Objective To evaluate the effect of internal iliac artery or abdominal aorta blockade on the pressure of internal iliac artery net in order to provide theoretical basis for reasonable option of arterial blockade in management of arterial bleeding of pelvic fractures.Methods Five goats were included in the study.The measurement of the pressure of internal iliac artery net was made in the following steps:( 1 ) measurement of the pressure of normal internal iliac artery,(2) measurenent of the pressure following blockade of unilateral internal iliac artery,(3) measurement of the pressure following blockade of bilateral internal iliac arteries,(4) measurement of the pressure following blockade of abdominal aorta and bilateral internal iliac arteries simultaneously,(5) measurement of the pressure following blockade of abdominal aorta only.Results The normal internal iliac artery pressure was ( 57.84 ± 13.46 ) mm Hg.The pressures following the blockade of unilateral internal iliac artery,bilateral internal iliac arteries,abdominal aorta and bilateral internal iliac arteries sinultaneously,and abdominal aorta only were (38.40±17.39) mm Hg,(29.70 ± 12.16) mmHg,(32.80 ± 17.02) mm Hg and (29.20 ± 18.52) mm Hg,respectively.All the blocking designs had obvious effect on the pressure of normal internal iliac artery ( P ＜ 0.05 ),while the various blockade modes themselves showed no statistical differences (P ＞ 0.05). Conclusion The upper described four modes of blockade are similar in decreasing the pressure of the internal iliac artery net.Thereby,only one of them is enough in management of artery hemorrhage following pelvic fractures.

Objective To study the effect of the uncellular tissue engineering complexes of autolegous red bone marrow wrapped by facial flap with vessels in repair of large segment bone defect infected with low virulence bacteria so as to provide evidence for the clinical application. Methods The study included 38 cases of limb bone defect infected with low virulence bacteria after trauma.Autologous red bone marrow (ARBM) was taken to prepare uncelluar tissue-engineered complexes with osteoinductive absorbing material (OAM) containing bone morphogenetic protein (BMP).A facial flap with capillary network originating from an anonymous vessel adjacent to the bone defect was prepared to wrap the tissue engineered bone and fill the bone defect.Pathological focus clearance and tissue-engineered complexes compounded with ARBM implantation were performed in 18 cases (Group A) and pathological focus clearance and tissue-engineered complexes of autolegous red bone marrow wrapped by facial flap with vessels implantation in the other 20 cases ( Group B).The blood routine and supersensitive CRP were examined to monitor the inflammation reaction; X-ray was used to observe the bone defect repair; histology and bacteriology examinations were performed in partial cases at 3,6,12,18 months after operation. Results Six months after operation,5 cases of Group A were infected and the bacteria cultivation was as positive as that before the operation.The histological observation at ( 14.0 ± 0.5 ) months after operation showed that fibrous connective tissues between the bone fracture ends existed in the pathological area in 10 cases,of whom four cases were filled with inflammatory fibrous granulation tissues and few dead bones in the pathological area,and the bacterial examination was positive.There was no infection in Group B after operation.The histological observation manifested periosteum like tissues formation from the primary facial flap,mature bone structure formation in the primary pathological area and non-inflammatory infiltration in 16 cases and the bacteria cultivation was negative in these cases.The external fixation frame was taken out (12.2 ± 0.3 )months after operation because the synostosis appeared and the structure was stable in the other seven cases including three cases in Group A and four in Group B and the histological and bacterial examination were not performed.At each time point after operation,not only the blood routine but also the supersensitive CRP and the X-ray quantification grade of Group B were significantly more than those of Group A (P ＜ 0.05 ). Conclusions The uncellular tissue-engineered complexes of autolegous red bone marrow wrapped by facial flap with vessels is a feasible method for repairing the infected bone defect by first intention,since it can resist infection,obviously promote the bone recovery and advance the quality and quantity of osteanagenesis.

Objective To investigate the application of MRI in evaluation of the traumatic temporomandibular joint (TMJ) injury induced by type Ⅵ condylar fracture. MethodsMRI was performed in TMJs in 18 patients with type Ⅵ condylar fractures at days 3-14 post-injury and the MRI findings were analyzed. ResultsMRI findings of 18 patients with traumatic TMJ injury with 19 sides of type Ⅵ condylar fractures showed 15 sides of TMJ disk displacement,nine sides of capsule tear,16 sides of retrodiscal tissue tear (double-plate area) and 19 sides of joint effusion change. Conclusions MRI is very important in the diagnosis and evaluation of traumatic TMJ injury,since it can clearly display the TMJ injuries in type Ⅵ condylar fractures.Therefore,the clinical application of MRI is beneficial for selection of the therapeutic schedules.

