目的 探讨创伤性十二指肠破裂的死亡原因及破裂口修补后易再破裂的原因。方法 对广西省北海市人民医院近8年来所作的12例十二指肠破裂手术进行回顾性分析。结果 全组病例中，治愈9例，死亡3例。死因： ①合并伤过重； ②单纯修补术后破裂口渗漏，继发腹腔感染； ③多处破裂被遗留，造成高位肠瘘。结论 对创伤性十二指肠破裂患者，①应首先处理重要合并伤； ②对十二指肠破裂应详细检查，防止遗留多发性破裂伤； ③十二指肠旷置减压术能有效降低十二指肠内压，减少胰液和胆汁分泌，提高破裂口的愈合率。
Objective To observe the efficacy of vitreoretinal surgery in the treatment of early traumatized eyes with no light perception. Methods We performed vitreoretinal surgery on 17 eyes of early traumatized eyes with no light perception.The patients were followed up for 2～14 months. Results Retinal reattachment was achieved in 11 eyes after srugery.8 eyes got visual acuity better than light perception postoperatively.Visual acuities of 5 eyes were better than 0.05 and the best one reached to 0.2. Conclusion Timely vitreoretinal surgery is valuable to the early traumatized eyes with no light perception.Retinal reattachment is the most important thing for the treatment of this kind of cases. (Chin J Ocul Fundus Dis，2000，16：213-284)
Thoracic trauma has the characteristics of complexity, specificity, urgency and severity. Therefore, the treatment is particularly important. Thoracic Traumatology Group, Trauma Medicine Branch of Zhejiang Medical Association organized the writing of the thoracic trauma and further optimization consensus of Zhejiang thoracic surgery industry Treatment and diagnosis of rib and sternum trauma: A consensus statement by Zhejiang Association for Thoracic Surgery (version 2021), compiled the popular science book Emergency Treatment and Risk Avoidance Strategy of Thoracic Trauma and Illustration of Real Scene Treatment of Trauma, actively prepared to build the trauma database of Zhejiang Province, and participated in the construction of trauma group in the Yangtze River Delta. Although Zhejiang Province has carried out many related works in the diagnosis and treatment of chest trauma, it is still inconsistent with the development requirements of the times. Standardization of chest trauma treatment, popularization of relevant knowledge, management of trauma big data, grass-roots radiation promotion tour and further optimization of industry consensus are the requirements and objectives of this era.
Objective To evaluate the effects of in situ subtalar arthrodesis with bone graft for subtalar traumatic arthritis, and to analyse the plantar pressure distribution so as to provide the evidence for effectiveness evaluation. Methods Between March 2004 and December 2008, 26 patients with unilateral subtalar arthrodesis undergoing bone graft fusion wereenrolled (test group). After operation, the imageology diversity and the effect of subtalar arthrodesis on adjacent joint wereobserved. American Orthopaedic Foot and Ankel Society (AOFAS) ankle and hindfoot score and radiographs were used to assess the foot function before and after operation. Twenty-six normal subjects served as controls. Footscan system was used to test the distribution of maximum plantar pressure and the change of gravity center curve. No significant difference was found in gender, age, height, and weight between 2 groups (P gt; 0.05). Results All patients were followed up 18.2 months on average (range, 14-71 months). The mean subtalar arthrodesis time was 5.6 months (range, 4 months and 15 days to 11 months). The mean AOFAS ankle and hindfoot score improved from 35.18 ± 8.16 preoperatively to 76.36 ± 6.90 postoperatively (t=13.910, P=0.000). Nine (34.6%) patients had satisfactory functional effects, and 13 (50.0%) patients basically satisfactory. The talocalcaneal height, talocalcaneal angle, talar decl ination angle, and calcaneus patch angle were 87.04% ± 6.17%, 76.73% ± 5.13%, 65.86% ± 7.01%, and 70.19% ± 8.33% of the contralateral side, respectively. Osteoarthritis of the adjacent joints occurred in 7 cases. The maximum plantar pressure increased in the third to fifth metatarsal bones and decreased in the first to second metatarsal bones, showing significant differences when compared with normal controls (P lt; 0.05). No significant difference was found in the plantar pressure between arthrodesis foot and contralateral foot of the test group (P gt; 0.05). The plantar pressure was well distributed in patient who was satisfied with the effect, but it was still different from normal controls. In patients who had high plantar pressure n middle foot, mild heel inversion occurred. The gravity center curve of the contralateral foot in the test group was almost the same as that of normal controls; curve medially shifted when forefoot touched down. The curve irregularly and laterally shifted in the subtalar arthrodesis foot; the curve did not medially shift when forefoot touched down. Conclusion In situ subtalar arthrodesis with bone graft has good cl inical results for subtalar traumatic arthritis. Gait analysis can be appl ied to assess the therapeutic effectiveness, and contribute to make a surgical plan. For the adaptive alteration of contralateral side after subtalar arthrodesis, a cohort of normal subjects should be used for comparison in gait analysis.
