内固定治疗C_1型骨盆骨折8例体会

目的 促进C1型骨盆骨折病人早期康复 ,降低死亡率及合并症。方法 采用骶关节脱位前方入路 ,切开复位内固定。结果 平均随访时间 6个月 ,骨折均愈合 ,无下肢不等长 ,亦无跛行和腰骶痛 ,疗效满意。结论 C1型骨盆骨折手术治疗为宜 。

锁定接骨板在老年股骨粗隆间骨折治疗中的应用

目的:总结股骨近端锁定接骨板(locking proximal femoral plate,LPFP)治疗老年股骨粗隆间骨折的临床疗效以及优势。方法:25例采用LPFP做内固定的老年股骨粗隆间骨折,男10例,女12例,年龄65～89岁,平均年龄74.5岁。根据Evans分型,Ⅰ型4例,Ⅱ型6例,Ⅲ型7例,Ⅳ型5例,Ⅴ型3例。结果:25例患者均获得随访,骨折愈合时间10～16周,无不愈合病例,无髋内翻及内固定失败。髋关节功能优良率88%(Harris评分标准)。结论:LPFP治疗老年股骨粗隆间骨折具有创伤小,操作简单,固定可靠,并发症少的优点。

髁支持钢板治疗股骨髁间和髁上骨折24例疗效观察

目的：探讨髁支持钢板治疗股骨髁间、髁上骨折的疗效。方法：回顾性分析2003年1月至2008年1月髁支持钢板内固定治疗股骨髁间、髁上骨折24例。结果：随访7～38个月，7—13个月全部愈合，膝关节功能恢复良好，采用Merchan提出的功能评定标准：优10例，良10例，中2例，差2例，优良率83．3％。结论：采用髁支持钢板治疗股骨髁间髁上骨折，固定牢靠，膝关节功能恢复好，是股骨髁间髁上骨折的理想选择。

Multilevel cervical spondylotic myelopathy treated by anterior cervical decompression in subsection and autograft fusion

Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.

Efficacy of Spinal Pia Mater Incision and Laminoplasty Combined with Internal Fixation for Old Spinal Cord Injury

Objective To evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury. Methods From March, 2009 to July, 2010, 16 cases with chronic cervical cord injury underwent spinal dura mater incision and unilateral open-door laminoplasty with internal screw fixation. Nerve functions of preand postoperation were evaluated by Frankel classification and the Japanese Orthopaedic Association (JOA) scale. The improvement rate of JOA score at the indicated time was recorded. Results Postoperative Frankel classification rating of 16 patients improved obviously. JOA scores at the 1st month, 3rd month, 6th month, and 12th month after surgery were 7.9±2.3, 8.5±1.6, 8.9±2.1, and 12.4±2.5, respectively, and significantly increased compared with that prior to surgery (5.5±0.6). At the end of follow-up period, JOA score was significantly higher than that of pre-treatment (P<0.05). The recovery was relatively rapid during the first 3 months following the surgery, then entered a platform period. Conclusion It is effective for patients with dated spinal cord injury to undergo spinal decompression and laminoplasty.

Endostatin promotes the anabolic program of rabbit chondrocyte

Endostatin is a natural occurred angiogenesis inhibitor derived from collagenXVIII. So far its function during the angiogenesis process of bone formation and arthropathy has not been well studied yet. The present study addresses the function of endostatin in rabbit articular chondrocytes (RAC). We found that endostatin can promote RAC adhesion and spreading as well as its proliferation. In monolayer cultured RAC, CollagenII, TIMP1 and collagenXVIII transcription were up regulated by endostatin while collagenI and MMP9 were down regulated. Moreover collagenXVIII and endostatin antigens are present at synovial fluid. These findings indicate new function of endostatin as a homeostatic factor in cartilage metabolism.