Objeetive To analyze traffic accidents involving pedestrians in Chongqing from 2000 to 2006 so as to understand injury characteristics of the pedestrians. MethodsThe data of pedestrian road traffic crashes and injuries in three districts including one district in downtown,one in suburb and one in county of Chongqing from 2000 to 2006 were collected from road traffic crash and road traffic injury database to analyze severity of crashes,casualties,action and location of pedestrians in crashes. Results The road crashes led to 7 934 pedestrian injuries (24.74％) and 867 pedestrian deaths (49.46％).Intensity of the pedestrian road crashes in rural areas was higher than that in downtowns and suburbs.Of all pedestrian casualties,57.91％ were due to illegally crossing the driveway,and 15.43％ of the casualties were on the crosswalk.Most of the casualties occurred on the main roads,the third class highways and second main roads in Chongqing.But serious crashes occurred on the first and second class highways and substandard highways,which led to average 3.17,4.13 and 5.42 deaths,respectively.Pedestrians accounting for 52.46％ of the total severe injuries were more than the proportion among the minor to moderate injuries.Head injuries were the most common for the pedestrians and chest injuries were also usual among the severe injuries. Conclusions The intensity of pedestrian road crashes is higher than that of other crashes,especially in rural areas.It should be noticed that the main injuries of the pedestrians are head injuries,which is mainly resulted from illegally crossing driveway.It is worth noticing that a rather high proportion of pedestrians are impaired on the crosswalks,indicating that we should pay more attention to protect right of the pedestrians on the crosswalks during transportation law enforcement and safety education in the future.

Objective To explore the related risk factors of injuries caused by non-motor vehicle crashes in Hefei,Anhui Province. Methods From June 2009 to June 2011,the wounded from nonmotor vehicle crashes in Hefei were admitted to our hospital.The data of the wounded were collected to perform hypothesis test to screen out the related risk factors,which were then analyzed with multiple-factor non-conditional Logistic regression analysis. Results A total of 205 cases who were wounded in the non-motor vehicle crashes were admitted to our hospital from June 2009 to June 2011.Among all the cases,146 cases were wounded in electric bicycle crashes and 59 cases in bicycle crashes.There were 147cases (71.7％) of mild to moderate injuries ( ISS ≤ 15 ),and 58 cases (28.3％) of severe injuries (ISS ＞ 15 ) including six deaths (2.9％).Single factor of different categories of the hypothesis test suggested that age,category,driving behavior,crash model,impact type,vehicle type were all related with the severity of injuries caused by non-motor vehicle crashes in Hefei.The multiple-factor non-conditional Logistic regression analysis showed four risk factors for the injury severity in non-motor vehicle crashes in Hefei,ie,vehicle type,crash model,violations of rules and regulations as well as age,according to the degree of correlation.Conclusion With the study of non-motor vehicle crashes in Hefei,primary identification of the risk factors for the traffic injuries is obtained,which provides scientific basis for the decrease of casualty and establishment of intervention measures.

Objective To analyze the injury characteristics in 2004-2009 road traffic accidents (RTAS) of 0-25 years old adolescents treated in Beijing 120 Emergency Center so as to provide scientific basis for making effective measures in prevention and control of RTAs. Methods The data of all the adolescents with traffic injuries treated in Beijing 120 Medical Emergency Center were collected for a retrospective analysis on sex,age,traffic injury time,wound regions,injury characteristics and death condition of the injured adolescents. Results( 1 ) There were 17 232 injuries and 259 deaths according to the traffic reports from 2004 to 2009. Among the total injury cases,there were 4 229 cases of 0-25 years old adolescents (24.5％),at (20.13 ± 4.43 ) years of age.The injury number showed a significant rising trend with the increase of age and the injury number of 20 years old group were obvious more than that of other age groups.(2) There were 2 252 males and 1 677 females,with ratio of males to females for 1.5:1 ( P ＜ 0.05 ).( 3 ) Total number of patients was decreased yearly.The high incidence of adolescent RTAs could be seen in September,October and May in one year; Friday,Saturday and Sunday in one week; and between 8:00 am and 11:00 pm in one day.The low incidence of adolescent RTAs could be seen in Tuesday in one week,and 3:00-6:00 am in one day (P ＜0.05).(4) Cases of limb and arthrosis wounds (53.4％) were more than those of head and neck wounds (35％).Most of the cases were pedestrians (49.1％ ).(5) There were 38 deaths,including 28 males and 10 females,at ageof (19.29 ± 5.30) years.The death were mainly resulted from craniocerebral injuries (87％),which mainly concentrated in July ( 13.2％ ) and August ( 15.8％ ). Conclusions The present condition ofadolescent traffic injuries is not good enough.We should strengthen traffic security education,increase executive powers in the traffic rush and promote cooperation and communication in pre-hospital emergency,as may be beneficial for decreasing adolescent RTA.

