Objective To analyze the reasons of internal fixation failure for subtrochanteric fractures of the femur and indicate the methods for avoiding the complications. Methods Thirty-nine patients with internal fixation failure for subtrochanteric fractures of the femur were treated from January 1993 to January 2004. There are 34 males and 5 females with an average age of 37 years (range from 21 to 65 years). The causes of injury included falls from bicycle in 3 cases, pedestrain injury in 1 case, traffic accident in 28 cases and falls from heights in 7 cases. The pattern of the fractures included Seinsheimer ⅡA type in 5 cases,ⅡB type in 2 cases,ⅡC type in 1 case,ⅢA type in 18 cases,ⅢB type in 1 case,Ⅳ type in 3 cases,Ⅴ type in 9 cases. The initial operation included open reduction and fixed with cerclage wires in 1 case, open reduction and fixed with Kuntscher nail and cerclage wire in 13 cases, closed reduction and fixed with Russell-Taylor reconstruction nail in 1 case, open reduction and fixed with 135? DHS in 6 cases, open reduction and fixed with plate in 18 cases. Two cases failed in 8 weeks postoperation, 26 cases failed in 6 months postoperation and 11 cases failed over 6 months. The pattern of failure of internal fixation include varus deformity of fracture in 35 cases, cutout of the lag screw from the femoral head in 2 cases and over medial migration of the distal femoral shaft in 2 cases. The reasons of internal fixation failure were nonanatomically reduction of fractures, unrigid interal fixation, over early weight bearing and poor placement of lag screw. Results The internal fixtion of fractures were revised, including open reduction and fixed with kuntscher nail in 2 cases, fixed with interlocking nail in 23 cases, fixed with 135? DHS in 6 cases, fix with plate in 4 cases, total hip replacement in 4 cases. The mean duration of follow up was 23 months (range from 19 to 37 months). The average time of fracture healing was 11.5 months (range from 11 to 13 months). Conclusion There are higher bending loads at the subtrochanteric area of the femur due to the eccentric loading. If extramedullary implant is selected, the stability at the medial cortex of the femur must be reconstructed intraoperatively and bone grafting is required.

Objective:To construct recombinant retrovirus expressing human bone morphogenetic protein-7 gene BMP7 and to discuss its apoptosis-inducing activities and the mechanism in liver cancer cell line HepG2. Methods:BMP7 gene was amplified and reconstructed with retroviral plasmid pLP-LNCX by loxP homologous recombination,and then the plasmid pLP-LNCX-BMP7 (pLLBMP7) was transferred into packing cell line PT67 and the supernatant was collected to assay viral titer. MTT assay was adopted to observe HepG2 cells amplification. 48h after pLLBMP7 infection agarose electrophoresis and flow cytometry were used to verify apoptosis of tumor cells,and then the expression of BMP7,caspase-3 and bcl-2 proteins were detected by Western blotting. Results:Recombinant retrovirus pLLBMP7 was justified and transformed into PT67 package cell with supernatant viral titer amounted to 5?109 pfu/ml. In MTT assay retrovirus group had no evident difference from controls in cellular inhibition 72h later (35.1% vs. 5.3%,68.5% vs.18.3%,p

Objective To provide anatomical evidence for a safe osteotomy line and direction in periacetabular osteotomy.Methods The pelvic CT images of 18 adults were obtained.With the help of Mimics software,three-dimensional CT reconstruction was performed,and periacetabular osteotomy was simulated.The length of osteotomy lines on the ilium,ischium and iliac columna posterior was measured,and the relationship between osteotomy lines and anatomic landmarks was explored. Results The length of osteotomy lines on the ilium,ischium and iliac columna posterior was(50.96?7.09) mm,(36.46?5.92)mm and(55.28?6.42) mm,respectively.The angles between the osteotomy line on the ilium and that on the iliac columna posterior,between the osteotomy line on the ischium and that on the iliac columna posterior,and between the osteotomy line on the iliac columna posterior and quadrilateral surface were 120.21??5.96?,115.49??6.46? and 60.31??4.96?,respectively.And the real periacetabular osteotomy has been performed on the pelvic specimens for verification.The vertical distances between the ending point of osteotomy line on the ilium and iliopectineal line,between osteotomy line on the ischium and iliopectineal line,and between the osteotomy line on the iliac columna posterior and greater sciatic notch were(11.98?5.26) mm,(45.08?8.59) mm and(18.52?6.49) mm,respectively. Conclusion The length and angles of osteotomy lines in periacetabular osteotomy can be well measured by three-dimensional reconstruction,and the relationship between the osteotomy lines and anatomic landmarks can also be well displayed,which provides anatomical data for the clinical application of periacetabular osteotomy.

Objective To study the expression of MCP-1 in the diabetes mellitus skin defect healing, then discuss its effect. Methods The diabetes mellitus models were established, and the expression of MCP-1 was detected by immunohistochemical staining and Elisa. Results The immunohistochemistry stain showed that the expression of MCP-1 in DM group was higher than that in control group at all time. And the serum value of MCP-1 in DM group had statistical significance ( <0.05) at 3 days or 1 week, but that in 2 weeks and 4 weeks was no statistical significance ( <0.05) . Conclusion The MCP-1 might play a role in the healing of diabetes mellitus skin defect through mediate abnormal inflammatory response.

