Objective To discuss the injury triage and process during large scale transportation of the wounded during earthquake by understanding injury severity and detecting vital signs of the woun-ded needing long distance transportation in Wenchuan earthquake. Methods Second medical rescue team of Beijing Health Administration finished transportation of 197 patients including 106 males and 91 females at age range of 6-81 years (average 37.5 years). During whole transportation process, we carried out 2 examinations, 4 checkouts and 1 scoring twice per patient and strengthened close collaboration a-mong different sub-transportation teams. Results Of 197 patients, 194 were smoothly transported ex-cept for three who returned to original hospital due to unstable situation on the way of transportation. Of successfully transported patients, 13 stated complaints including pain of affected extremity in seven pa-tients with fractures, chest distress and short breath in two with crush syndrome, aggravated chest pain in two with crush injury of the chest as well as dizziness and sicchasia in two during the course of transporta-tion. In the meantime, monitoring of vital signs and symptomatic treatment were done in all 13 patients who stated complaints. Conclusions Sufficient preparation, strict medical examination, sound medi-cal collaboration, understanding of injury condition, necessary monitoring and treatment, active communi-cation with patients and detailed relay are preconditions to guarantee successful transportation during large scale transportation of the wounded caused by earthquake.

Objective To study the effects of skeleton musclular relaxation on nerve conduction and regeneration. Methods Musclocontaneous nerve injury model was established in 96 mice and the animals were divided into skeleton muscle relaxation, skeleton muscle relaxation and neurotrophic drugs, neurotrophic drugs and control group. Nerve conduction and regeneration were evaluated by electromyography; muscle weight and counting of distal regenerated myelinated nerve fibers. Results The velocity of nerve conduction and regeneration in skeletal muscle group was the same as that in skeleton muscle relaxation and neurotrophic group, and higher than that in control group. Conclusion Skeleton muscle can enhance nerve conduction and regeneration.

Objective To observe the effect of contralateral C 7 root transfer to the radial nerve for the treatment of total brachial plexus root avulsion injury.Methods One hundred and seven patients with total brachial plexus root avulsion injury were treated by contralatera l C 7 root transfer to the radial nerve fro m1993to 1999.Among them 36patients were followed-up for more than 2years;there were 31male and 5female patients,with age ranged fro m 7to 44years,and 27years in average.The time of initial surgery from the time of injury was between 3to 36months,among which 4patients were tr eated between 3to 6months,29between 6to 12months,2between 12to24months and 1between 24to 36months;9.4months on the average.The whole surgical procedure was divided into three phases.Phase I:The exploration of the brachial plexus both above and below the clavicle;the phrenic nerve was transferr ed to the anterior branch of the su-perior trunk or was anastomosed with the musculocutaneous nerve;the accessory nerve was transferred to the supraclavicular nerve;the median nerve was previously placed subcutaneously at the anterior re gion of the arm-pit.PhaseⅡ:The contralateral C 7 nerve root was transferred to the uln ar nerve which was used for the bridging.PhaseⅢ:The intercostal nerve was transferred to the median nerve and the thorac odorsal nerve,the ulnar nerve and the radial nerve was a nastomosed.Patients were followed-up for 24months to 84months,38months on average.The follow-up sta ndards included:the recovery of the motor function of the muscles in-nervated by the radial nerve;the rec overy of the regeneration potential of the muscles;the change in the sensory function in the cutaneous re gion innervated by the radial nerve.Results Twenty-nine patients(80.6%of all)was improved in motor function,and 27patients(75.0%)in sensory function.Conclusion The overall effect of contralateral C 7 root transfer to the radial nerve for total brachial plexus root avulsion injury was satisfactory,while the functio nal recovery of triceps was not as exp ected.[

Objective To investigate the effect of calcitonin gene-related peptide(CGRP) on early-stage bone fracture healing and on the expression of bone morphogenetic protein-2(BMP-2) in bone tissue of rats.Methods Totally 30 SD rats with tibial fracture were randomly and equally divided into 3 group and received normal saline(control group),CGRP or CGRP receptor antagonist injection intraperitoneally.In 1,2 and 4 weeks later,the fracture sites from the 3 groups were subjected to X-ray scanning,callus measurement and HE staining.The expression of the BMP-2 was detected by immunohistochemical method.Results There was no obvious difference on callus amounts among the 3 groups,but at 2 weeks after treatment,there were significantly more callus in CGRP group with enlargement in the fracture site than in the other 2 groups;The enlargement of CGRP group became minimized with fused cortex and almost normal morphology and size.So were the other 2 groups.Immunohistochemical results showed that exogenous CGRP significantly increased BMP-2 expression,but the expression was decreased significantly after administration of CGRP receptor antagonist.Conclusion Our results suggest that CGRP may participate in the regulation of bone fracture healing,and induce BMP-2 production,implying that BMP-2 may be related functionally with CGRP in the mechanism of bone metabolism.

