[Objective]To study the injury mechanism of sacral plexus resulting from sacral zone-Ⅱ fractures of lateral compression.[Method]Six short-term(in a year) embalmed pelves were obtained from anatomic department of Hebei Medical University with preserving sacral plexus and resecting pubic symphysis,the models of sacral zone-Ⅱ fractures of lateral compression were produced.Quantitative analysis for fracture displacement was carried out to observe the characteristic and the mechanism of sacral plexus injury.Sacral plexus were replaced by proportional diameter silica gel pips fulled with contrast medium,experimental procedure was repeated under X-ray.The experimental data were analyzed by SPSS10.0 statistic software and the result was obtained.[Result]In lateral compression type sacral canal was closed and its volume reduced and small free fracture segment resulted in sacral plexus nerves oppressed,especially of L_5,Sland S_2.At the same time,the more overlapping of pubic symphsis,the more serious of compression.[Conclusion]Sacral plexus is conncted with the wall of pelvic cavity and fixed.Zone-Ⅱ sacral fracture is likely to damage sacral plexus.In lateral compression type of sacral fracture nerve injury is mainly compression injury which position is in nerve canal,especially of S_1,S_2.And L_5 can be crushed in fracture interspace to be damaged seriously.

ObjectiveTo observe the effect of continuous passive motion (CPM) on postoperative functional rehabilitation in lower limb.Methods267 patients operated in lower limb were separated to CPM group (162 cases) and control group (105 cases). Patients of the CPM group used CPM device at early period post operation, and cases of the control group received instruction to exercise by themselves. The efficacy of two methods was evaluated.ResultsThe knee activity of affected extremity of CPM group at 10 day and 1 month was better than that of control group, as well as the rate of swelling extinction of affected extremity (P<0.05～0.01).ConclusionIt is propitious to functional rehabilitation of patients operated in lower limb that using CPM early post operation.

Objective To compare the treatment of displaced intra-articular calcaneal fractures by homeopathic closed leverage anatomical plate with compression bolt through small posterior lateral approach vs.traditional open reduction and internal fixation.Methods A retrospective case control study was made on 98 cases of displaced intra-articular calcaneal fractures admitted from September 2012 to May 2015.According to the random number table,the subjects were assigned to homeopathic closed leverage anatomical plating with compression bolt through small posterior lateral approach (experiment group,58 cases,66 sides) and open reduction and internal fixation through L-shape approach (control group,40 cases,45 sides).Experiment group consisted of 50 male and eight females cases aging from 27-56 years (mean,41.9 years),and the Sanders classification was 40 cases of type Ⅱ,24 type Ⅲ and two type Ⅳ.Control group consisted of 36 male and four female cases aging from 25-58 years (mean,43.7 years),and the Sanders classification was 25 cases of type Ⅱ,18 type Ⅱ and two type Ⅳ.Operation time,bone reduction,postoperative Bohler's angle,width of the calcaneum,and incision healing were recorded.Functional outcomes were evaluated with Maryland hindfoot scoring system at last follow-up.Results Operation time was (52.6 ± 11.2) min in experiment group,significantly shorter than that in control group [(86.4 ± 14.1) min] (P ＜ 0.01).All cases were followed up from 18-50 months (mean,30.8 months).Reduction of the calcaneal posterior facet in 53 sides (80％) was graded as nearly anatomical in experiment group,and 38 sides (84％) in control group (P ＞ 0.05).Postoperative Bohler's angle was (28.0 ± 6.2) ° in experiment group,and (26.8 ± 7.0) ° in control group (P ＞ 0.05).Width of the calcaneum was (31.3 ±3.6)mm in experiment group and (34.9 ± 4.0)mm in control group (P ＜ 0.01).All cases presented satisfactory shape of the calcaneus without lateral-side impact syndrome.No case had wound infection and incision-edge necrosis in experimental group,while two cases of superficial wound infection and three cases of incision-edge necrosis were found in control group (P ＜ 0.01).At last follow-up,Maryland hindfoot score was (87.1 ± 7.6)points in experiment group and (84.9 ± 9.1)points in control group (P ＞ 0.05).Conclusion Homeopathic percutaneous leverage and anatomical plate with compression bolt through small posterior lateral approach is an effective method for treatment of displaced intra-articular calcaneal fractures,for it has advantages of minimal invasion,less operation time,good reduction and function,and less wound complications.

