Objective〓〖WTBZ〗To assess treating results of functional reconstruction of irrecoverable partial injury of brachial plexus and to improve the function ofinjured upper extremity. Methods Seventiy-nine cases with irrecoverable partial injury of brachial plexus were treated in transfer of muscle (tendon) or by fuctional anthrodesis (fixation of tendon) from January 1984 to June 2003. According to the evaluation criterion by American Shoulder and Elbow, Hand Association,all patients were followed up in motion of reconstructive joint and daily activities after operation for 1 year to 19 years. The effect of the operation was comprehensively scored and evaluated. Results Final results in 54 caseswere as follows: 30 patients with good results, 19 patients with fair results, and 5 with poor results. The results demonstrated some points as follow: ①if the shoulder was instable, athroedesis of shoulder would be a better choice;②the flexion of the elbow joint should be only reconstructed with the dynamic reconstructive methods. The reconstruction of flexion of elbow by transfer of pectoral major muscle was more effective than that by transfer of flexor carpi ulnaris muscle; ③the dynamic reconstruction of extension of digital and carpi was better than that of flexion of digital and opposition function of the thumb; ④the supination of the forearm was effectively reconstructed by transfer of flexorcarpi ulnaris muscle. Pronation teres muscle should be studied more in reconstruction of supination function of the forearm.
OBJECTIVE: To summarize the importance of surgical management to repair vascular injury in limbs salvage, and to analyze the influence factors in the management. METHODS: From 1993 to 2000, 42 cases of 58 vascular injuries were reviewed; there were 37 males and 5 females, aging from 12 to 70 years old. Emergency operations were performed in 38 cases and selective operations in 4 cases from 1 hour to 45 days after injury. There were 22 cases of complete rupture in 32 blood vessels, 5 cases of partial rupture in 6 blood vessels, and 15 cases of vascular defect in 20 blood vessels, with 5 cm to 10 cm defect. The operation management included end-to-end anastomosis in 22 cases, side-to-end anastomosis in 1 case, vascular repair in 5 cases and vascular grafting in 14 cases. All of the cases were followed up for 6 months to 7 years. RESULTS: In those received emergency operations, it was successful in 35 cases, with amputation in the other 3 cases; after operation, there were 5 cases of post-operative angio-crisis, 1 case of hematoma and 1 case of pseudoaneurysm. In those received selective operation, all succeeded but 1 case of post-operative angio-crisis. After the follow-up, except for 3 cases of amputation, the other limbs survived; and function of the survived limbs recovered satisfactorily after operation except poor recovery in 7 cases of replantation of the limbs. CONCLUSION: To repair vascular injury immediately, to manage angio-crisis and to remove influence factors is the key to save the injured limbs and to maintain the function of them.
In order to enhance the therapeutic effectiveness of peripheral nerve injury, intraoperative extrab electrical stimulation was used in peripheral nerve surgery. In 16 cases of incomplete peripheral rnerve injuries or poorly regeneratedn erves, continuous intraoperative electrophysiological monitoring was used for guidance of neurolysis. Meanwhile, extrastong electrical stimulation was applied. The latency and amplitude before and after electrical stimulation were recorded and the extent of improrement was compared. In all cases, the latency and amplitude were improved after neurolysis and electrical stimulation. Clinical follow-up also showed that the function of corresponding innorvated muscle was improved. Continuous intraoperative extrab electrical stimulation could be used as an practical measure to increase the effectiveness of peripheral nerve treatment.