Objective To evaluate the clinical efficacy of Achillon,a novel guide for Achilles tendon suture produced by Newdeal Ltd in France,in the mini-invasive surgical treatment of acute Achilles tendon rupture. Methods Between December 2010 and March 2011,7 patients(7 feet) with acute Achilles tendon rupture were treated in our department.They were 5 males (5 feet) and 2 females (2 feet),with an average age of 34.2 years (range,21 to 53 years).The interval between injury and operation ranged from 1 to 11 days(3.8 days on average).A longitudinal incision approximately 2.0-3.5 cm in length was made around the ruptured Achilles tendon for minimally invasive repair after insertion of the Achillon.Postoperative rehabilitation was carried out. Results All the wounds healed at the first stage.All patients were followed up for 5 to 11 months, with an average of 7.2 months. All patients regained normal weight-bearing walking 3 months after operation without any re-rupture. According to the ankle-hindfoot scoring system of American Orthopaedic Foot and Ankle Society (AOFAS),they scored 93.2 points.By the visual analogue scale(VAS),they scored 1.2 points at the operation site. Conclusion The surgical treatment of acute Achilles tendon rupture with Achillon has advantages of mini-invasion,a low rate of incision problems and quick function recovery.

SUMMARY Trauma is a global social problem, with the number of deaths up to 5.8 million all over the world annually.Currently, severe trauma has become the first cause of death in young adults in China. Nowadays, there are many problems in the trauma rescue system, including long pre-hospital transfer pe-riod , several secondary transfers, no information exchange between pre-hospital and in-hospital care, and the poor integrated treatment, which results in the situation that the overall treatment level of severe trau -ma in China is relatively low.In order to solve these problems, we carried out the research and promotion of severe trauma rescue standard, involving completing severe trauma information database , providing lo-cal rescue medical workers with standard training , and building up the information system for the linkage and warning of severe trauma.In addition, we developed and promoted the new standard system for se -vere trauma in 15cities with 124 medical centers.Due to our research, the treatment ability of severe trauma in the pilot areas was enhanced, and the mortality and morbidity of severe trauma were reduced significantly.To sum up, we had got the expected results after implementing the project .

Objective To analyze the injury characteristics in 2004-2009 road traffic accidents (RTAS) of 0-25 years old adolescents treated in Beijing 120 Emergency Center so as to provide scientific basis for making effective measures in prevention and control of RTAs. Methods The data of all the adolescents with traffic injuries treated in Beijing 120 Medical Emergency Center were collected for a retrospective analysis on sex,age,traffic injury time,wound regions,injury characteristics and death condition of the injured adolescents. Results( 1 ) There were 17 232 injuries and 259 deaths according to the traffic reports from 2004 to 2009. Among the total injury cases,there were 4 229 cases of 0-25 years old adolescents (24.5％),at (20.13 ± 4.43 ) years of age.The injury number showed a significant rising trend with the increase of age and the injury number of 20 years old group were obvious more than that of other age groups.(2) There were 2 252 males and 1 677 females,with ratio of males to females for 1.5:1 ( P ＜ 0.05 ).( 3 ) Total number of patients was decreased yearly.The high incidence of adolescent RTAs could be seen in September,October and May in one year; Friday,Saturday and Sunday in one week; and between 8:00 am and 11:00 pm in one day.The low incidence of adolescent RTAs could be seen in Tuesday in one week,and 3:00-6:00 am in one day (P ＜0.05).(4) Cases of limb and arthrosis wounds (53.4％) were more than those of head and neck wounds (35％).Most of the cases were pedestrians (49.1％ ).(5) There were 38 deaths,including 28 males and 10 females,at ageof (19.29 ± 5.30) years.The death were mainly resulted from craniocerebral injuries (87％),which mainly concentrated in July ( 13.2％ ) and August ( 15.8％ ). Conclusions The present condition ofadolescent traffic injuries is not good enough.We should strengthen traffic security education,increase executive powers in the traffic rush and promote cooperation and communication in pre-hospital emergency,as may be beneficial for decreasing adolescent RTA.

