mm in diameter and 12 mm in deep,which was drilled in the lateral aspect of rabbit lateral femoral condyle,was filled with CCaS(Citrated Calcium Sulphate)cylinder or Osteoset tablets respectively.Rabbits were killed 3,6,13 weeks after surgery.And then general oberservations and mechanical analyzing were conducted.[Result]After surgery,rabbits had good movements,spirits and eating,good healing of incision.There was no arthroedema and inflammatory response around the joints.Mechanical analyzing reports:both anticompressive strength and elasticity coefficient in the artificial bone repair bone defect area 3 weeks after surgery,were higher than in that of normal femur condyle;Anti-compressive strength and elasticity coefficient in the defect area 6 weeks,which drop comparing to 3 weeks,was lower than that of normal femur condyle;Anti-compressive strength and elasticity coefficient 13 weeks,which is higher than 6 weeks,is approaching normal.Mechanics intensity of two groups in the different time had no significant difference,but was significantly higher than one of the same time blank group.[Conclusion]To some extent,Calcium Sulphate has mechanical supportive effects on cancelloues bone defect in spite of the absorption and degradation of Calcium Sulphate.There is no significant difference between Citrated Calcium Sulphate and Osteoset tablets.
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[Objective]To explore the effects on surrounding tissue and bone regeneration by citrated calcium sulphate(CCaS) and Ostesset~.[Method]Bilateral or lateral femoral condyles were drilled into defects in 18 rabbits,and divided into 3 groups: A,12 rabbits,left defect filled with CCaS cylinder,right defect with osteoset~;B,3 rabbits,left defect with CCaS,right defect blank;C,3 rabbits,left defect with osteoset~GFDA3,right defect blank.The rabbits were sacrificed at 3 wks,6 wks and 13 wks,and defect samples were taken for histological exam,roengenographic observation and bone tissue calculation by image-plus CCD system.[Result]The defects that were not grafted were filled with bone marrow and there was minimal new bone,only at the margen of the defects CCaS and osteoset~GFDA3 implanted in the defects were gradually absorbed,and substituted by new bone trabecula,which became more mature and thicker.The area fraction and trabecula thickness of new bone in defects treated with CCaS were not significantly different from defects treated with osteoset~ after 3,6,13 wks.However,the degradation velocity of CCaS was slower than that of osteoset~.No inflammatory and foreign body response was observed.[Conclusion]Just like osteoset~,CCaS is more benefitial to new bone formation compared with osteoset~,because CCaS has relatively slower degradation velocity.
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[Objective]To probe the efficacy of total hip arthroplasty(THA)in the treatment of patients with ankylosing spondilitis(AS).[Method]Ninety-eight THA were performed in 56 patients who had AS,and 42 patients(76 hips)were analyzed retrospectively with an average follow-up period of 5.6 years(ranged,2.5 to 5.5 years).The clinical results were evaluated by the Harris hip scoring system and radiographic analysis.[Result]For the latest follow-up,the average Harris hip score improved from 26.8 points(ranged,4 to 51 points)preoperatively to 85.2 points(ranged,55 to 94 points)at the final postoperatively evaluation.89.5% of the patients had an excellent or good results evaluated by Harris hip scoring system postoperatively.One patient was revised for infection,fissured fracture of neck of femur or calcar femorale above the lesser trochanter happended in two patients,one patient had footdrop and recovered 3 months later,1 patient had deep vein thrombosis.There was no sign of loosening,dislocation or fracture of the prosthesis.According to the system of Brooker,the incidence of heterotopic ossification was 9.2 %(7 hips).[Conclusion]THA can greatly relieve the pain of the patients who have AS and reconstruct the function of hip joint.Compared with THA operated for other cause of disease,THA in AS leads to no high risk.
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Objective This paper is to study a new sutureless vascular bonding method. Methods New-Zealand rabbits were randomly assigned to one experimental group and one control group. 10 end-to-end bonding on rabbit femoral arteries (1.2mm vessel) were performed using the experimental technique with histoacryl glue (OB) and a central channel soluble stent. In the control group, 10 rabbit femoral arteries (1.2mm vessel) were anastomosed with the standard suture method. The patency rates and anastomotic time were recorded. The late anastomoses were evaluated with arteriograph and stoma tissue pathological section. Results The anastomosis mean time of the experimental group is 7.91 minutes and the one of the control group is 12.90 minutes. The immediate patency rates of two groups are both 100% and the late patency rates are 80% and 90% respectively. There are no haemorrhage when the clamp released and no distortion and stricture caused by sutures. Conclusion The sutureless vascular bonding method has no needs for suture needle and line, and thus the possible injuries during suture are reduced. The stent makes the vessel free from stoma stricture and binder invasion. The stoma leakage is also avoided through the adhensive. The enhanced suture speed results from the short clotting time and the hollow structure of the stent. With all the above-mentioned excellences, the method proves simple and efficient.
