Objective To study the effect of the human umbilical cord blood on the content of trace elements in whole blood during fracture healing in rabbits and to explore the mechanism of promoting fracture healing. Methods The right tibial fracture model was made in 63 white New Zealand rabbits (aged, 4-5 months; weighing, 2.0-2.5 kg). The fracture site was treated with 3 mL human umbilical cord blood (group A, n=21) and 3 mL normal saline (group B, n=21) at 3 and 8 days after operation, and was not treated as a control (group C, n=21). At 1, 2, 3, 4, 5, and 6 weeks after operation, the X-ray and histological observations were done; the contents of zinc, copper, magnesium, ferrum, calcium, and phosphorus were detected. Results X-ray observation showed that the fracture healing speed of group A was significantly faster than that of groups B and C; the fracture healing X-ray score of group A was significantly higher than that of groups B and C at 2-6 weeks (P lt; 0.05). The histological observation indicated that new trabeculae and osteoid of group A were significantly more than those of groups B and C; at 2-5 weeks, the histological score of group A was significantly higher than that of groups B and C (P lt; 0.05); at 6 weeks, the score of group A was significantly higher than that of group B (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Changes trend of the trace elements in 3 groups after operation was basically consistent. The content of copper first decreased and then gradually increased; the contents of ferrum, zinc, and magnesium at different time points decreased, but were basically stable; the content of calcium first increased and then decreased; the content of phosphorus first decreased and then increased. The contents of copper, zinc, magnesium, ferrum, calcium, and phosphorus in group A were significantly higher than those in groups B and C at different time points (P lt; 0.05), but there was no significant difference between groups B and C (P gt; 0.05). Conclusion Injection of the human umbilical cord blood at the fracture end of rabbits can significantly slow down the loss of trace elements in whole blood, ensure the contents of necessary trace elements during fracture healing, which may be one of the mechanisms of the umbilical cord blood promoting fracture healing.
目的 观察盐酸氨基葡萄糖对Pilon骨折的辅助治疗作用。 方法 2007年6月－2010年9月，将43例接受手术治疗的Pilon骨折患者随机分成两组，A组术后口服盐酸氨基葡萄糖，B组作为对照组（仅服用安慰剂）。A组21例患者，平均年龄（35.7± 8.0）岁，B组22例患者，平均年龄（36.7 ± 7.1）岁。两组患者年龄、性别、骨折分型及手术时机相比较，无统计学差异（P＞0.05）。定期随诊（术后6、12、18个月），根据美国足与踝关节协会踝与后足功能评分（AOFAS）评分系统对患者进行功能评分，进行前瞻、对照、双盲研究。 结果 术后6、12、18个月，A组患者的AOFAS评分均明显高于B组，差异有统计学意义（t=2.530，2.856，2.881；P=0.015，0.007，0.006）；术后18个月，A组临床疗效优良率为95.2%，B组优良率为72.3%，差异有统计学意义（χ2=3.995，P=0.046）。A组2例患者分别发生轻度头晕及恶心，无严重不良反应发生。 结论 盐酸氨基葡萄糖辅助治疗Pilon骨折可改善踝关节功能，减少创伤性骨关节炎的发生。
Objective To research the biomechanical effect of different length bone plates on treatment of tibial shaft fracture. Methods Forty-five tibia specimens from fresh adult corpse (20-40 years old) were donated (30-38 cm in length, 34 cm on average) and were divided into 3 groups randomly (n=15). Under the following three conditions, the experiment was made separately. Compression stress-strain indexes of whole tibia were determined under the reverse, three spots curving and compression. The vertical elastic strain was 0-1 000 N, the reverse angle was 0-3º, and three bending stresswas 0-400 N. Then the center-section squint non-damage bone fracture model was made, fracture was fixed by 6, 10, 14stainless steel AO LC-DCP, respectively. The compression stress-strain indexes were determined under reverse angle, three spots curving and compression, statistical analysis was done. Results The vertical direction strain value of 6, 10 and 14 hole steel plate under vertical compressions, was 0.449 ± 0.241, 0.093 ± 0.003, 0.139 ± 0.005, respectively ; showing significant difference between 10 and 14 hole steel plates and 6 steel plate (P lt; 0.01) and no significant difference between 10 and 14 