CLINICAL APPLICATION OF THE TRAFIXINSTRUMENTATION IN CORRECTING SCOLIOSIS

To evaluate the results of the TRAFIX instrumentation in correcting s coliosis. Methods. Since October 1997, 47 patients with scoliosis received spinal fixation with the TRAFIX instrumentation at the Peking Union Medical College Hospital. T he average age was 14.3 years (range 10 to 38 years). There were 27 idiopathic c ases, 16 congenital cases, 2 cases with Marfan syndrome and 2 with neurofibromat osis. Twelve of the 47 patients underwent anterior release, while 4 patients rec eived the revision approach. The average follow up time was 26 months (13～38 m onths). Results. The measurements of primary coronal deformity before and after surgery were 74°(50°～115°) and 38.7° (11°～95°), respectively. The average curve correction was 54%. The average number of fused segments was 12.5 (7～17) verte brae. The distance between the center of apex and the C7 plumb line was 56.8 mm before surgery (25～107mm) and 31 mm after surgery (10～87mm). Conclusion. The TRAFIX instrumentation provides three dimensional correction wi th refinement, convenience and reliable fixation.

ANTERIOR SPINAL FUSION WITH TSRH INSTRUMENTATION FOR SCOLIOSIS

Objective. To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.Methods. The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results. Preoperatively, the Cobb's angle on the coronal plane was 55. 8° (range 35° - 78°), and 14° postoperatively, with an average correction of 74. 8 %. The average unfused thoracical curve was 35. 9 ° preoperatively (range 26° - 51°) and 21. 8° (10°-42° ) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27. 9° and postoperative 25. 7° respectively. The trunk shift was 13.4 mm (5 - 28mm) preoperatively and 3. 5 mm (0-7 mm) postoperatively. The averaged apic vertebra derivation was 47. 8 mm (21 - 69 mm) before operation and 10. 8 mm (3-20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19. 5 mm(16 - 42)preoperatively and 11. 3 mm (0-32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.Conclusion. If used appropriately, TSRH anterior spinal system is a good treatment for low thoracic or thoracic lumbar scoliosis.

Comparative study of various internal fixation methods for treating patellar fractures by three-dimensional photoelasticity

Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin three dimensional photoelasticity patellar models were made by precise moulding, and were fixated by nitinol patellar concentrator (NT-PC), tension band and wire circle respectively. The patellar models with frozen stress stripes were put into the polarized light field and the stress distributions were compared. As for the model fixated by NT-PC, by dividing layer, photographing and tracing, we used the iterative method to calculate the stress value of every internal node of the epoxy resin patellar model, and the character of stress was analyzed. Results: An overall stress field was yielded when the patellar model was fixated by NT-PC, and the stripes were more than that of tension band model and wire circle model, which have only few stress stripes in the fixated layers. Further analysis indicated that there were continuous fixated stresses in the facies articularis and distal pole of patella, and the character of stresses produced by NT-PC were mainly in longitudinal direction, then in transverse direction. The shearing stresses were small. Conclusion: The initiative and continuous memorial stress of NT-PC and its overall stress distribution character are the essence of NT-PC distinguished with tension band and wire circle in treating patellar fractures. The stress character produced by NT-PC is good for the stability of fracture site and prompts fracture healing.

Oxygen Gasification of Municipal Solid Waste in a Fixed-bed Gasifier

Four waste materials, paper, wood, textile and kitchen garbage, in municipal solid waste were gasified separately with oxygen in a fixed bed reactor. The yields of products char. tar and gas, the composition of gas components H2, CO, CO2 and CH4, and the lower heating value （LHV） were examined at temperatures between 700 and 900 ℃ and equivalence ratio （ER） between 0.14 and 0.32. Characteristics of gas evolution during gasification were inves- tigated. Results show that a higher temperature improves the formation of H2 and CO while lowers the yield of CO2 and CH4. The LHV of syngas increases with temperature and varies in the range of 6-10 MJ. m-3 reaching the maximum at 800 ℃ or above. As ER increases, both combustible gas component and LHV of syngas decrease while the yield of CO2 rises linearly. The appropriate ER for obtaining high quality gas is in the range of 0.18-0.23. Temperature and ER have significant effects on the product distribution. Higher temperature and ER are favorable for higher gas yield and lower yield of char and tar in the gasification of textile and kitchen garbage. At 800 ℃, the gas evolution may be divided into two regions. In the first region, the flow rate of gas increases and then de- creases ranidlv, while in the second reuion the flow rate decreases monotonically to lower level.