Objective:To investigate the repair effects and mechanism of mesenchymal stem cell osteogenesis-derived exosomes deliver miRNA-222-5p on tendon cell injury.Methods:Mesenchymal stem cell exosomes were collected, isolated and characterized. The mice achilles tendon was collected after cutting one week later. The tendon cells were isolated and cultured to obtain a tendon cell injury model (injury group). The subjects were divided into three groups. During the process of osteogenic differentiation, mesenchymal stem cells were co-cultured with tendon cells (co-culture group). Further, miRNA-222-5p mimics were transfected into mesenchymal stem cells, the co-cultured mesenchymal stem cells and tendon cells during the process of osteogenic differentiation (miRNA-222-5p group). Clone formation and Transwell were used to detect the ability of mesenchymal stem cells to secrete exosomes and exosomes transported miRNA-222-5p to repair damaged tendon cells. qPCR, Western-blot and fluorescence staining were used to detect the expression levels of cartilage-related proteins and bone-related proteins on mRNA and protein. Western-blot was used to detect the expression of signal pathway factors.Results:The shape of the exosomes was a typical cup - like structure. The exosome proteins marker was all expressed positively ( P<0.05). After counting the colony formation and Transwell test, the number of cell communities and cell invasion were significantly increased in the co-culture group compared with those in the injury group. The number of those in miRNA-222-5p group were significantly increased compared with those in co-culture group ( P<0.05). The qPCR, Western-blot and fluorescent staining test results showed that the mRNA and protein expression levels of SOX-9, COL2A1, ACAN, BMP2, Runx2, and OPN in the co-culture group were significantly increased compared with the injury group. The mRNA and protein expression levels of the above proteins in the miRNA-222-5p group were significantly increased compared with those in co-culture group ( P<0.05). We also detected the protein expression levels of signal pathway related factors. Western-blot results showed that the expression levels of NF-κB, Erk2, STAT3, STAT5 and Smad2 in the co-culture group were significantly increased compared with those in the injury group. The expression levels of the above factors in the miRNA-222-5p group were significant increased compared with the co-culture group ( P<0.05). Conclusion:The co-culture of mesenchymal stem cells and achilles tendon cells could promote the osteogenic differentiation of achilles tendon cells. Exosomes derived from mesenchymal stem cells could further promote the osteogenic differentiation of achilles tendon cells by transporting miRNA-222-5p. The mechanism may be related to the up-regulation of signal pathway factors in injured tendons, including NF-κB, Erk2, STAT3, STAT5 and Smad2.

Objective To observe the effects of decimeter wave irradiation on the rehabilitation of the acute peripheral nerve injury of rats. Methods Eighty Sprague-Dawley rats(200～250 g)were randomly divided into 2 groups:group A,the decimeter wave irradiation group and group B,the blank control group.The right sciatic nerves of all the rats were crushed with forceps to establish the experimental animal model of acute peripheral nerve injury.Then the rats of group A were exposed to decimeter wave irradiation for 10 minutes every day for 8 weeks.The rats of group B were also fixed on a table as those in group A but receive no decimeter irradiation.At different time points observation with light and electron microscopy,immunochemical staining,axon morphometric analysis,electrophysiological examination were carried out.Results Morphometric analysis showed that at different time points after operation the recovery of nerves in group A was better than that in group B.Axon morphometric analysis showed that the number,the diameter and the thickness of sheath of myelinated nerve fibers in group A were greater than those in group B. Electrophysiological assessment showed that the latency was shorter,the amplitude was higher,and the nerve conduction velocity was faster in group A than those in group B at the end of 8 weeks of decimeter wave treatment after operation.Conclusion Decimeter wave had significant effects on the rehabilitation of the acutely injured peripheral nerves.

Objective To evaluate the effects of post-operation rehabilitation treatment of patients with calcaneus fracture by dynamic plantar pressure analysis,and assess the value of the Footscan system.Methods Sixty-two patients with unilateral calcaneus fracture were randomly divided into a rehabilitation group and a control group.The patients in the rehabilitation group were given early,systemic standard rehabilitation treatment,while those in the control group took functional exercise following the doctors'advice.At 3 months and 6 months after operation,the plantar pressure distribution of the patients in both groups was analyzed with the Footscan system,respectively.Results After 3 months of treatment.there was statistically significant difference between the injured and the uninjured sides in both groups,with regard to the contact time,average plantar pressure and pressure-time integrals at different phases of gait.However,there was no significant difference between the injured and the uninjured sides after 6 months in rehabilitation group.But in control group,there was still statistically significant difference between the two sides with regard to the above parameters.Conclusion Early rehabilitation treatment could significantly improve the function outcome of patients with calcaneus fracture.Footscan System can objectively evaluate the recovery of the calcaneous fracture.

Objective To evaluate the possibility of deep vein thrombosis defluvium of lower limb using ultrasonography to provide important reference for the implantation and retrieve of retrievable inferior vena cave (IVC ) filters.Methods Sixty-four patients who were diagnosed as lower limb deep vein thrombosis using ultrasonography were enrolled.Fourteen patients with critical values were allocated to high risk group,50 patients without critical value to low risk group.All the patients underwent inferior vena cava filter operation.Of all these patients,ultrosonography were performed once again before IVC filters were retrieved.Seventeen patients with broken thrombosis were allocated to unstable group,47 patients with stable thrombosis to stable group.Relationships between conditions of thrombosis and ultrasonography results were analysed.The conditions of thrombosis were recorded.The rates of thrombosis defluvium were compared.Results In high risk group,10 patients (71 .43%)had thrombosis.In low risk group,8 patients (16%)had thrombosis.There were significant differences in the rates of thrombosis defluvium beteen the high risk group and low risk group(P <0.05).In unstable group,12 patients (70.59%)had thrombosis.In stable group,6 patients (12.77%) had thrombosis,there were significant differences in the rates of thrombosis defluvium between the unstable group and stable group (P < 0.05 ).Conclusions Ultrasonography can be used to evaluate the possibility of lower extremity deep vein thrombosis defluvium which will guide the pratice of the retrievable inferior vena cava filter.

