OBJECTIVETo study the effect of vascular endothelial growth factor (VEGF)and anti-VEGF on the expression of fracture healing-related factors and observe pathological changes at fractured sites.

METHODSFracture models were established in 105 New Zealand white rabbits and they were randomly divided into control group, VEGF group and anti-VEGF group. The relevant factors expression at fractured sites was assayed and pathological changes were observed in decalcified samples at 8, 24, 72 hours and 1,3,5,8 weeks after fracture.

RESULTSAfter application of VEGF, the expression of BMP appeared earlier and expression time lasted longer. On the contrary, anti-VEGF completely inhibited the expression of BMP. The fractured sites were filled with fibrous callus, cartilaginous callus and bony callus at the 3rd week and woven bone was constructed at the 5th week. Fracture healing was accomplished at the 8th week in VEGF group. In anti-VEGF polyclonal antibody group, cellular necrosis increased at early period. Continuous focal necrosis was seen in the fractured sites from the 1st week to 5th week. Vascularization reduced obviously at the 3rd week.

CONCLUSIONSFracture healing is a result of mutual regulation and coordination among many factors. VEGF may be an important factor in fracture healing.

Animals ; Bone Morphogenetic Proteins ; metabolism ; Electrophoresis, Polyacrylamide Gel ; Fibroblast Growth Factor 2 ; metabolism ; Fracture Healing ; physiology ; Rabbits ; Radius Fractures ; physiopathology ; Vascular Endothelial Growth Factor A ; physiology

OBJECTIVETo study the effect of allograft compound vertebra on vertebral reconstruction in rabbits so as to provide biomechanical direction for manufacturing and selecting vertebral reconstruction materials.

METHODSTwenty-five healthy New Zealand white rabbits were divided randomly into three groups: normal group (Group A, n equal to 5),iliac bone graft group (Group B, n equal to 10) and allograft compound vertebra group (Group C, equal to 10). After C4 was resected, iliac bone implantation and allograft bone cage transplantation were fulfilled in Group B and Group C, respectively. Every 5 rabbits from Group B and Group C were selected to test the biomechanical strength and biological activity one and two months postoperatively.

RESULTSNo significant statistical difference was found between Group A and Group C one and two months postoperatively (P larger than 0.05). The biomechanical strength of Group B was much weaker than that of Group A and Group C one month postoperatively (P less than 0.05), but at two months postoperatively, no statistical difference was found among the three groups. The biological activity and vertebral moulding ability of Group C were better than those of Group B at one and two months postoperatively.

CONCLUSIONSCompound vertebra, which is made up of allograft cortical bone cage and autogenous cancellous bone, shows instantaneous and permanent biomechanical stability and biological activity, therefore, it is an ideal material for vertebral reconstruction.

Animals ; Biomechanical Phenomena ; Bone Substitutes ; Bone Transplantation ; Ilium ; transplantation ; Models, Animal ; Rabbits ; Reconstructive Surgical Procedures ; Spinal Neoplasms ; surgery ; Transplantation, Homologous

OBJECTIVETo evaluate the therapeutic effect of combined reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) simultaneously by using allograft patellar tendon under arthroscopy.

METHODSFrom May 2003 to November 2005, 10 cases of ruptured ACL and PCL were fixated with compressed screws and reconstructed under arthroscopy with allograft patellar tendon simultaneously. The clinical results were evaluated according to IKDC, Lysholm, and Tegner clinical rating scales.

RESULTSAll patients were followed up for 12-30 months (mean: 18 months). At the last follow-up, there was no knee extension limitation and knee flexion was between 120 degree and 135 degree,with an average of 128.38 degree. The Lysholm score of the 10 cases was 66.5+/-5.6 before operation and 89.8+/-3.4 at last follow up. The difference was statistically significant (P less than 0.01). The average Tegner activity score decreased from 6.9+/-1.7 (range: 4-9) before injury to 5.5+/-1.6 (rang:2-9) at the follow-up (P equal to 0.53). At the end of follow-up, IKDC score was graded as A in 4 cases (40.0%), B in 5 (50.0%), and C in 1 (10.0%). Of the 10 patients, 8 returned to the same sports level as before injury and 2 were under the level.

CONCLUSIONArthroscopic combined reconstruction of ACL and PCL with allograft patellar tendon has the advantages of minimal trauma in surgery and reliable satisfactory outcome.

Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Patellar Ligament ; transplantation ; Posterior Cruciate Ligament ; injuries ; surgery ; Reconstructive Surgical Procedures ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo evaluate the biomechanical performance of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures.

METHODSSixteen bovine thoracolumbar spines (T11-L1) were divided into 4 groups (A,B,C and D). After burst-fracture model was created, 12 vertebral bodies in Groups A, B and C were augmented with calcium sulfate cement (CSC), calcium phosphate cement (CPC) and polymethylmethacrylate (PMMA) bone cement, respectively. Each anterior vertebral body height was measured with a caliper at 4 time points: intact conditions (HInt), post-fracture (HFr), post-reduction (HRe) and post-vertebroplasty (HVP). The filling volume of 3 different bone cements was also measured. Each vertebral body was compressed at 0.5 mm/s using a hinged plating system on a materials testing machine to 50% of the post-vertebroplasty height to determine strength and stiffness. Difference was checked using t test or One-way ANOVA.

RESULTSThe average strike energy was 66.2 J. Vertebroplasty with different cements could sustain vertebral height. The average filling volume of bone cement in 3 groups was 4.35 ml (CSC), 3.72 ml (CPC) and 3.95 ml (PMMA), respectively, and there was no statistically significant difference among them (P larger than 0.05). Vertebroplasty with PMMA completely restored strength (116%) and stiffness (105%). CSC or CPC partly recovered vertebral strength and stiffness. However, greater strength restoration was got with CSC (1659 N) as compared with CPC (1011N, P less than 0.01). Regarding stiffness, differences between CSC (140 N/mm+/-40 N/mm)and the other two bone cements (CPC:148 N/mm+/-33 N/mm, PMMA:236 N/mm+/-97 N/mm) were not significant (P larger than 0.05).

CONCLUSIONSFor a burst-fracture of calf spine, use of CSC for vertebroplasty yields similar vertebral stiffness as compared with PMMA or CPC. Although augmentation with CSC partly obtains the normal strength, this treatment still can be applied in thoracolumbar burst fractures with other instrumental devices in light of its bioactivation.

Animals ; Biomechanical Phenomena ; Bone Cements ; therapeutic use ; Calcium Sulfate ; therapeutic use ; Cattle ; Male ; Spinal Fractures ; physiopathology ; surgery ; Vertebroplasty

OBJECTIVETo analyze the data of patients with spinal cord injury (SCI) induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning.

METHODSIn this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated.

RESULTSAmong 64 patients with SCI, 38 patients (59.4%, 36 males and 2 females, aged 27.42 years+/-9.44 years on average) were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases (68.4%) and 12 cases (31.6%), respectively. And 31 patients (81.6%) had complete SCI. Conus medularis (T12-L2) was the most affected level.

CONCLUSIONSResults are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.

Accidents, Traffic ; statistics & numerical data ; Adolescent ; Adult ; Equipment Design ; Head Protective Devices ; Humans ; Iran ; epidemiology ; Middle Aged ; Seat Belts ; Spinal Cord Injuries ; epidemiology ; prevention & control ; surgery

Foreign bodies in the heart are a rare but serious form of cardiac injury. The objects usually are sharp pointed. Such as acupuncture needles, sewing needles, coat hangers, fragments of Kirschner wires, pins, etc.(1) We report a patient with a metallic pellet lodged in the heart, which was accurately diagnosed and successfully removed.
Adult ; Foreign Bodies ; diagnosis ; surgery ; Heart ; Humans ; Male ; Metals

The first skin-flap procedures were performed in Mongolia by a team of Chinese doctors (Chenod, Chen) who treated children with burn injuries in the 1950s. The field of plastic surgery was further developed through assistance from the former Soviet Union and is now widely practiced by a number of surgeons around the country. In recent years, the fast evolving field of plastic surgery in Mongolia has created a need for clear and consistent system for the classification of various plastic materials. A team of Mongolian surgeons at the National Hospital for Traumatology, Orthopedics, Rehabilitation and Teaching Research have completed a research programme aimed at adopting a leading classification system that can facilitate effective communication between plastic surgeons. This requires the chosen system to be in line with modern trends in plastic surgery and the established international norms. As a result of extensive research and analysis, they have developed a customized version of Vasiliev's classification that focuses on formulating general principles of the description of plastic materials based on their functional characteristics. The main reason for this selection is its similarity with existing Mongolian standards as well as its principles that contain important implications for surgery.
Humans ; Mongolia ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps

OBJECTIVETo investigate the change of serum levels of interleukin-6 (IL-6), C-reactive protein (CRP) and creatine kinase (CK) in patients undergoing microendoscopic discectomy (MED) and open discectomy.

METHODSForty-four patients with single level lumbar disk herniation were treated, either by MED (Group A, n equal to 22) or open discectomy (Group B, n equal to 22). Peripheral venous blood samples were taken before surgery and at 24 and 48 hours postoperatively. The operating time, intraoperative blood loss, postoperative hospital stay were recorded. The pain severity of incision was evaluated by visual analog scale after operation and the clinical outcome was evaluated by Oswestry disability index. Statistical comparison was performed by the analysis of variance and Student's t test.

RESULTSThe data showed that patients in Group A had a less intraoperative blood loss (P < 0.05), shorter operating length (P < 0.05), shorter postoperative hospital stay (P < 0.05) and less postoperative pain of incision than those in Group B. Serum levels of IL-6 (mean, 31.60 ng/L +/- 9.88 ng/L vs 39.16 ng/L +/- 11.14 ng/L, P < 0.05) and CK (mean, 167.91 U/L +/- 51.85 U/L vs 401.55 U/L +/- 108.86 U/L, P < 0.05) all get to the peak at 24 hours after operation and Group A with the response statistically less than Group B. Serum level of CRP peaked at 24 hours in Group A (mean, 12.68 mg/L +/- 7.10 mg/L vs 20.82 mg/L +/- 8.79 mg/L, P less than 0.05)and peaked at 48 hours after surgery in Group B (mean, 10.77 mg/L +/- 5.25 mg/L vs 29.95 mg/L +/- 14.85 mg/L, P < 0.05). The clinical outcomes of both groups were the same at 6 months after surgery.

CONCLUSIONSBoth MED and open discectomy have made good clinical outcomes, however, the less change of IL-6, CRP and CK after operation proves that MED procedure is less traumatic to patients than open discectomy.

Adult ; C-Reactive Protein ; analysis ; Creatine Kinase ; blood ; Diskectomy ; methods ; Endoscopy ; Female ; Humans ; Interleukin-6 ; blood ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Minimally Invasive Surgical Procedures ; methods

OBJECTIVETo explore the effect of fluvastatin on vascular endothelial growth factor (VEGF) in rats with osteoporosis in the process of fracture healing.

METHODSFractures at the intermediate piece of the femur were made on 72 Sprague Dawley (SD) rats (weighing initially 290-340 g and aged 6 months) with osteoporosis after ovariectomy for three months, then these rats were divided randomly into the medication administration group (the experimental group) and the control group, 36 rats each. In the experimental group, the rats received fluvastatin lavage (10 mg/kg per day) since the next day of operation lasting for 6 weeks, and the rats in the control group received placebo. Then the expression of VEGF and VEGF mRNA in bony callus of the two groups was measured respectively with immunohistochemistry and in situ hybridization on days of 3rd, 7th, 14th, 21st, 28th, and 42nd, and image analysis was made with real-color image analysis machine.

RESULTSNo difference was found in the cellular localization of VEGF and VEGF mRNA gene expression between the experimental group and the control group in process of fracture healing and their expression modes were almost similar. On the 14th day postoperatively, the positive extent of positive cells in the experimental group was higher than that of the control group (P < 0.05).

CONCLUSIONFluvastatin can promote the VEGF level in rats with osteoporosis in process of fracture healing.

Animals ; Fatty Acids, Monounsaturated ; pharmacology ; Fracture Healing ; Immunohistochemistry ; In Situ Hybridization ; Indoles ; pharmacology ; Osteoporosis ; metabolism ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A ; analysis ; genetics

OBJECTIVETo ascertain an accurate approach to inserting the pedicle screw into C3-C7 segments of the cervical vertebra.

METHODSAnatomic morphology of lateral mass and pedicle, and their anatomic relationship with the adjacent tissue were observed on C3-C7 segments of 25 adult embalmed cadavers (50 sides).

RESULTS1) The inferior edge of the base of the posterior tubercle of the transverse process and the inferior edge of the pedicle were connected with each other on 25 adult embalmed cadavers (50 sides). The transverse section which passed through the median point between the superior edge and the inferior edge of the base of the posterior tubercle of the transverse process, and the transverse section which passed through the central axis between the superior edge and the inferior edge of the pedicle, were in the same horizontal plane. The superior and inferior position of placing the pedicle screw was determined by this transverse section, which passed through the median point between the superior and the inferior edge of the base of the posterior tubercle of the transverse process. 2) There was a directed internal-downwards "triangular sulcule" between the base of the posterior tubercle of the transverse process and the anterolateral edge of the inferior articular process. The anterior wall of the triangular sulcule was the base of the posterior tubercle of the transverse process, the posterior wall was the anterolateral edge of the inferior articular process, and the bottom of the sulcule was connected with the interior edge of the pedicle. The vertical length between the top of triangle and the planes of inferior edge of the pedicle was (2.78+/-1.71) mm. The inferior edge of the cervical pedicle could be detected using a blunt probe along the "triangular sulcule" between the base of the posterior tubercle of the transverse process and the anterolateral edge of the inferior articular process in surgical operation. 3) The lateral fovea of the articular process was observed on all lateral masses (50 sides). The internal and external position of the entrance point could depend on anatomic landmarks: the lateral edge of the lateral fovea of the articular process. The horizontal length between the lateral fovea of the articular process and the entrance point was (3.14+/-1.45) mm. 4) The diameter of pedicle screw, about (2.78+/-1.71) mm, was the transverse diameter of the cancellous bone of the greatest narrow part of the cervical pedicle.

CONCLUSIONSThe median point between the superior edge and the inferior edge of the base of the posterior tubercle of the transverse process, the lateral fovea of the articular process, and the triangular sulcule between the base of the posterior tubercle of the transverse process and the anterolateral edge of inferior articular process, are easy to be exposed and identified in surgical operation. The pedicle screw can be precisely inserted through this method.

Adult ; Bone Screws ; Cervical Vertebrae ; anatomy & histology ; surgery ; Humans