[Objective]To explore the method and effect of elbow joint distraction arthroplasty in the treatment of post-traumatic elbow joint flexion contracture.[Method]An Ilizarov ring distractor of elbow joint was designed.From March 2003 to July 2005,three cases of elbow joint flexion contracture aged 16～17 years (one male and two females) with a flexion deformity of 70? in one case and 45? in two cases were treated.The joint distractor was applied with the wires in the upper limb and the joint hinge at the rotational centre of the elbow joint.No skin incision was made.To correct the deformity gradually,a continuous distraction force was applied by turning the nut on the distraction bar and periodic X-ray films were taken to confirm the position of the elbow joint.[Result]The elbow joint was finally extended to 0?～10?with an average 45?correction of flexion after an average 32 days of distraction.The range of elbow joint movement increased from pre-operative 75?to post-operative 115?.[Conclusion]The elbow joint distraction arthroplasty is effective in the correcting of the elbow joint flexion contracture and improving of joint function.

[Objective] According to the basic principle of Ilizarov technique,the apparatus assembly,indications,operation methods and clinical effectiveness of Ilizarov technique in the correction of foot and ankle deformities were explored.[Method]In accordance with pathological changes and requirements for correctioning talipes equinus,cavus,calcaneus and forefoot varus or valgus,four standard external fixators were designed on the basis of Ilizarov apparatus assembly and tested biomechanically to correct the above four foot deformities.The innovation had expanded Ilizarov technique to correcting scar talipes equinus and severe foot valgus caused by rheumatoid arthritis and congenital fibular deficiency.[Result]The clinical applications of the four kinds of external fixators showed reasonable apparatus structure,convenient installation and adequate adjustment of distraction tension.They had been used in 105 cases and achieved satisfactory correction of deformity and functional recovery without severe complications.[Conclusion]The four new assemblies of external fixators showed simple structures,good performance,and practicality.Ilizarov technique has played an irreplaceable role in the correction of severe foot and ankle deformities.

Objective To investigate the effects of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients. Methods Twenty patients with severe traumatic brain injury aged 18-60 yr were randomly divided into 2 groups (n=10 each):ice bay cooling group (group IBC) and endovascular cooling group (group EVC).The state of consciousness was scored on a Glasgow coma scale (GCS).The patients had GCS scores of 3-8. The patients underwent emergency surgery.A probe of intracranial pressure monitor was placed during operation.In group EVC intravascular heat exchange catheters were inserted via femoral vein and connected to intravascular heat exchange system (CoolGard 3000, Alsius, USA). In group EVC body temperature was reduced to 34℃ and maintained at this level for 48 h. MAP, HR, body temperature and intracranial pressure (ICP) were continuously monitored and cerebral perfusion pressure (CPP) was calculated. Blood samples were taken from peripheral vein for determination of serum concentrations of neuron specific enolase (NSE), myelin basic protein (MBP) and S-100B (by enzyme linked immunosorbent assay) and GCS scores were assessed at 10 min before (baseline) and 12, 24, 48 and 72 h after operation. The state of consciousness was again assessed 3 months after operation and scored on Glasgrow outcome scale(GOS). Results ICP was significantly lower and CPP was higher after operation in group EVC than in group IBC. Serum concentrations of NSE, MBP and S-100B were significantly lower after operation in group EVC than in group IBC. Conclusion Mild hypothermia induced by endovascular cooling with heating exchange catheters can effectively reduce severe traumatic brain injury in patients.

Objective To observe effect of intra-and post-operative mild hypothermia using an ice blanket on patients with severe traumatic brain injury (sTBI).Methods Twenty sTBI patients with Glasgow Coma Scale (GCS) of 3-8 points were included and were assigned to either ice bag cooling (Bag group) or ice blanket cooling (Blanket group) (n =10 each) according to random number table.Patients in Bag group had temperature reduction by placing ice bag over great vessels,whereas in Blanket group an ice blanket (temperature was set as the nasopharyngeal temperature of 33℃-34℃) was employed to have temperature reduction.Hypothermia therapy in the two group groups was initiated from the beginning of operation and continued for 48 hours after operation.Intracranial pressure,cerebral perfusion pressure (CPP) and GCS in both groups were recorded respectively at 10 minutes before operation (T0) and at 8,12,24,48 and 72 hours after operation (T1,T2,T3,T4 and T5).Venous blood of the two groups was harvested to assay the serum concentration of neuronspecific enolase (NSE),myelin basic protein (MBP)and S-100β at T0,T3,T4,-Ts and at 96 hours after operation (T6) by ELISA method.Glasgow Outcome Scale (GOS) was evaluated at postoperative six months.Results In Bag group,body temperature (T1-T5) of the patients had no significant decrease (P ＞ 0.05) and NSE (T3-T6),S-100β (T3-T6) and MBP (T4-T6) were increased (P ＜ 0.05 or 0.01) when compared with those in T0 ; intracranial pressure (T2-T5) was increased (P ＜ 0.05) and CPP (T3-T5) was lowered (P ＜ 0.05) when compared with those in T1.In Blanket group,body temperature (T1-T6) of the patients presented was decreased significantly (P ＜ 0.01) and NSE (T3-T6),MBP (T5-T6) and S-100β (T4-T6) were increased (P ＜ 0.05 or 0.01) when compared those in T0 ; intracranial pressure (T2-T6) was increased (P ＜ 0.05) and CPP had no significant changes (P ＞0.05) when compared with those in T1.By contrast with those in the same time points in Bag group,lower body temperature (T1-T5) (P ＜ 0.001),lower intracranial pressure (T2-T5),higher CPP (T3-T5) as well as lower NSE (T4-T6),MBP (T4-T6) and S-100β(T6)were observed in Blanket group (P ＜0.05 or 0.01).Changes of GCS and GOS in the two groups were no significance (P ＞0.05).Conclusion Intraoperative and postoperative mild hypothermia therapy using an ice blanket may alleviate the degree of brain injury in sTBI patients.