EFFECTS OF RAPAMYCIN ON INTRACELLULAR CHOLESTEROL HOMEOSTASIS OF GLOMERULAR MESANGIAL CELL IN THE PRESENCE OF INTERLEUKIN-1β

Objective To investigate the effects of rapamycin on cholesterol homeostasis of glomerular mesangial cells and the underlying mechanisms. Methods Intracellular cholesterol accumulation was measured by Oil Red O staining and high performance liquid chromatography. The effects of rapamycin on interleukin-1β（1L-1β）-induced mRNA and protein changes of low-density lipoprotein receptor （LDLR） and ATP-binding cassette transporter Al （ABCAl） were assayed by quantitative real-time PCR and Western blot. Transient expressions of 3 types of mammalian target of rapamycin （mTOR）, including mTOR-WT （wild type）, mTOR-RR （rapamycin resistant, with kinase activity）, and mTOR-RR-KD （rapamycin resistant, without kinase activity）, were obtained by plasmid transfection. Results Rapamycin had no significant influence on intracellular cholesterol concentration trader normal condition, but it significantly decreased the intracellular cholesterol concentration in the presence of IL-1β. Rapamycin dose-dependently suppressed the increased expression of LDLR induced by IL-1β and up-regulated the suppressed expression of ABCAl caused by IL-1β Transient expression of 3 types of mTOR all reduced ABCAl mRNA expression significantly, which all could be overroded by rapamycin. Conclusions Rapamycin may contribute to the maintaining of glomerular mesangial cell intracellular cholesterol homeostasis under inflammatory state by both reducing cholesterol uptake and increasing cholesterol effiux. And the effect may be not completely mediiated by mTOR.

THE DISTRACTION REDUCTION FIXATION SYSTEM AND ITS APPLICATION IN SPONDYLOLISTHESIS

Objective． An internal fixation apparatus—— distraction reduction fixation system(DRFS) was designed to satisfy the clinical needs for spondylolisthesis. Methods. Since 1996, 53 patients were treated with DRFS. Among them, 35 had spondylolisthesis, 12 had lumbar canal stenosis accompanied with instability, 2 had vertebral tumors and 4 suffered from spinal fracture. The average age was 53.6 years old (ranged 24～ 72yrs). The mean time for follow- up was 30.6 months (16～ 44 months). Results． The slip rate was 0.15± 0.10 before operation, and decreased to 0.09± 0.07 after operation. Entire slip reposition was achieved in 19 cases (54.3％ ). The change in height of the intervertebral space within the fixation segments was 0.7± 0.17. Conclusion． DRFS achieved better results for spondylolisthesis less II degree and no other adverse effects were found. Compared with other foreign and domestic techniques, it had advantages in less implants, less operation gears required and ease to utilize in operation. It was proved to be an ideal internal fixation apparatus.

ANNUAL CHANGES IN PLASMA LEVELS OF CORTISOL AND SEX STEROID HORMONES IN MALE RAINBOW TROUT, ONCORHYNCHUS MYKISS

The profiles of cortisol, testosterone, 11 ketotestosterone and 17α, 20β dihydroxy 4 pregnene 3 one in male rainbow trout reared under constant water temperature and natural photoperiod were determined by radioimmunoassay. Gonads of male rainbow trout reached maturity when the fish were two years old. Changes in the plasma levels of both sex steroid hormones and cortisol were closely related to the GSI. Plasma levels of testosterone, 11 ketotestosterone and 17α, 20β dihydroxy 4 pregnene 3 one showed a clear peak in the annual breeding season, when the GSI reached their maxima. Plasma cortisol levels also showed clearly seasonal changes in both two and three year old fish. The results suggest that the elevated plasma levels of cortisol may not just be due to stresses during the breeding season but have certain physiological functions in the reproduction of rainbow trout.

THE TREATMENT OF LUMBOSACRAL INSTABILITY BY THE DIAPASON SYSTEM

Objective. To introduce a new internal fixation system of spine and its characteristics. Methods. To review 16 patients with lumbosacral instability who were treated by this new technique, including their clinical outcomes and radiographic evaluation. Results. Fifteen patients gained complete recovery from their preoperative symptoms. One patient who had experienced two operations before and with problems of urinary and fecal incontinence and walking difficulty still had lower limb pain, muscle weakness and urinary incontinence after operation.There is no evidence of spine glide on X-ray, implant failure, neural complication or infection during follow up. Conclusion. Diapason system can achieve good early postoperative results with few complications and ease to use for lumbosacral instability.