Objective To compare the therapeutic results between low-molecular-weight heparin therapy and combined therapy of low-molecular-weight heparin and Shuxuetong for deep venous thrombosis (DVT) after lower extremity fracture.Methods Forty-two patients with DVT from 1,037 patients with lower extremity fracture treated from December 2010 through November 2012 were included in the study.There were 31 males and 11 females,aged from 26 to 82 years (mean,63 years).The patients were assigned to administration of 4,250 IU low-molecular-weight heparin subcutaneously,twice daily (Group A,n =19)and 4,250 IU low-molecular-weight heparin subcutaneously,twice daily plus shuxuetong to 6 ml intravenously,once daily (Group B,n =23) according to the random number table.A period of treatment was a week.Color Doppler sonography was performed to detect DVT.Results Longest course of treatment was 3 weeks.In Group A,the results were recanalization in 2 patients with mean time of 2.50 weeks,significantly effective in 3 patients with mean time of 2.67 weeks,effective in 7 patients with mean time of 3 weeks,and invalid or worse in 7 patients with mean time of 3 weeks.Whereas in Group B,the results were recanalization in 7 patients with mean time of 1.86 weeks,significantly effective in 12 patients with mean time of 1.83 weeks,effective in 3 patients with mean time of 3 weeks,and invalid or worse in 1 patient with mean time of 3 weeks (P ＜ 0.05).Conclusion Low-molecular-weight heparin plus Shuxuetong is effective in treatment of DVT after lower extremity fracture and hence can be as an option in clinical application.

Objective To measure the normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom by ultrasonography. Methods One hundred and twenty volunteers' sagittal and coronal diameters of thumb and great toe distal phalanx bottom were measured by ultrasonography. The measurements was analysed by the statistical method. Results The thumb and great toe distal phalanx bottom showed hyperechoic zone,clear boundary with the adjacent fascia and tendon tissue showed low echo area at cross section by high frequency ultrasound. The sagittal diameters of thumb distal phalanx bottom was (8. 07 ± 0. 67)mm in men, while that of great toe distal phalanx bottom was (8. 34 ± 1. 02) mm( t = 1.73, P =0.86).The coronal diameters of thumb distal phalanx bottom was (11.61 ±0.89)mm in men, while that of great toe distal phalanx bottom was (14. 25 ± 0. 84)mm( t = 16. 77, P = 0. 00). The sagittal diameters of thumb distal phalanx bottom was (7. 52 ± 0. 62) mm in women, while that of great toe distal phalanx bottom was (7. 72 ± 0. 67) mm( t = 1. 72, P =0. 14). The coronal diameters of thumb distal phalanx bottom was (10.94 ± 0.97) mm in women, while that of great toe distal phalanx bottom was (13. 51 ±0. 75) mm( t =16.21, P = 0.00). Conclusions The normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom measured by the ultrasonography can guide the operation of wrap-around flap of a great toe with phalanx ungual for thumb II degree defect reconstruction.

Objective To analyze the diagnostic value of MSCT and MRI in detecting the distal third of tibia shaft fracture complicated with occult posterior malleolar fracture.Methods One hundred and fifty-one patients with the distal third of tibia shaft spiral fracture underwent X-ray examination.For patients without posterior malleolar fracture on X-ray,MSCT and MR imaging were further performed.A binomial test was used to evaluate the significance of the differences between MSCT and MRI in the detection of posterior malleolar fractures and cortical involvement.Results A total of 126 (83.4％) in 151tibia shaft fracture were found to be associated with posterior malleolar fracture.Twenty-seven ( 21.4％ ) cases with posterior malleolar fracture were detected on X-ray.MSCT and MR examination were performed in 124 cases.Ninety-nine posterior malleolar occult fractures were detected on MRI,which included 81cases showed on MSCT.The sensitivity,specificity and accuracy of posterior malleolar occult fracture on MRI were 100％ (99/99),100％ (25/25) and 100％ ( 124/124),while they were 81.8％ (81/99),100％ (25/25)and 85.5％ (106/124) for MSCT respectively.The accuracy of posterior malleolar occult fracture on MRI was significant higher than MSCT ( Z =2.56,P =0.01).Seventy-eight cortical fractures were found on MSCT among 99 posterior malleolar occult fractures,while 51fractures were found on MRI.The sensitivity,specificity and accuracy of cortical fracture involvement were 100％ (78/78),100％ (21/21) and 100％ ( 99/99) for MSCT,while they were 65.4％ (51/78),100％ (21/21) and 72.7％ (72/99) for MRI respectively.The accuracy of cortical fracture involvement on MSCT was significant higher than MRI ( Z =4.02,P =0.00).Conclusions MRI has a higher accuracy than MSCT in detecting the distal third of tibia shaft fracture complicated with occult posterior malleolar fracture,while MSCT has a higher accuracy than MRI in detecting cortical fracture involvement.