Objective: To investigate the prophylactic effect of EEN on pulmonary infection in patients with severe traumatic brain injury.Methods: 60 cases of young adults with severe brain injury were randomized into the early enteral nutrition group(experimental group) or the control group.The experimental group was feeded 12～24 hours after injury or surgery and the control group was feeded 24 h～5 d after injury or surgery.The double-sugar test method was used for determination of intestinal barrier function,and the duration of pulmonary infection was recorded.Results: The lactulose/mannitol ratio in experimental group was significantly lower than in control group on the 7th postoperative day.The average body temperature and duration of pulmonary infection in experimental group were significantly lower than in control group.According to ADL scores,the daily capacity of convalescent patients in experimental group was significantly better than in control group.Conclusion: The early enteral nutrition can improve mucosal barrier function,reduce the incidence of pulmonary infection and improve overall prognosis in patients with severe traumatic brain injury.

Objective To observe the changes of cerebral vascular morphology and blood flow after craniocerebral trauma so as to investigate the role of transcranial Doppler sonography (TCD) combined with CT angiography (CTA) in judgment of the operative effect and prognosis of severe craniocerebral trauma.MethodsA total of 56 patients with craniocerebral trauma were monitored dynamically by using TCD before and after surgery.Dynamic CTA of head was also performed by using 128-slice spiral CT.Results TCD and CTA indicated that both the cerebral blood flow and vascular morphologychanged after craniocerebral trauma.CTA manifested mainly the vascular displacement or angiostegnosis and TCD showed mainly the high-resistance blood flow,indicating good operative effect.For the patients with vasospasm,the TCD manifested high-resistance flow (relatively good operative effect) or nail flow(mostly poor operative effect). The patients with vascular occlusion were associated with nail flow on TCD,with poor operative effect.ConclusionsTCD shows the velocity of cerebral blood flow and CTA shows the morphological change of cerebral vessels.Thereby,the combination of TCD and CTA can effectively judge the cerebral perfusion and provide a promising way for validating the operative effect and prognosis of craniocerebral trauma.

Objective To investigate the strategies of reducing the incidence of missed diagnosis of severe traumatic brain injuries combined with multiple trauma. Methods Data of 432 patients with severe traumatic brain injuries and multiple trauma (ISS≥20) from January 2000 to August 2007 were analyzed retrospectively. All patients were divided into missed diagnosis group (MD group, n =54) and non-missed diagnosis group (NMD group, n =378) for correlation analysis on ISS, GCS, anatomical locations of the missed diagnosis, the time of delayed diagnosis and the prognosis. Results ISS was (42.97±10.94) points in MD group, with statistical difference compared with NMD group (P < 0.05). The patients with GCS≤8 in MD group was more than those in NMD group (P < 0.05). Conclusions It is effective to prevent missed diagnosis and improve the survival of patients with severe traumatic brain injuries combined with multiple trauma by judging injury severity quickly and precisely based on the principle of "life first" and repeated and systemic physical examination.

PURPOSETo investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling.

METHODSTwenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4-5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-of-interest in two groups were analyzed and compared before and after treatment.

RESULTSCompared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group.

CONCLUSIONExternal ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.

Adult ; Aged ; Brain ; physiopathology ; Brain Edema ; physiopathology ; therapy ; Brain Injuries ; complications ; Cerebrovascular Circulation ; Drainage ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Retrospective Studies

Objective: To explore the role of tentorium cerebelli hiatusincision in treating severe and most severe brain injuries complicated by tentorial herniation.Methods: From July 1994 to July 1999 tentorium cerebelli hiatus incision was done based on intracranial hematoma evacuation and bone flap craniectomy decompression in 70 cases of severe and most severe brain injuries complicated by tentorial herniation.Results: Of the 70 cases, GCS 3-5 was in 23 and GCS 6-8 in 47; satisfactory recovery in 39 cases (55.7%), moderate disability in 12 (17.1%), severe deficit in 6 (8.6%), vegetative survival in 4 (5.7%) and 8 (11.4%) died.Conclusions: Tentoriun cerebelli incision is helpful in alleviating secondary brain stem injury from tentorial herniation and in reducing the disability and death rate of the patients.