Objective To investigate the correlation between MR imaging and pathological features of nucleus pulposus degeneration in the lumbar disc, and to provide a reliable evidence to evaluate the nucleus pulposus degeneration by MR imaging relative signal intensity. Methods From January 2001 to December 2001, 91 patients who underwent operative treatment for lumbar disc diseases were recruited for the study, while 4 lumbar fracture patients with no previous low back pain and 2 fresh brain-injury cadavers were recruited for contrast study. Before operation, the relative signal intensity was measured in MRI T2WI images. All 117 specimens were dyed with HE and Alcian blue CEC. The water content was also detected. The correlation between MRI relative signal intensity and chondroitin sulfate index, water content was analyzed with SPSS 10.0 software, the correlation between chondroitin sulfate index and water content was analyzed as well. Results There was significant difference between the above mentioned two groups when MRI relative signal intensity, chondroitin sulfate index and water content was compared. Whereas there was no significant statistical difference when keratin sulfate index was compared between the two groups. MRI relative signal intensity positively correlated with water content and chondroitin sulfate index, and the chondroitin sulfate index positively correlated with water content. Conclusion The MRI relative signal intensity reflects not only the water content, but also the pathological characteristics of nucleus pulposus degeneration. The quantitative classification of relative signal intensity in MRI is a method to identify the grades of nucleus pulposus degeneration.

OBJECTIVETo improve the treatment for severe open tibia-fibular fracture.

METHODSFrom 1994 to 2000, 146 patients with severe open tibia-fibular fracture were treated. According to Gustilo classification, all patients were of type III. Among them, 96 patients belonged to III A, 36 III B, and 18 III C. One hundred and eight patients were male and 38 female, aged from 11 to 68 years, with an average of 31. All patients were treated with unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire). Thirty patients were treated with secondary flap operation. Among them, 19 patients received pedicle gastrocnemius muscle flaps, 9 free vastus lateralis muscle flaps, and 2 free latissimus dorsi muscle flaps.

RESULTSThree patients of type IIIB were subjected to amputation because of advanced age and associated cerebral or thoraco-abdominal injury. Five patients of type III C had amputation because of insufficient postoperative blood supply and necrosis. The rupture of other 138 patients was well reduced, and firmly fixed. They were followed up for 6 months-6 years, with an average of 2.5 years. The average time of fracture-union was 27 weeks, and the average time for removal of fixtors was 28 weeks. The motion of knee joint ranged from 0 to 120 degree in 110 patients; from 0 to 100 degrees in 25, and from 0 to 90 degrees. The motion of ankle joint was approximately normal.

CONCLUSIONSFor patients with severe open tibia-fibular fracture, comprehensive analysis should be made for preservation of the wounded limb or amputation as for elderly patients with vessel-nerve injury or with cerebral- thoracoabdominal injury, emergency amputation should be done. Unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire) for severe open tibia-fibular fracture is advantageous for a simple and reliable fixation. It is less traumatic.

Adolescent ; Adult ; Aged ; Child ; External Fixators ; Female ; Fibula ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery