Objective To discuss morphology and biomechanics of the sacrum fractures so as to provide scientific basis for corresponding clinical treatment. Methods A total of 10 fresh pelvis specimens were collected for dynamic impact test and static destruction test, in the former one of which, the dynamic parameters were measured to make sure the dynamic characters of the fractures. Meanwhile, the fractures of the sacrum wing, the sacral foramina and the sacrum edge were made decalcification, slice of paraffin wax and staining (Masson, Mallory, HE) in order to make a cytological observation of the tissue. Results (1) The form of sacrum fracture or acetabulum fracture, crista iliaceis fracture was relevant to the impact energy. Low impact energy usually caused fractures of the ilium, acetabulum or sacroiliac crest. High impact energy resulted in following three kinds of fractures, just as the classification of Denis: sacral ala fractures belonged to typeⅠfractures, sacral hiatus fractures to type Ⅱ fractures and central vertebral canal fractures to type Ⅲ fractures. All three types of fractures might involve lateral or bilateral nerve roots. (2) There was a significant mechanic difference in regard of the mechanism of both dynamic destruction and static destruction of pelvis, ie, not only the limit pressure differed but also the former increased rapidly with the higher rate of the strain. The clash energy beyond 25 J would beget the cleft fractures of the sacrum via sacrum hiatus and even involve the nerve roots. The clash energy under 20 J usually resulted in fractures of the ilium and the sacrum. The clash energy between 20 J and 25 J more easily caused type Ⅰ fractures. While fracture of the ilium and the acetabulum would happen most in static destruction. (3) The cross section of the sacrum was cracked and the bone board of Haversian system is brittle, as led to separation of bone board and malposition of a few cross bone boards. Conclusions Under dynamic state, the sacrum fractures mostly belong to type Ⅰ and type Ⅱ (Denis classification of sacral fractures), usually involving the nerve roots. The sacrum fracture is relevant to the microstructure, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of the sacrum. The fractures of the ilium and the acetabulum more frquently appear in static state, with slight wound of peripheral tissues.

OBJECTIVETo compare the efficacy difference of analgesia and detumescence on ankle sprain among acupuncture at Xiaojie point combined with tendon regulation manipulation, acupuncture at Xiaojie point and tendon regulation manipulation.

METHODSSixty cases of ankle sprain were randomized into a combined therapy group, a Xiaojie point group and a tendon-regulation manipulation group, 20 cases in each one. The combined therapy of acupuncture at Xiaojie point and tendon regulation manipulation, the acupuncture at Xiaojie point and the simple application of tendon-regulation manipulation were applied respectively in the three groups, once a day, 3 treatments were required. The symptom score such as pain, ecchymosis, swelling and motor dysfunction and the total score were observed before and after treatment in the three groups. The different values of pain and swelling scores were compared before and after treatment in the three groups. The efficacy was compared among the groups.

RESULTSThe total effective rate was 100.0% (20/20) in each group. But the curative rate was 85.0% (17/20) in the combined group, 65.0% (13/20) in the Xiaojie point tion manipulation group. After treatment, the symptom scores of pain, ecchymosis, swelling and motor dysfunction and the total score were all improved as compared with those before treatment in the three groups (P < 0.01, P < 0.05). The pain score in either the combined therapy group or Xiaojie point group was lower than that in the tendon-regulation manipulation group after treatment (0.20 -/+ 0.41, 0.15 +/- 0.37 vs 0.60 +/- 0.50, both P < 0.05). Swelling score in the Xiaojie point group was different significantly from that in the tendon-regulation manipulation 0.49 vs 06.4 vs. 20+0.41, P < 0.05). The different value of pain score in either the combined therapy group or Xiaojie point group was higher than that in the tendon-regulation manipulation group before group after treatment (0.65 bined therapy group or Xiaojie point group was higher than that in the tendon-regulation manipulation group before and after treatment (2.35 +/- 0.59, 2.45 +/- 0.51 vs 2.00 +/- 0.46, both P < 0.05). The different value of swelling score in the tendon-regulation manipulation group was higher than that in the Xiaojie point group before and after treatment (2.30 +/- 0.57 vs 1.60 +/- 0.60, P < 0.05).

CONCLUSIONAcupuncture at Xiaojie point combined with tendon-regulation manipulation achieve an apparent effect of analgesia and detumescence on ankle sprain.

Acupuncture Analgesia ; Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Ankle Injuries ; physiopathology ; therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Tendons ; physiopathology ; Therapy, Soft Tissue ; Young Adult

OBJECTIVETo evaluate the feasibility and efficacy of unilateral pedicle screw fixation in treating thoracolumbar fractures through paraspinal approach.

METHODSFrom January 2006 to January 2009,21 patients with single level thoracolumbar fracture without neurological symptoms were treated with unilateral pedicle screw fixation through paraspinal approach. There were 14 males and 7 females,aged from 21 to 65 years old with a mean of 36.4 years. The duration from injury to operation ranged from 6 h to 5 d with an average of 3 d. According to the classification of Denis fracture, compression fractures happedned in 12 cases and burst fractures happened in 9 cases,including 1 case with T5 fracture, 2 cases with T7 fracture, 2 cases with T10 fracture, 3 cases with T11 fracture, 8 cases with T12 fracture, and 5 cases with L1 fracture. Based on the Flankel grade, all patients were classified as grade E. Anterior vertebral body height ratio, sagittal Cobb angle, condition of internal fixation failure, visual analogue score (VAS) were evaluated.

RESULTSAll patients were followed up from 12 to 36 months with an average of 20.5 months. No internal fixation failure was found. Anterior vertebral body height ratios at preoperative 3 days after operation and last follow-up were 54.3 +/- 2.8, 92.9 +/- 1.5, 93.8 +/- 1.7, respectively;sagittal Cobb angle at the three timepoints were (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; the difference was statistical significant (P < 0.05). VAS was (1.2 +/- 0.4) points at last follow-up and had obviously improved (P < 0.05).

CONCLUSIONTreatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach is safe with the advantages of micro-trauma and less blood loss,which can not only completely retain the posterior spinal complex structure, reinforce the spinal stability, raise the reductional quality, but also improve the strength of fixation and the distribution of stress force.

Adult ; Bone Screws ; Feasibility Studies ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo explore the effect of electro-acupuncture to improve the bladder function after acute spinal cord injury in rats and its possible mechanism.

METHODSSixty healthy adult male SD rats of SPF grade, with body weight of 220 to 250 g, one week after feeding adaptation, were randomly divided into sham operation group, model group, electro-acupuncture group, electro-acupuncture control group with 15 rats in each group. Sham operation group underwent no stimulation, and the moderate damage model of spinal cord injury were made in other three groups according to modified Allens method. The model group were not treated, electro-acupuncture group were treated with electro-acupuncture on Zhibianxue and Shuidaoxue, and electro-acupuncture control group were treated with electro-acupuncture on 0.5 inch next to Zhibianxue and Shuidaoxue. The frequency of 2/100 Hz, current of 1 mA, stimulation time of 15 min, once a day, left and right alternately stimulate every time, for a total of 7 times. The changes of residual urine volume and urine output in rats at the 1st and the 7th days after operation were observed. And 7 d later, the rats were sacrificed and the injured spinal cord were taken out to observe the apoptosis, and to detect the changes of Bcl-2, Bax, Bad content.

RESULTSAfter modeling,the rats of three groups showed different bladder dysfunction. In electro-acupuncture group and electro-acupuncture control group, the residual urine volume of the 7th day after operation was significant lower than the 1st day after operation (P < 0.001), and there was statistically significant difference on the 7th day after operation between two groups (P < 0.001). Compared with model group, the urine output of electro-acupuncture group and electro-acupuncture control group was significantly increased on the 7th day after operation, and there was sig- nificant difference between electro-acupuncture group and electro-acupuncture control group (P < 0.001). Electro-acupuncture can inhibit apoptosis of spinal cord neurons by TUNEL detection. Postoperative at 7 d, the rate of nerve cell apoptosis in electro -acupuncture group and electro-acupuncture control group was significant increased than model group (P < 0.01, P < 0.05), and there was significant difference between electro-acupuncture group and electro-acupuncture control group (P < 0.005). Compared with model group, the positive expression rate of Bax, Bad decreased (P < 0.01, P < 0.05), and Bcl-2 increased (P < 0.01) in electro-acupuncture group and electro-acupuncture control group,there was significant difference between electro-acupuncture group and electro-acupuncture control group (P < 0.01).

CONCLUSIONElectro-acupuncture can obviously promote the repair of acute spinal cord injury,its mechanism may be through increasing Bcl-2, inhibiting the expression of Bax, Bad, which inhibits the apoptosis of spinal cord neurons.

Animals ; Apoptosis ; Electroacupuncture ; Immunohistochemistry ; In Situ Nick-End Labeling ; Male ; Neurons ; cytology ; physiology ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries ; pathology ; physiopathology ; therapy ; Urinary Bladder ; physiopathology

Objective To evaluate the effect of a novel orthopedic biomaterial,graded composite zireonia(ZrO2)hydroxyapatite(HAP)on activity of rat osteoblast ceils(OB)cultured in vitro. Methods The pure zirconia material was used as control to measure surface roughness of the composite material that was examined by using scanning electron microscope(SEM)and X-ray diffraetometer (XRD).The rat osteoblast cells were cultured on the two materials.Alkali phosphatase(ALP)of the two groups was measured and ELISA was used to detect IL-6 and TGF-?eoncentration of the supematant of OB cells.Tumor growth factor-?(TGF-?)mRNA was detected by RT-PCR.SEM was used to observe OB cells on the two materials.The extract of the composite material was used for a eytotoxicity test to cal- culate the relative proliferation rate(RGR)and classify the toxicity.Results The surface roughness of the gradual composite materials was significantly higher than that of the control materials(P＜0.01). The ALP of the gradual material group was markedly higher than that of the control group at different in- tervals.There was significant difference of the IL-6 and TGF-?concentrations 2-4 days after culture be- tween two groups(P＜0.05,P＜0.01).The mRNA level of TGF-?of the two OB groups also showed marked statistical difference(P＜0.01).The ossification of the OB cells on the composed material was marked after 14 days.The MTT color experiments showed no statistic significance between materials group and negative group,with the toxicity at levelⅠand 0(P＜0.05).Conclusion Graded composite ZrO2 HAP can significantly promote proliferation and differentiation of OB cells cultured in vitro and has good biocompatibility.

This study was aimed to retrospectively analyze and compare the clinical curative efficacy of patients with hematologic malignancies after G-CSF-mobilized sibling HLA-matched (sm) peripheral blood hematopoietic stem cell transplantation (sm-allo-PBHSCT) and sm-allo-PBHSCT combined with bone marrow transplantation (BMT). 100 patients received sm-allo-HSCT in a single center from October 2001 to October to 2010, included 38 patients received sm-allo-PBHSCT and 62 patients received sm-allo-PBHSCT combined with BMT. The myeloablative or reduced intensity conditioning regimens were chosen according to the condition of patients. All patients received standard cyclosporine (CsA) and mycophenolate mofetil (MMF) as prophylaxis for GVHD. The results showed that the rapid hematopoietic reconstitution was observed in all patients. The median time of ANC ≥ 0.5 × 10(9)/L in both groups were 12 days, the median time of platelet count ≥ 20 × 10(9)/L was 15 days in sm-allo-PBHSCT group and 16 days in sm-allo-PBHSCT + BMT group. The incidence of acute GVHD, acute GVHD of III-IV grade and chronic GVHD in sm-allo-PBHSCT and sm-allo-PBHSCT + BMT groups were 37.1% and 34.2%, 7.89% and 8.06%, 36.11% and 41.38% respectively, there were no statistical differences. The relapse rates were similar in two groups (sm-allo-PBHSCT 13.16% vs sm-allo-PBHSCT + BMT 12.9%). The 3-year disease-free survivals in sm-allo-PBHSC and sm-allo-PBHSCT + BMT groups were 57.1 ± 8.7% and 61.3 ± 6.4% respectively (p = 0.852). The 2-year overall survival of high-risk patients was 41.4 ± 12.8% in sm-allo-PBHSCT group, while 60.9 ± 9.6% in sm-allo-PBHSCT + BMT group (p = 0.071). It is concluded that the rhG-CSF mobilized sibling matched allo-PBHSCT + BMT is superior to the rhG-CSF mobilized sibling matched allo-PBHSCT in increasing the overall survival of high-risk hematologic malignancies.
Adolescent ; Adult ; Aged ; Bone Marrow Transplantation ; Child ; Child, Preschool ; Female ; Granulocyte Colony-Stimulating Factor ; therapeutic use ; HLA Antigens ; immunology ; Hematologic Diseases ; immunology ; therapy ; Humans ; Male ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Retrospective Studies ; Siblings ; Tissue Donors ; Young Adult

OBJECTIVETo study the significance and safety of flexible bronchoscopy and balloon dilatation in the diagnosis and treatment of respiratory diseases in children.

METHODSA total of 438 children (236 males and 202 females) with respiratory diseases who were aged from 17 days to 15 years, were examined and/or treated by bronchoscopy (including bronchoscopic intervention) under local anesthesia.

RESULTSOf the 438 children, 311 were diagnosed with pulmonary infection, 68 with atelectasis, 36 with recurrent cough and asthma, 6 with hemoptysis of unknown origin, 6 with bronchial foreign body, 5 with congenital bronchopulmonary dysplasia, 2 with bronchiectasis, 1 with ciliary dyskinesia syndrome, 1 with lung tumor, and 2 with congenital immunodeficiency disease. After bronchoscopic examination, local flushing or bronchoalveolar lavage, and foreign body extraction, marked response was seen in 379 cases and response was seen in 46 cases. High-pressure balloon dilatation under bronchoscopy was performed in 5 cases with inflammatory stricture and achieved satisfying clinical effect. No severe complications were found in bronchoscopy.

CONCLUSIONSBronchoscopy and balloon dilatation under local anesthesia is safe and effective for the diagnosis and treatment of respiratory diseases in children.

Adolescent ; Anesthesia, Local ; Bronchoscopy ; adverse effects ; methods ; Child ; Child, Preschool ; Dilatation ; methods ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Respiratory Tract Diseases ; diagnosis ; therapy

OBJECTIVETo investigate the therapeutic mechanism of point 8L54-through-point ST2S acupuncture with elongate needles in treating urinary retention after spinal cord injury.

METHODSThirty-five healthy Japanese rabbits (weight 2.5 +/- 0.25 kg, 3 months old, male or female), used as experimental subjects, were divided into 4 groups involving blank group, model group, acupuncture group, elongate needles group (5 rabbits in blank group, 10 rabbits in each of the other group 10). Modified Allen's method was used to cause spinal cord injury model for the model group, the acupuncture group and the elongate needles group, the blank group was only sham surgery. Immediately after spinal cord injury model,the elongated needle group was given the bilateral acupoints of the elongated needle penetration needling and electric stimulation, electrical stimulation 15 mm stimulation frequency of 20 to 40 times/mm, intensity 1.5 to 3 V the acupuncture group immediately was given ordinary electric needle acupuncture, given other disposals as the elongated needle group; model group was not given electric needle acupuncture, waiting 15 minutes, started to detect and record the observed indicator as the elongated needle group; the blank group was only sham surgery. The following indicators including the Tarlov score ,urinary bladder pressure point, the threshold urination, voided volume, were observed in the first day and the fifth day after surgery.

RESULTSThree groups of animals which modeled were urinary retention after operation. Compared to 1 d, Tarlov score of model group, acupuncture group and elongate needles group significantly improved at postoperative 5 d (P < 0.05). Compared with acupuncture group, the Tarlov score of elongate needles group had no significant difference at postoperative 5 d (P > 0.05). Compared with model group, values of urinary bladder pressure point decreased with varying degrees in the acupuncture group and elongate needles group at postoperative 5 d (P < 0.05); relative to the acupuncture group, the point of the bladder voiding pressure in the elongate needles group decreased more significantly at postoperative 5 d (P < 0.05); compared with model group, micturition threshold of acupuncture group and elongate needles group had been significantly improved at the fifth day after surgery (P < 0.05); relative to the acupuncture group, the improvement is more obvious in the elongate needles group. Compared with model group, voided volume of acupuncture group and elongate needles group had increased significantly at the fifth day after surgery (P < 0.05); relative to the acupuncture group, the increment is more evident in the elongate needles group (P < 0.05).

CONCLUSIONTo treat urinary retention after spinal cord injury, the method, which was point-through-point acupuncture with elongate needles in the "Zhibian" and "Shuidao", was better than general acupuncture method. The therapeutic mechanism may be related to stimulate peripheral nerve of bladder, and to rectify the dysfunction between detrusor and sphincter.

Acupuncture Points ; Acupuncture Therapy ; Animals ; Electroacupuncture ; Female ; Male ; Rabbits ; Spinal Cord Injuries ; complications ; Urinary Retention ; etiology ; therapy

OBJECTIVETo study the effects of mild hypothermia therapy on severe brain-injured patients whose intracranial pressure (ICP) could be maintained below 25 mm Hg.

METHODSForty severe brain-injured patients with ICP below 25 mm Hg were divided randomly into one treatment group (n=20, mild hypothermia therapy) and one control group (n=20, normothermia therapy) to observe the changes of the concentration of excitatory amino acids (glutamate and glycine) and cytokines (interleukin-1beta and interleukin-6).

RESULTSThere were no significant differences in the daily changes of the concentration of excitatory amino acid and cytokines between two groups. The outcome of two groups had no significant differences.

CONCLUSIONSMild hypothermia has no additional beneficial effects on severe brain-injured patients compared with normothermia therapy if ICP can be maintained below 25 mm Hg by using conventional therapy.

Analysis of Variance ; Chi-Square Distribution ; Craniocerebral Trauma ; cerebrospinal fluid ; therapy ; Enzyme-Linked Immunosorbent Assay ; Female ; Glasgow Coma Scale ; Humans ; Hypothermia, Induced ; Intracranial Pressure ; Male ; Treatment Outcome

OBJECTIVETo observe the morphological characteristics of sacral fracture under different impact loads.

METHODTen fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded. Morphological characteristics were observed under scanning electron microscope.

RESULTSThe form of sacral fracture was related to the impact energy. Under low energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type I fracture; sacral foramen cataclasm fracture, Type II fracture; central vertebral canal fracture, Type III fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture. The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different. When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury. When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 approximately 25 J, Type I fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards.

CONCLUSIONSIn dynamic state, sacrum fracture mostly belongs to Type I and Type II, and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.

Biomechanical Phenomena ; Humans ; Male ; Microscopy, Electron, Scanning ; Sacrum ; injuries ; pathology ; Spinal Fractures ; pathology ; physiopathology ; surgery ; Spinal Nerve Roots ; injuries