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Objective To research and make one kind of sealant gel to prevent glue from leaking effectively,and protect vascular anastomosis site,raise the vascular anastomosis patency.Methods The experiment was carried out based on theory and methods in chemistry;According to the membrane performance,the membrane water solubility,and other characters,the author took experiment on the alginic acid sodium,chitsan,the gelatin and other biological materials.Results Through the experiment by membrane performance,the alginic acid sodium met the requirement,which became the membrane with the CaCl2 reaction at once.Its membrane was not dissolved in the water.And the characters of its 1%-3% solution were good on fluidity and surface contact angle determines.The biological compatibility of the compound of it with 20% CaCl2 solution was good.Conclusion The characters of the composition,which is double component sealant made from 1-3% alginic acid sodium and 20%CaCl2 solution,is best in the biological experiment.Before new medical glue appeared in clinical,this gel is hopeful to be applied in clinic and provide theory basis for clinical anastomosis.
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Objective To research and make one kind of intravascular soluble hollow stent for vascular anastomosis. Methods According to the chemical industry, CaCl2, polyethylene glycol (PEG)and gelatin were used to make one kind of intravascular soluble hollow stent for vascular anastomosis, whose surface was covered with CaCl2 membrane(CaCl2 hollow stent). After putting the stent into the two cut sides of vascular, the author put the two sides together, and dropped alginic acid sodium solution, CaCl2 solution, and glue respectively. As soon as the glue solidified, the anastomosis was finished. Results The CaCl2 hollow stent could not only support the cannel of vascular, but also generate two membrane in the two side of anastomosis site. Thus the thickness of sealant was increased. It was effective to prevent leaking of cyanoacrylate glue and its toxicity. Conclusion The CaCl2 hollow stent can generate two membrane in the two side of anastomosis site, and could increase seal effectively. Using this stent could improve the anastomosis patency by increasing the sealant thickness, and preventing leakage of cyanoacrylate glue and its toxicity.
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Periosteal autograft from different sources have been used to repair 1.5cm bone defects of radius in 10 rabbits.On the left side,sharp-dissected grafts were implanted and the animals were sacrificed 4,8,14,30 and 60 days after operation.Bone formation was studied with X-ray and histologic technique.The results showed that the way of sharp-dissecting can preserve the periosteum completely,and good bone formation was found in this group.It suggested that the sharp-dissecting of the periosteum is the important key for periosteal graft.
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In order to determine the efficacy of mannitol and anisodamine in the treatment of compartment syndrome, a new animal model of compartment syndrome was used to observe the changes in CPK, MDA, tissue pressure and pathology before and after the use of the drugs. The results showed that the values of CPK, MDA and intracompartmental pressure declined and pathological changes improved after the therapy. The result indicated that this new animal model is reproducible and successful. Mannitol is useful in the treatment of compartment syndrome, and at the same time it acts as a free radical scavenger, so that it can prevent reperfusion injury. Anisodamine can improve the limb's microcirculation. CPK can be an index for judging the therapeatic effect in the treatnent of compartment syndrome.
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Bi-polar,bi-pedicled separation delayed flaps were designed on the backs of New Zealand rabbits with the application of a medical silicon membrane as the separation material. Values of glucose and lactic acid, PtcO 2 were measured separately at proximal,middle and distal areas of the flaps after the distal pedice was cut at 0,1,4,7,14,21 days,respectively, after the formation of flaps. After flap delaying,PtcO 2 in separated flap was always lower than that of the mormal control,accompanied with glucose decrease and lactic acid increase, although there were significant differences in different areas of the flap. The survived area of the flap increased after 7 days. Furthermore,all the length of the flap survived after 21 days,although the level of glucose in the flap was still lower and lactic acid was still higher.The results suggested that by separation and delaying the flap may adapt gradually to hypoxia via lowered metabolism.For flap survival,the threshold value of glucose in flap is 0 01mmol/L , lactic acid is 0 47mmol/L,and PtcO 2 is 3mmHg .
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Objective To evaluate the causes,clinical manifestations and diagnosis of tarsal tunnel syndrome. Methods Operation was performed for 18 patients ( 21 sides) with tarsal tunnel syndrome. Preoperative Takakura index was 3-7 points with an average of 6.4 points. Ganglion was found in 15 cases (17 sides), varicosity in 2 cases (3 sides) and lipoma in 1 case. Results The symptoms disappeared without recurrence in 0.5 to 17 years' follow-up (average 7.3). Postoperative Takakura index was 9-10 points (average 9.7). Conclusion Tarsal tunnel syndrome is rare in the clinical practice with varied causes and different clinical manifestations. Operation can be performed with satisfactory results for the patients unsuitable for conservative treatment.
