Trauma has been one of the public haza rds in the modern society.About 1/2t o 2/3of modern traumas involve the musculoskeletal system.The priority in an em ergency care of a severely injuried p a-tient is to save his life and preserve major functions of his body as much as possible.To minimize the rate of mortality or disability,it is of prime importance to start timely emergency resuscitation process,control of life -threatening conditions(such as hypovolemic shock),hemostasis,adequate ventilation,restoring normal perfu-sion,and prompt diagnosis and skill ful evaluation of the general and local significant risks so as to adopt fu rther interventions,especially for multiply injured patients.After satisfactory recovery of vital signs and stable main-tenance of adequate perfusion press ure,surgical procedures,such as debridement,fracture fixation,repair of soft tissue and management of associated lesions are advisable at an early sta ge.[

BACKGROUND: Previous studies have demonstrated that acidic fibroblast growth factor (aFGF) combined with partially deproteinized bone (PDPB) (aFGF/PDPB) well promotes avascularization in animals with early-stage avascular necrosis of the femoral head (ANFH), but the histological results remain unknown.OBJECTIVE: To observe the histological repairing effects of aFGF/PDPB on early-stage ANFH in rabbits. METHODS: New Zealand rabbits were established models of bilateral ANFH and were randomly divided into a blank group, a simple PDPB group, and an aFGF/PDPB group. PDPB and aFGF/PDPB bone were implanted into the PDPB and aFGF/PDPB group accordingly. The blank group did not receive any implantation. At 2, 4, and 8 weeks after surgery, all animals were sacrificed for histological examination to observe the osteogenesis by hematoxylin-eosin staining.RESULTS AND CONCLUSION: Defects were filled with granulation tissues and fibrous connective tissues, only a little osteoid tissue formed at the borderline in the blank group at the end of the 8th week. In the PDPB group, a little new bone and cavitas medullaris formed. At 8 weeks, lots of graft was absorbed and cavitas medullaris formed with more osteoplasts and myeloid cells in it. The osteogenesis in the aFGF/PDPB group was better than that of PDPB group in each time point. At 4 weeks, the transplanted cavity was filled with osteoid tissues, a lot of osteogenic precursor cells and osteoblasts could be seen. Plenty of micrangium was observed, and osteoid tissues began to rebuild. At 8 weeks, the graft was replaced by bone tissues, and cavitas medullaris were formed with lots of bone marrow cells in it. At the borderline of the bone trabecula, there were lots of osteoplast and little osteoclasts, which may play a role in bone remodeling. There were mature bone cells in bone lacuna. Results indicate that aFGF/PDPB has better repair effect on rabbit model of ANFH than that of simple PDPB.

Objective To analyze the magnetic resonance imaging(MRI) appearance and pathological changes of pig thigh of soft tissues after been shot by rifle,so as to offer a theoretical foundation for wound management in early stage of gunshot injuries.Methods Seventeen adult pigs were intravenously anesthetized and suspended in supine position,the pigs were shot in 10 meters away by domestic-made rifle of 95 type.The wound limb were undergone 1.5T MRI scans and histological observation at 2h,6h,12h,24h,48h,9day,and 18day after shot injury.Results The wounded tissues included four areas of different pathological changes:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.The thickness of coagulative necrosis area was about 1 to 3 millimeters,which showed double-hypointense signal phenomenon in both T2 weighted image and enhanced T1 weighted image.The tissue disruption area and part of tissue distortion area showed double-hyperintense signal phenomenon in both T2 weight image and enhanced T1 weighted image.Conclusion Penetrating gunshot wound in soft tissues of hind limb can be divided into four areas:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.MRI can clearly show primary ballistic cavity and coagulative necrosis area.Tissue disruption area and tissue distortion area are hyperintense signal areas on the outside of the primary ballistic cavity,which can be distinguished clearly by pathalogical observation,but tissue disruption area and part of tissue distortion area are undistinguishable by MRI.

[Objective]To evaluate the method and curative effect of posterior internal fixation and bone grafting fusion for atlantoaxial fracture or dislocation.[Method]Posterior internal fixation and bone grafting fusion were made on 26 patients with atlantoaxial fracture or dislocation in condition of tracheal intubation anesthesia.Occipitocervieal fixation(Aixs) and bone grafting fusion were performed on patients with fracture of vertebral lamina-arch.Vertebral lamina splint fixation (Apofix) was performed on patients without fracture of vertebral lamina-arch and decompression of vertebral canal.[Result]Followed up for 5 to 60 months(averaged,16.8 months),the vertebral artery and spinal cord injury were not occurred and clinical symptom was relieved in all patients.X ray examination showed screws in vertebral articular process and occipital condyle were normotopic without laxation and fragmentation.The bone grafting transformed into osseous fusion after 3 months.[Conclusion]Aixs fixation and bone grafting fusion and Apofix fixation are effective methods for atlantoaxial fracture or dislocation.