Objective To analyze the injury features of the wounded in the bullet train crash in July 23,2011 in Wenzhou of Zhejiang and explore treatment experience.Methods A total of 177 cases who were injured or died in the 7.23 Wenzhou bullet train crash were involved in the study.The age,gender,injury types,injury regions and injury severity were analyzed by using Trauma Database System V3.0 ( produced by China Trauma Data Center of Third Military Medical University). Results A total of 137 cases were admitted to our hospital within 24 hours after the bullet train crash in Wenzhou.There were 76 males and 61 females,with no significant difference.Of the 137 cases,136 survived and one died after medical treatment.The major injury types included impact injury,crush injury and heavy weight falling injury.Among the 136 survivors,108 cases were with multiple injuries,accounting for 79.4％.The most common injury region of the survivors was the chest,followed by the head and limb.The minimum trauma index (TI) was 5 points and the maximum 27 points.There were 4 cases(3.7％ )with TI ≤9 points,86 (79.6％) with 10-16 points and 18 (16.7％) with ≥ 17 points.Of all,78 cases (72.2％) had ISS score ＜ 16 points and 30 (27.8％) had ≥16 points.The minimum ISS was 3 points and maximum 75 points.There were 40 deaths including the one died after medical treatment,who were all with multiple injuries,with head injury the main cause.ConclusionsThe causes of the bullet train crashes are complicated,with high incidence of multiple injuries.The injury severity is varied,but the overall situation is not serious.Distribution of common injury regions is significantly different between the wounded and the dead.Injury triage,patient transfer and specialist treatment of the wounded should be carried out appropriately during the initial stage of medical rescue based on those injury features after the bullet train crashes.

Objective To investigate the harm of drug abuse of drivers on traffic safety and discuss the countermeasures.Methods Data were collected from sources including statistics of drug driving traffic accidents reported by mass media,inference analysis of the theoretical data,survey of outpatients in drug rehabilitation center,drug-related screening with drivers license during Shanghai World Expo 2010 Moat Security and integrated data from various areas.ResultsOf the over 10 million drug abusers including the registered and unregistered in China,more than 2 million drug abusers had drivers license,which greatly threatened the traffic safety.Conclusion Drug abuse (drug driving) has done great harm on traffic safety,which calls for appropriate preventive countermeasures.

Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage.

Objective To study the effect of articular step-off on knee joint contact pressures in fractures of the medial tibial plateau. Methods Eight specimens of embalmed adult knee joint were used to establish models of articular step-off of the medial tibial plateau by 0,1,2,3 mm respectively (Schatzker Ⅳ fracture) .The technique of pressure sensitive film was used to measure the contact pressures on the weight-bearing area of the knee joint in the 3 models. Results When the step-offs of medial tibial plateau were 0,1,2,3 mm,the average contact pressures on the lateral compartment were respectively 3.34 ± 0.06 MPa,3.48 ± 0.06 MPa,4.19 ± 0.05 MPa,4.19 ± 0.04 MPa,while the average contact pressures on the medial coMPartment were 4.04±0.17 MPa,4.57±0.20 MPa,5.64±0.20 MPa,5.64±0.19 MPa.When the step-off of medial tibial plateau was 2 mm,the average contact pressures on the medial and lateral plateaus increased by 39.6％ and 25.4％ compared with the 0 mm step-off,with statistically significant differences (P ＜0.05). Conclusions If the step-off of the medial tibial plateau reaches ≥ 2mm,open reduction and internal fixation should be indicated to prevent secondary traumatic arthritis.When the step-off of the medial tibial plateau is ＜ 2 mm,conservative treatment can be a proper choice.