Objective To analyze the varus deformity of caput humeri and its correlation with fuuctional outcome of unstable proximal humeral fracture managed with locking plate.Methods The study involved 62 patients (24 males and 38 females,at age range of 32-83 years,mean 63.7 years)with proximal humeral fracture who were treated by open reduction and locking plate internal fixation from May 2008 to June 2010 and had full follow-up data.According to Neer classification,there were 11 patients with two parts fractures,41 with three parts fractures,five with four parts fractures and five with dislocation.Their clinical results were evaluated with Constant-Murley scores.ResultsThe mean duration of follow-up was 20.3 months (range,14-37 months),which showed fracture healing in all the patients.There were 11 patients with varus deformity of the caput humeri. The significant difference was found in Constant-Murley score of shoulder function ( P =0.045 ),forward elevation ( P =0.006 ) and abduction (P =0.022) between the varus and non-varus groups.But there was no significant difference in shoulder external rotation( P =0.08 ).The fracture types ( P =0.037 ) and varus deformity of caput humeri ( P =0.006) were closely correlated with the shoulder function between two groups.ConclusionsThe varus deformity of caput humeri mav be predictive factor for poor outcome of the unstable proximal humeral fracture. Restoration of humeral head-shaft alignment and sound reduction should be done as possible during operation.

Objective:To measure vertical axis length of humerus head in patients with proximal hu-meral fractures and to evaluate the use of structure screws in proximal humerus internal locking osteosyn-thesis system ( PHILOS) .Methods:From January 2007 to February 2014,117 patients with proximal hu-merus fracture were treated by PHILOS plate.Preoperatively, all the patients tookanteroposterior X-ray of shoulder, and the vertical axis length of humerus head were measured, and the use of structure screws in PHILOS plate was observed.Results: There were 40 male and 77 female patients; The vertical axis length of humerus head in male patients was (47.64 ±3.44) mm, and the rate of structure screw use was 52.5%;The vertical axis length of humerus head in female patients was (42.46 ±3.21) mm, and the rate of structure screw use was 32 .5%.The vertical axis length of humerus head and the rate of structure screw use had significant difference in the male and female groups (P<0.05).Conclusion:The rate of structure screw use was low in the treatment of proximal humerus fracture by PHILOS plate, especially for women.We should improve the design of plate according to the anatomical characteristics of Chinese.

Objective:To apply modified proximal femoral nail anti-rotation ( PFNA ) fixation tech-niques performed by percutaneous placement of guide wire combined with true lateral view and to make the procedures simpler.Methods:A retrospective study was used to analyze the clinical data of femoral intertrochanteric fractures cases, which were treated with conventional PFNA fixation or modified PFNA fixation performed by percutaneous placement guide wire combined with true lateral view in our hospital, from March, 2011 to May, 2014.In the study, 60 cases were followed for average 13 months.The oper-ation time, the amount of bleeding, the fluoroscopy time, postoperative radiographic measurements ( tip apex distance, TAD ) and hip function scores were analyzed.Results:In modified PFNA group, the amount of bleeding, the operation time and the fluoroscopy time were (70.5 ±12.5) min, (34.9 ±6.1) mL, ( 63.6 ±9.7 ) s respectively.In conventional PFNA group, they were ( 80.6 ±17.1 ) min, (47.8 ±6.7) mL, (68.5 ±8.7) s respectively.There were significant differences in the above respects between the two groups (P were 0.006, 0.013, and 0.022 respectively).There were no significant differences in TAD, fracture healing time, postoperative hip scores between the two groups (P>0.05). Conclusion:Fracture line is a natural entry point for some cases of femoral intertrochanteric fractures when we use proximal femoral nail anti-rotation to fix the fracture.Applying percutaneous insertion of the guide pin combined with true lateral view could reduce the operation time, amount of bleeding, and fluo-roscopy time significantly, make the procedures simpler and acquire satisfactory results .