OBJECTIVE To analysis the clinical characters of gluteal sciatic nerve injuries and investigate the treatment options. METHODS From October 1962 to June 1997, 190 patients with gluteal sciatic nerve injuries were adopted in this retrospective study. In these cases, the sciatic nerve injuries were caused by injection in 164 patients(86.32%), stab injury in 14 patients, pelvic fracture and hip dislocation in 11 patients, and contusion injury in 1 patient. Among them, 15 cases were treated by conservative method and the other 175 cases were operated. According to the observation during the operations, the injuries were occurred at the region of gluteal muscle in 146 cases, at the region of piriform muscle in 26 cases, and at the region of pelvic cavity in 3 cases. Then neurolysis was performed in 160 cases, epineurial neurorrhaphy in 12 cases and nerve grafting in 2 cases, and nerve exploration but no repair in 1 case. Late stage functional reconstruction of the foot and ankle was carried out in 23 cases. RESULTS One hundred and fifty-one patients were followed up 8.5 years in average. The occurrence of excellent and good nerve recovery was 56.95% and the occurrence of excellent and good functional reconstruction of late stage was 78.26%. CONCLUSION The gluteal sciatic nerve injury has since been challenging because of the tremendous difficulty in treatment and the poor outcome. The injury situation at the different region was closely related to the regional anatomy. According to this study, it is advised that the surgical treatment should be carried out actively. Neurolysis should be performed as soon as possible in the cases of injection injury. Epineurial neurorrhaphy should be performed in the cases of nerve rupture. In case of the gluteal sciatic nerve injury which caused by pelvic fracture or hip dislocation, the reduction and decompression is suggested in the early stage, and exploration and nerve repair is indicated in the late stage. The functional reconstruction of foot and ankle should be carried out in the late stage for the improvement of the limb function.
Objective To establish a new model on isolated human cadaver testes with ischemiareperfusion (I/R). MethodsThirteen isolated cadaver testes contributed by 13 persons were preserved under 0℃-4℃ hypothermia and then reperfused under 37℃. Histological and histochemical changes were observed. Results4℃ cold ischemia in 12 hours induced only trivial swelling and vascular degeneration of endothelial cells (ECs), obvious pathologic changes occurred after 24 hours, including detachment of ECs, separation between basement membrane and seminiferous epithelium, degeneration and detachment of spermatogenous cell and edema of mesenchyme. Injury was worse along with the prolongation of cold preservation time. Changes of LDH and SDH activities were found by histochemical staining. Reperfusion following 6 hours ischemia induced tissue injury and unusual enzyme activity. All changes were more obvious after reperfusion following 12,18,24 or 36 hours cold ischemia.Conclusion This new model on isolated cadaver testes with ischemiareperfusion is successful, it can substitute other solid organs of human beings for I/R injury study.
【 Abstract 】 Objective To investigate the effects of 250 ml/m3 carbon monoxide (CO) inhalation or intraperitoneal infusion on lipopolysaccharide (LPS) induced rat intestinal tract injury, and to detect the roles of p38 mitogen-activated protein kinase (MAPK) pathway during CO administration. Methods After received 5 mg/kg LPS or an equal volume of normal saline by intravenous injection, 108 male SD rats were randomly divided into 6 groups: control group, CO inhalation (250 ml/m3) group, CO intraperitoneal infusion (250 ml/m3 at a rate of 2 L/min) group, LPS (5 mg/kg) group, LPS (5 mg/kg)+CO inhalation (250 ml/m3) group and LPS (5 mg/kg)+CO intraperitoneal infusion (250 ml/m3 at a rate of 2 L/min) group. The animals were differently sacrificed at 1, 3 and 6 h for the observation, and the ileum tissues were homogenized for determination the levels of platelet activator factor (PAF), intercellular adhesion molecule-1 (ICAM-1) and interlukin-10 (IL-10) with enzyme-lined immunosorbent assay, the content of maleic dialdehyde (MDA) with thiobarbitric acid, the activity of myeloperoxidase (MPO) with chemical method, the activity of superoxide dismutase (SOD) with hydroxylamine, the activity of phosphorylated p38 MAPK with Western blot, the pathology with light microscope, and the extents of cell apoptosis were showed by the ratio of the apoptotic cells which had less DNA to the total cells of a cell-suspension sample by using the flow cytometry after being stained with propidium iodide. Results Compared with both control, CO inhalation and intraperitoneal infusion group at the same time point, the levels of PAF, ICAM-1, MDA, MPO, cell apoptosis rate and the phosphorylated p38 MAPK protein in LPS group were increased, while IL-10 and SOD were decreased (P ＜ 0.05 or 0.01), and accompanied by severe intestinal tract injury. There were no statistics differences at the different time point in the same group. PAF, ICAM-1, MDA, MPO and cell apoptosis rate in both LPS+CO inhalation group and LPS+CO intraperitoneal infusion group were lower, while IL-10 and SOD were higher than the corresponding value in LPS group at the same time point (all P ＜ 0.05), with ameliorate injury too, but the expression of phosphorylated p38 MAPK was further up-regulated than that of LPS group (all P ＜ 0.05). However, there were no significant differences in these parameters between LPS+CO inhalation group and LPS+CO intraperitoneal infusion group. Conclusion 250 ml/m3 CO inhalation and intraperitoneal infusion exerts the similar protection against LPS induced rat intestinal tract injury via anti-oxidant, anti-inflammation, and anti-apoptosis. This may involve the p38 MAPK pathway.
