BACKGROUND:Ideal models of spinal cord injury should simulate human spinal cord injury, exclude confounding factors affecting effects, and have extensive repeatability. Spinal cord transection model is an ideal choice at present. Nevertheless, the operation is diverse, so therapeutic effects have great differences, and the research results lack of comparability. OBJECTIVE:To compare and analyze behavioral changes and pathological features of rat hindlimb after spinal cord transection by establishing standardized model of transected spinal cord in rats. METHODS:A total of 60 adult female Sprague-Dawley rats were randomly divided into sham surgery group (n=12), conventional spinal cord transection group (n=24) and microscopic spinal cord transection group (n=24). Each group was randomly assigned to 7-day, 14-day and 28-day groups according to time points after model establishment. T9 vertebrae were considered as a center. Sham surgery group underwent laminectomy. Other groups underwent spinal cord transection. Thus, models of acute spinal cord injury were induced. Models in the conventional spinal cord transection group were established by conventional surgical methods. Models in the microscopic spinal cord transection group were established by standardization micromanipulation technique. At 7, 14 and 28 days after model establishment, motor function of hindlimb was evaluated using Basso, Beattie and Bresnahan (BBB) scoring system. Histopathology of transected spinal cord was observed. The thickness of the glial scar, the longitudinal distance between the two stumps, the transverse diameter of the spinal cord cavity and cerebrospinal fluid cyst formation were measured at the transected site of the spinal cord. RESULTS AND CONCLUSION:In the sham surgery group, preoperative and postoperative BBB scores and pathology of the spinal cord did not clearly change. In the conventional spinal cord transection group and microscopic spinal cord transection group, complete paralysis of hindlimb was detected after model establishment. Hindlimb function did not recover in the conventional spinal cord transection group. At 1 to 2 weeks after model induction, spontaneous recovery of hindlimb function was visible in rats of the microscopic spinal cord transection group. Spinal pathology index value was significantly lower in the microscopic spinal cord transection group than in the conventional spinal cord transection group (P<0.01). Pathological observations were not correlated with BBB scores in each group. These data indicated that standardized spinal cord transection method helps to eliminate individual differences and to quantitatively analyze and to compare studies addressing therapeutic effects.

Objective To investigate the application and clinical significance of the medial plantar flap on repairing the medial ankle and foot soft tissue defects. Methods A total of 13 patients with the medial ankle and foot soft tissue defects were repaired by the local transferred medial plantar flap alone or in combination with sural neurovascular flap transplantation in the Yuebei People's Hospital Affiliated to the Medical College of the Shantou University from Jun. 2006 to Dec. 2012. Results All patients were followed-up of 4-21 weeks,and the average follow-up periods were 6. 3 weeks. All of the skin and soft tissue defects of the medial ankle and foot were repaired,and there were 2 cases of partial necrosis of flap were repaired after tow times skin grafting operation,and all cases without complications of wound infection or iatrogenic nerve injury. Conclusion The medial plantar flap on treating ipsilateral medial malleolus and foot skin and soft tissue defects is useful and effective with less complications,satisfactory effects,intact the ankle flexor and extensor device,allowing early functional exercise,good functional recovery.

Objective:To explore the technical points and efficacy of gradual traction-unlocking closed reduction technique (GT-UCRT) for Tile C old pelvic fractures.Methods:From August 2012 to June 2021, 6 patients with Tile C old pelvic fracture were treated and followed up at Department of Orthopedics, The Fourth Medical Center, General Hospital of Chinese PLA. They were 4 males and 2 females with an age of (35.8±10.5) years. By Tile classification: 4 cases of type C1.2, 1 case of type C1.3, and 1 case of type C2; time from injury to surgery: 153.8 (64.3, 204.8) days. The 6 patients were treated with GT-UCRT. The time for gradual traction reduction, operation time, hospital stay, intraoperative blood loss and complications were recorded. The modified Matta score was used to evaluate the reduction quality of pelvic fractures, and the Majeed score was used to evaluate the pelvic function at the last follow-up.Results:The 6 patients were followed up for (40.3±22.9) months (from 12 to 72 months) after surgery. The time for gradual traction reduction was (26.7±4.6) days, operation time (119.2±4.6) minutes, hospital stay (11.5±2.9) days, and intraoperative blood loss (533.3±189.6) mL. By the modified Matta score, the pelvic reduction after surgery was rated as satisfactory in 5 cases and as unsatisfactory in 1 case. The length disparity between both lower limbs in the 6 patients was (6.9±1.6) cm before surgery and (1.0±0.4) cm immediately after surgery, showing a statistically significant difference ( t=11.135, P<0.001). One fracture healed 3 months after surgery and 5 fractures 6 months after surgery. The Majeed pelvic score at the last follow-up was (80.8±9.0) points for the 6 patients, yielding 2 excellent cases, 3 good cases and 1 fair case. Delayed wound healing was reported in 1 patient, calf intermuscular venous thrombosis in 2 cases, and emotional anxiety and sleep disorder in 1 patient. No new lumbosacral plexus injury was found in any patient. Conclusions:In the treatment of Tile C old pelvic fractures, since our self-designed GT-UCRT combines the advantages of Ilizarov technique and unlocking closed reduction technique, it can not only protect the lumbosacral plexus but also obtain satisfactory reduction of the fracture.