[Objective]To explore the outcome of repairing nerve defects with nerve allografts stored in green tea polyphenol solution.[Method]Forth-eight male mice were randomly divided into 4 groups of nerve grafting,with 12 rats in each group.A 1.0 cm sciatic nerve segment,5 mm away from infrapiriform foramen,was removed and repaired by 4 kinds of nerve allografts.Group A:autografts.Group B:allografts.Group C:cryopreserved nerve allografts.Group D:nerve allografts stored in green tea polyphenol solution.At 6 weeks and 12 weeks,a series of examinations were performed,including the gross appearance,electrophysiological test,histological observation,electron microscopic study and quantitative analysis with image analysis system.[Result]All the parameters of groups A and D were better than those in groups B and C(P

[Objective]To study the combination of calcium phosphate cement(CPC) and morselized bone and their optimum mixing ratio. [Methods]Bilateral nemora of macro-ears rabbits were made into morselized bone.There were two groups:experimental group and control group.In the experimental group,the ratios of morselized bone to CPC were 1 to 1,1 to 2,1 to 3,1 to 4 and 1 to 5.In the control group CPC was used after it was solidified.The maximum compression strength and solidified time of the materials in experimental and control groups were tested.The cell multiplication was evaluated by MTT after mesenchymal stem cells were cultivated.[Results]The cell multiplication in materials mixed with ratios of 1 to 2 and 1 to 3 was better than those in the materials mixed with the other ratios by MTT.It indicated that there was a significant difference(P

[Objective]To observe the effect of vacuum sealing drainage(VSD) on bacteria and microcirculation of acute explosion wounds in pigs.[Method]Twelve blast wounds,created by explosion of a specific type of electric detonations which were fixed at 1 cm over the skin of the hips of six Lanzhou healthy pigs(30-40 kg),were divided into two matched groups.Debridement was performed at 6 hours after injury.Group A was treated with conventional dressing change,and group B was treated with VSD under the pressure of-20kPa.Tissue specimens collected from different sites of the wound bed before and at 12,24,48,72 hours after treatment,and experienced bacteria counting.The microcirculation of the blast wounds was examined by color B-mode ultrasonic diagnostic equipment before and 72hours after treatment.[Result]The difference of wound bacteria loads between group A and group B was statistically signficant at different time points.Bacteria loads in group B were increased to 105cfu/g at 48 h after treatment,compared with group A at 24 h.No signal of blood flow in blast wound was found before treatment.In contract,the blast wound had plenty of signals of blood flow in group B.[Conclusion]VSD could reduce the bacteria loads,and delay the time of infection.Meanwhile it improved the microcirculation of the acute blast wound.

[Objective]To confirm the effect of combination of calcium phosphate cement and small amounts of autoallergic micromorselized bone for reparing bone defect and provide the basis for clinical use.[Method]The animal models of bilateral radius defect were created by surgery on Japan white big ear rabbits.The combination with a ratio of 3 to 1 in one lateral leg was implanted in experimental group,and calcium phosphate cement was used in the control group.The X-rays,bone density,and maximum torsional moment were carried out at different time points,and osteogenesis and degradation of the materials in the two groups were analyzed.[Result]Enhancement of osteogenesis was found in the experimental group,and the materials were enclosed significantly by bony callus at the 8~(th) week,the defects were repaired and the materials were degraded completely at the 16~(th) week.The bone mineral content in the experimental group was higher than that in the control group(P

Objective To investingate the expression method of bcl-2 and it's significance in osteogenic tumor and tumor-like diseases.Method The protein of PCNA, p53, Fas and bcl-2 were examined immunohistologically in osteosarcoma, ossifying fibroma, fibeous dysplasia of bone and normal bone callus. The results were analysed combing with the information of metastasis and hisomorphology.Results PCNA and p53 were highly expressed in low-differentiated osteosarcoma, bcl-2 were highly expressed at high-differentiated osteocoma and ossifying fibroma. When PCNA, p53 and bcl-2 were all expressed at high level, the metastasis rate was high, when only bcl-2 was expressed at high level, the progmosis was better. Conclusion The mechanism for benign and malignant tumor are different, the benign and low-degree malignant tumor may be caused by over accumulated mutation cells sipported by high level of bcl-2, while malignant tumor may be the result of multi-gene cooperation abnormally.

Objective To probe the repair effect of bone defect after getting rid of free bone in chronic osteomyelitis patients. Method Eighteen chronic osteomyelitis patients were reconstructed with vascularized fibula graft at one stage after getting rid of free bone and 2 cases were reconstructed with regional transplantation of pedic fibula after inflammable bone segment were exsected. Result Twenty chronic osteomyelitis patients who were treated with vascularized fibula graft or regional transplantation of pedic fibula after getting rid of free bone were followed up 3 - 6 months (mean 3. 5 months). The reconstructed bone unioned well,the inflammation of all bones near to joints were controlled; the repaired limbs achieved satisfactory function and outline. Conclusion The operation to reconstruct bone defect after getting rid of free bone in chronic osteomyelitis patients with vascularized fibula graft or regional transplantation of pedic fibula primerally is a good method' The advantage lies in avoiding the long alteration period of free bone, bettering the blood circulation of receipt region, controlling inflammation, shortening the resident period,times and operation times,and so. The method is a good attempt to repair inflammatory bone defect using vascularized bone graft.