OBJECTIVE: To measure the length and extent of the injured blood vessels in an avulsion amputation model. METHODS: Twenty rabbits were randomly divided into 2 groups. Group A was a sharp amputation group, and group B was an avulsion amputation group. The length and extent of the injured blood vessel was observed with naked eye, operation microscope and electron microscope, and the limbs were replanted. Group A and B were explored at three days and ten days after the replantation respectively. The patency rate and healing process were compared. RESULTS: All the severed ends of vessels in group A were neat with almost the same injured range in the three layers of the vessel wall about 1 mm away from the severed end. The vessels of group B were damaged seriously, the endothelial cells were deleted. The "jumping-like" damage could be observed in the elastic fibers. The injury of 2 to 3 mm away from the normal vessel wall could be observed by operation microscope. CONCLUSION: The damage of avulsion amputation vessels was irregular, 2 to 3 mm or more tissues should be excised under the microscope in the process of operation in order to ensure the healthy intact blood vessel walls.
Incidences of injuries to peripheral veins indicated certain proportions among vascular injuries, most of venous injuries were accompanied by arterial injuries. Elevated venous pressure is an important factor which cause a compression syndrome in muscular compartment of the extremities when the injured major veins are ligated or not repaired. Persistent red deep color bleeding at wound site, diffusive subcutaneous hematoma, edema and cyanosis of the extremities are characteristics of the venous injuries. The examinations of Dopplor ultrasound and phlebography would be available for diagnosis of the venous injuries. The repair means include lateral sutere, vein pathch grafts, end-to-end anastomosis and autogenous venous grafts. The venous thrombosis may occur at the early phase after repair operations and also could be prevented.
OBJECTIVE: To review the anatomy, etiology, therapy strategy of Achilles tendon injury and its related advances in recent years. METHODS: The related articles in recent years were extensively reviewed. RESULTS: There still were many arguments about the effect of corticosteroid on the treatment of tendon disease. Fluoqmnolone was found to be related with Achilles tendon injury. Acute rupture of Achilles tendon could be treated with open operation, percutaneous repair, or conservative therapy. For old rupture, many kinds of operations could be selected. CONCLUSION: The growth factors found in recent years provide us with new prospect for future treatment of Achilles tendon injury.
Objective To study the diagnosis and treatment of the acute medial collateral ligament ruptures of the knee.Methods From August 1998 to August 2003, 87 cases of acute medial collateral ligament ruptures were examined with physical method and MR imaging. Out of them, 35 cases of Ⅰdegree and Ⅱ degree ruptures were treated with non-surgery and 52 cases of Ⅲ degree ruptures were treated surgically. The torn medial collateral ligaments were mended, 21 of which were strengthened with the anterior partial gracilis muscle tendon after the arthroscopy. Results In 35 cases of Ⅰ and Ⅱ degree ruptures, 32 were followed up 13 months on average. According to Lysholm scoring system, the clinical results were classified as excellent or good in 93.7% of the cases. In 52 cases of Ⅲ degree ruptures, 50 were followed up 16 months on average. The excellent or good result was 90%.Conclusion For Ⅰ and Ⅱ degree ruptures, MR imagimg is an important way to definitely- diagnose medial collateral ligament ruptures. Abduction stress test of knee extension shows that the medial direct instability is a main way to definitely diagnose Ⅲ degree ruptures. The results of conservative treatment of Ⅰ degree and Ⅱ degree ruptures are excellent. Surgical therapy are fitfor the cases of Ⅲ degree ruptures.