hole steel plate (P gt; 0.05). The lateral strain value of 6, 10 and 14 hole steel plate was 0.120 0 ± 0.000 4, 0.127 5 ± 0.010 0, 0.237 0 ± 0.000 6 respectively, indicating a significant difference between stell plates of 6 and 10 hole and 14 hole steel plate (P lt; 0.01) and no difference between 6 and 10 hole steel plate (P gt; 0.05). The torque of 6, 10 and 14 hole steel plate was (5.066 ± 2.715) × 10-3, (5.671 ± 2.527) × 10-3 and (4.570 ± 2.228) × 10-3 Nm, respectively and three spot curving vertical direction strain value was 0.049 ± 0.009, 0.124 ± 0.017, 0.062 ± 0.009, respectively. There were significant differences between various steel plates (P lt; 0.01). Conclusion For the fixation of tibial obl ique fracture, 14 hole steel plate’s stabil ities of anti-vertical compression, anti-reverse and anti-curving are better than those of 6 hole steel plate under the condition of the same material qual ity, thickness, width and screw quantity used.
Objective To summarize the cl inical appl ication of minimally invasive percutaneous locking compression plate (LCP) internal fixation in the treatment of tibial fractures and to evaluate its cl inical effects. Methods From September 2005 to September 2007, 13 patients with tibial fractures were treated with indirect reduction and minimally invasive percutaneous LCP internal fixation, 8 males and 5 females, aged 18-35 years old (27 on average). Among them, the fractures were caused by traffic accidents in 3 cases, by fall ing in 5 cases, by fall ing from height in 4 cases and by bruise in 1 case. The fractures were located at 1/3 upper tibia in 2 cases, at 1/3 medium tibia in 6 cases and at 1/3 lower tibia in 5 cases. All fracture were closed ones. According to the AO classification, 4 cases were type A, 7 type B and 2 type C. The time between fractures and operation was from 3 hours to 5 days (2.5 days on average). Results All incisions obtained heal ing by first intention. All patients were followed up for 10-18 months (13 months on average). All fractures reached cl inical heal ing, and the heal ing time was 12-20 weeks (16 weeks on average). There was no delayed fracture heal ing, nonunion, infection and internal fixation failure. No compl ications such as rotation, crispatura deformity and internal fixation loosening were found. According to the HSS scoring, the function of the knee joint was graded 85-95 (90 on average), and the range of motion was 100-130° (120° on average). According to the AOFAS Ankie Hindfoot Scoring, the function of the ankle joint was graded 80-95 (92.4 on average). Nine cases were excellent, 4 good, and the choiceness rate was 100%. Conclusion Minimally invasive percutaneous LCP internal fixation is in accord with biological set principles and beneficial for tibial fracture heal ing and reconstruction of soft tissues.
Objective To compare the clinical effect of reamed and nonreamed intramedullary interlocking nails on treating open tibial fractures. Methods From February 2002 to February 2004, 92 cases of open tibial fractures (86 patients) were treated with intramedullary interlocking nails. Of the 86 patients, 65 were male and 21 were female. Their age ranged from 18 to 68 years (36.5 on average). Of the 92 cases, 54 were in the reamed group and 38 in the nonreamed group. Patients moved with the support of crutch after their wounds were healed. Results All patients were followed up regularly for 6 to 24months. Infection rate in the reamed group and nonreamed group was 20.3% and 5.3% respectively, and there was significant difference between them (Ｐlt;0.05). The averagehealing time of the fractures was 22.5 weeks in reamed group and 19 weeks in nonreamed group, and there was no significant difference between them (Ｐ＞0.05). Delayed unions occurred in 8 cases and 3 cases in reamed group and nonreamed group respectively. Conclusion Compared with reamed group, nonreamed intramedullary interlocking nails have lowerinfection rate and fewer delayed unions and ununions.