AN EXPERIMENTAL STUDY OF THE INTERLEUKIN 1 LEVELS IN AQUEOUS HUMOR AFTER TRANSSCLERAL FIXATION OF INTRAOCULAR LENSES

Purpose. To study the interleukin 1 (IL-1)levels in aqueous humor after transscleral fixation of in- traocular lenses (IOLs) implantation in rabbits and discuss the effect of IL-1 on postoperative anterior ocular inflammation. Methods. Twenty-seven pigmented rabbits were divided into three groups: GI, transscleral fixation of posterior chamber (PC) IOLs implantation; G2, Lens of rabbits were removed without IOLs implanta- tion; G3, the control group, without surgical intervention. On the 1st, 3rd, 7th and 14th postoperative days, aqueous humor samples were obtained. Methyl thiazolyl tetrazolium (MTT) colormetry was used to detected for the presence of IL-1. The data were analyzed by using analysis of variance of SAS soft ware. Results’ It was found that IL-1 level in aqueous humor was increased after transscleral fixation of I- OLs implantation, IL-1 level reached its maximum on the 14th postoperative days in the IOL implanted group. IL-1 levels on 1st, 3rd, 7th and 14th days postoperatively was significantly higher (P<0. 05) in I- OLs implanted group than that of only extracapsular lenses extraction but no IOLs implantation group and that of the none surgical intervention group. COnclusions.IL-1 levels increased had a close relationship with a specific response to IOL implanta- tion. The increase of IL-1 may be suggested as the principal mediators of immunological and inflammatory responses, so that may play critical role in anterior ocular inflammative response after IOL implantation.

CHANGES IN AIRWAY SPACE FOLLOWING MANDIBULAR SETBACK USING SAGITTAL SPLIT OSTEOTOMY AND RIGID INTERNAL FIXATION

The changes in airway space following mandibular setback using sagittal split osteotomy and rigid internal fixation were studied in 28 Japanese patients with mandibular prognathism. The correlation between the amount of mandibular setback and airway space changes,as well as the correlation between the amount of airway space changes and relapse of pognion point during the following-up period were also studied. Lateral cephalometric radiographs were taken immediately before and shortly after surgery as well as 5 to 12 months postoperation. The cephalometric evaluations of airway space width and area were based on stable craniofacial landmarks. The mean setback of mandible was 8.3 mm in the right side,and 8. 2 mm in the left side. The mean amount of relapse of pogonion point during the following-up period was 0. 52 mm horizontally,and 0. 92 mm vertically. A significant decrease in airway space width and area,especially in the lower part of airway space was found following mandibular setback shortly after surgery. Although there was some increase both in airway space width and area during the following-up period,they did not increase to their original values. This suggests that the narrowing of airway space following mandibular setback using sagittal split osteotomy can be permanent. No significant correlation was found between the amount of mandibular setback and airway space changes. Since the relapse of pogonion point during the following-up period was too small,there is no significant correlation between it and the amount of airway space changes.

ROA of Real Estate Development in ZA

Although, there are numerous empirical studies that explore option pricing on vacant land, there is hardly such study based on a South African case study. Moreover, phenomena observed in certain countries are not always prevalent due to different economic circumstances. This case study explores option value emerging on vacant land due to office building in the Northern Suburbs of Johannesburg, South Africa （ZA） because land value ＂increased＂ in ＂price＂. Since late 1990s, Northern Suburbs are one of the most expensive areas of Johannesburg. Samuelson-McKean （1965） model is used to calculate option value on vacant land （Geltner ＆ Miller, 2001） and the model is used to estimate option values, first, when there are no costs, then when total costs are taken into account and lastly, when improvements are taken into account. The results are synonymous with option pricing theory （OPT） in sense that costs and land improvements increase option value; however, the impact of fixed costs on option value is debatable as fixed costs lead to an increase in option value while according to OPT they should not as fixed costs could easily be ＂hedged＂.

Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm ofprofunda femo- ris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.