Objective To explore the operative methods of open reduction and fixation for the old trimalleolus fractures. Methods Fifty-eight patients of the old trimalleolus fractures were treated from January 2000 to January 2004. There are 41 males and 17 females with an average age of 43 years (ranged from 19 to 61 years). The average time of postinjury was 48 days (ranged from 29-76 days). The fractures were classified by Lauge-Hansen system. Supination-external rotation type in 37 cases. Pronation-external rotation type in 21 cases. The anterior-medial approach and anterior-lateral approach were chosen. Explore the original fracture line of medial and lateral malleolus sharply, resect scar tissue at the fagment and ankle mortise, make the ankle joint valgus, expose the posterior malleolus fragment directly and explore the original fracture line. Reducted and fixed the posterior malleolus. According to the fibular crest, the normal length and alignment were recovered. The fracture was fixed with 1/3 tubular plate or ordinary plate. Medial malleolus was fixed with screw or tention band. The time of partial weight bearing was 10-12 weeks. Results The mean duration of follow up was 37 months (range from 18-65 months). Superficial skin necrosis was in 2 cases. The wound delayed union in 4 cases. The average time of fracture healing was 25 weeks(range from 21-29 weeks). The fibula malalignment in 2 cases. 6 cases developed arthrosis. 2 cases in this 6 patients had a good reduction of fractures. The average time of the operation in this 6 patients was 58.5 d after injury. According to the AOFAS scoring system, excellent in 31 cases, good in 22 cases, fair in 5 cases. The total rate of good results was 91.4%. The pain score was up to 20 in 5 cases. 9 cases had restriction of dorsiflexion with less than 10?. Conclusion The excellent reduction and clinical results were obtained by explore the original fracture line sharply, reduct posterior malleolus fragment directly and maintain normal length of the fibula, rotation and alignment for the old trimaleolus fractures which injuried within 76 days.

Objective To evaluate the early and middle outcome of deep circumflex iliac arterial vascularized iliac bone grafting to delayed femoral neck fractures in young patients. Methods Thirty-one delayed femoral neck fractures were treated from January 1997 to December 2003. Complete data were available in 26 cases (19 males and 7 females). The patients' age ranged from 15 to 38 years old with the average of 25 years old. 17 cases suffered from traffic accidents and 9 cases from falling injury. There were 11 cases in Garden type Ⅲ and 15 cases in type Ⅳ. 11 cases exhibited nonunion after conservative treatment and another 15 nonunion cases had previous surgery history. The initial operation included closed reduction and steinmann pin fixation or open reduction and threaded pin or steinmann pin fixation. The average duration from injury to the second operation was 8.5 months (range from 6 to 17 months). Most of the patients presented shorten limbs and limited hip function in difference degree. Open reduction, deep circumflex iliac artery vascularized iliac bone grafting and cannulate screw fixation were performend. Partial weight bearing started on 6 to 8 months postoperatively and full weight bearing on 11 months postoperatively. Results The mean duration of follow up was forty-one months (range from 28 to 69 months). Fracture healed successfully in 26 cases. The average time of fracture healing was 12.5 months (range from 11 to 15 months). Two femoral head necroses were noted during the follow-up period. The 5 cases of obvious shortened limbs stop progressing after surgery. Harris hip joint function score was on average 82.8. Conclusion Deep circumflex iliac artery vascularized iliac bone grafting can improve the blood supply to fractured femoral head. As a result, it's an effective way to enhance delayed femoral neck fracture.

Humans ; Facial Injuries/etiology* ; Wound Healing

China ; Conservation of Natural Resources ; Electricity

Objective:To investigate the beneficial effect of erythropoietin(EPO)on experimental allergic encephalomyelitis(EAE).Methods: The severity of EAE mice with or without EPO therapy were evaluated through clinical symptoms score and histological observation.Mononuclear cells from spleens,lymph nodes, brains and lumber spinal cords were applied to flow cytometry to detect ratios of CD4~+T subgroup, scales of apoptotic and dead cells, levels of inflammatory cytokines.LDH release of peripheral mononuclear cells were examined after incubating with EPO at different concentrations.Results: EPO ameliorated clinical symptoms and infiltration of pathological inflammatory cells in EAE mice(P＜0.05); Ratio of CD4~+T subgroup, levels of IL-17 and IFN-γ in EAE mice with EPO therapy were significantly lower than those of EAE control group(P＜0.05).No statistical significant differences existed on scales of dead cells, levels of IL-10 and CD4~+ CD25~+ T cells (P＞0.05).EPO at the concentrstions of 1-1 000 U/ml had no effect on LDH release of peripheral mononuclear cells(P＞0.05).Conclusion: EPO play the role of neuroprotecion in EAE mice by the way of decreasing infiltrating inflammatory cells and lowering the levels of IL-17 and IFN-γ.

AIM: To observe the neovascularization process with no intervention in rat allogenic penetrating keratoplasty. METHODS: Allogenic penetrating keratoplasties were successfully performed in 34 female SPF SD rats with no intervention after operations. Corneal neovascularization(CNV) process was noted on day 4, 7, 15 and 30 with operating microscope. The vascular area surface was calculated using the formula C/12×3.14×[r2-(r-I)2].RESULTS: CNV was noted in 29 out of 34 rats (85%). Firstly, the new vessels distributed around the cornea like a brush then gradually extended towards the center. The vessels were distorted and massive with branched tails, they continued growing to reticulated veins in peak time then gradually atrophied. The average neovascularization area (SE) on day 4, 7, 15 and 30 was 11.8±3.5mm2, 18.5±4.0mm2,14.4±4.3mm2 and 6.0±1.8mm2 respectively and 12.7±1.9mm2 in total. The average percentage that new vessels accounting the whole cornea area(SE) was 30.8%±8.7%, 65.3%±12.8%, 59.4%±14.5%,36.2%±10.9% and 48.7%±6.4% in total.CONCLUSION: In rat allogenic penetrating keratoplasties without intervention, CNV presented on day 4 and reached the maximum area on day 7. Then the vessels gradually atrophied, about 50% of the maximum area still remained on day 30.