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Objective A retrospective study of the results of surgical or non-operative treatment in patients with herniation of lumbar disc 10 years or longer before,in order to evaluate the efficacy of different therapeatic strategies for lumbar disc herniation. Method Definite diagnosis of lumbar disc herniation was made in all cases before treatment,and the follow-up period was 10 to 38 years. The patients were divided into three groups according to different treatment methods: non-operative group,simple nucleus resection group,and nucleus resection combined with space fusion group. The long term therapeutic effects and image change of the three groups were observed. The difference of height of intervertebral space at the herniation site was measured before treatment and at the latest follow-up. Adjacent spaces were also observed. The data were analyzed statistically by t -test and ? 2 -test. Results Among 98 cases in non-operative group,85 cases enjoyed almost a normal life and work;vertebral canal decompression was performed for the rest 13 cases because of intermittent claudication. The protruded space was narrowed for 3.17?1.65mm in height in average after non-operative treatment,and there was degeneration of adjacent spaces in 13 cases. Among the 84 cases in simple nucleus resection group,relative good outcome was seen in 71 patients,and the remaining 13 cases had to receive a second operation because of symptom relapse. The protruded space was decreased 5.50?1.51mm in height in average as measured at the latest follow-up comparing with that of before operation. The degeneration of the adjacent space was observed in 15 cases. In 71 patients who received nucleus resection combined with space fusion experienced a good relief of symptoms. The space,where disc herniation had occurred,fused very well and no re-narrowing occurred. Degeneration of the adjacent space was observed in 39 cases,but the patients were symptomless. Conclusions The effect of either non-operative therapy or operation for patients with lumbar disc herniation was good after a long-term follow-up if the indication was chosen properly. We suggest that non-operative therapy should be the first choice for the lumbar disc herniation. The relatively normal nucleus should be preserved as much as possible when nucleus resection was performed. Intervertebral fusion was a relative better treatment comparing with the other two treatments.
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Objective The complications of internal fication for calcaneal fracture were summarized and discussed to increase awareness of these complications, and to improve decision making and efficacy of the treatment. Methods The patients admitted to our hospital from October 1997 to June 2003 were followed up. The fracture in 68 feet (66 patients) was treated with open reduction and internal fixation (ORIF) using steel plate. The complications associated with ORIF were analyzed and discussed as to etiology, incidence, diagnosis, prevention and treatment. Results The patients were followed up for 7 to 57 months. Complications were found in 14 cases, including postoperative wound dehiscence in 5 (infection in 2), malunion (failure to achieve reduction) and arthritis in 9, accompanied by nerve injury in 6. The percentage of complication was 20 6%. With timely treatment, good function was regained in most of the patients. Conclusion Should attention be paid to the operation, many complications could be avoided. ORIF with plate is one ot the options for the treatment of this fracture, but the operative technic and the device should be improved. As the anatomy of the calcaneus is different from a long bone, it is unsuitable to apply the principle and device that are used in the internal fixation of a long bone to this fracture. The plate and screws used in the fixation of the calcaneal fracture can not give enough support
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A stent for bloodvessel anastomosis, with a slippery, soft out layer and a rapidly soluble inner layer, is developed in this paper. The out layer is made up of the gelatin with a high purity and a low molecular weight, and the inner one of polyglycol with a molecular weight of 20000. The structure changes of the stent surface are studied with anastomosis environment simulated. The result proves that the stent can be applied to bloodvessel anastomosis
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In this paper, the solution modes of two stents with different structures are compared, and then one involved is elected as the optimum stent for anastomosis. Made of PEG20 000, two stents are solid and hollow respectively. The result proves that the hollow one, with the advantages of nonblocking bloodstream, undeflected and rapid solution, low requirement for raw materials, is fitter for anastomosis than the solid one.
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Objective To design a new flap model using for study on effects of some drugs which would maximize flap survival,and to evaluate its experimental availability.Methods The Wistar rat was used as the experimental animal.On the back of each rat,a skin flap,measuring 1.5 cm ? 6 cm,caudally based,was elevated and separated.Wound edges and the flap bed were separated from the flap by a silicone sheet and the drug was put in the areas between flap and sheet.On the seventh day after the flap elevation,historical and physiological measurement to blood flow and skin specimens would be done.The repeatability of the model was calculated.Results Single pedicle separaration flap needed 26 rats as samples when the resolution was 10% in testing,while the back flap model(10 cm ? 3 cm ) needed 28 rats.The needed samples were 2 rats and 5 rats respectively when the resolution was 25%.So it was believed that with high repeatability,the model of pedicle separation flap met the basic principle of testing design and was suitable for the study of the same kind.Conclusion The model can be used with confidence to study the effects of drugs on the flap survival.
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Objective To study the effect of the VitC, bFGF, Magnesium sulfate and Papaverine in single pedicle separation flap survival. Methods The Wistar rats were used as the experimental animal. On the back of each rat, a skin flap, measuring 1.5 cm?6cm, caudally based, was elevated. Wound edges and the flap bed were separated from the flap itself by a silicone sheet. The VitC, bFGF, Magnesium sulfate and Papaverine were taken in the areas between flap and sheet. With 8 rats in each group, the drug-taken group was as trial group, while the physiological saline group was as control group. On the seventh day after the flap elevation, flap survival length was measured. Results The selected drugs could improve flap survival in some way, among which the effects of the VitC was the most distinct. Conclusion All the drugs can improve blood-flow, so it is believed the selected drugs can improve flap survival by improving flap’s blood-flow.