Objective To investigate the methods of establishing 3-dimensional skull model using electron beam CT(EBCT) data rapid prototyping technique, andto discuss its application in repairing crainomaxillofacial trauma. Methods The data were obtained by EBCTcontinuous volumetric scanning with 1.0 mm slice at thickness. The data were transferred to workstation for 3-dimensional surface reconstruction by computeraided design software and the images were saved as STL file. The data can be usedto control a laser rapid-prototyping device(AFS-320QZ) to construct geometricmodel. The material for the model construction is a kind of laser-sensitive resinpower, which will become a mass when scanned by laser beam .The design and simulation of operation can be done on the model. The image data were transferred to the device slice by slice. Thus a geometric model is constructed according to the image data by repeating this process. Preoperative analysis, surgery simulation and implant of bone defect could be done on this computer-aided manufacture d3D model. One case of craniomaxillofacial bone defect resulting from trauma wasreconstructed with this method. The EBCT scanning showed that the defect area was 4 cm×6 cm. The nose was flat and deviated to left. Results The -3dimensional -skull was reconstructed with EBCT data and rapid prototyping technique. The model can display the structure of 3-dimenstional anatomyand their relationship.The prefabricated implant by 3-dimensional model was well-matched with defect .The deformities of flat and deviated nose were corrected. The clinical result wassatisfactory after a follow-up of 17 months. Conclusion The 3-dimensional model of skull can replicate the prototype of disease and play an important role in the diagnosis and simulation of operation for repairing craniomaxillofacial trauma.
Objective To observe the effect of visible light on apoptosis of cultured human retinal pigment epithelium (RPE) cells. Methods Being the light source,500lx,(2 000±500)lx and (3 400±200)lx cold white light were used. The duration of exposure was 0,6,12 and 24 hours respectively. Apoptosis was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labelling, Annexin V-flunorescein isothiocyanate/Propidium iodium labelling and flow cytometry. Results Apoptosis and necrosis were found in cultured human RPE cells which were exposed to visible light.(1)A significant increase in apoptotic and necrotic percentages was consistent with a higher light intensity.(2)Apoptosis was the main response to shorter (6 h and 12 h) exposure duration,while necrosis was more pronounced correlated to the prolongation of post-exposure culture (P＜0.05),and the longer the post-exposure period was, the more apoptotic necrosis were seen.Thirty-six hours after exposure the necrotic percentages were more pronounced (P＜0.01). Conclusions Visible light (＞500 lx) increases the proportion of apoptosis and necrosis of human RPE cells in vitro.The extent is related to exposure intensity and duration. It demonstrates that the lower intensity and the shorter duration of exposure to light are, the more pronounced apoptotic percentages are observed,otherwise necrosis. (Chin J Ocul Fundus Dis, 2002, 18: 227-230)
Objective To analyze the value of serum levels of miR-141-3p, miR-130a, miR-29a-3p, and miR-210 in predicting early neurological deterioration (END) in non-traumatic intracerebral hemorrhage. Methods The patients with non-traumatic cerebral hemorrhage who met the selection criteria and were admitted to Chengde Central Hospital between February 2021 and October 2022 were prospectively selected by convenience sampling method. The serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels upon admission and the occurrence of neurological deterioration within 24 h were collected, and the patients were divided into a deterioration group and a non-deterioration group according to whether neurological deterioration occurred. The correlation of serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels with the END of non-traumatic intracerebral hemorrhage and their predictive value to the END of non-traumatic intracerebral hemorrhage were analyzed. Results A total of 235 patient were enrolled. Of the 235 patients, 45 (19.1%) showed neurological deterioration and 190 (80.9%) showed no neurological deterioration. The levels of miR-141-3p and miR-29a-3p in the deteriorating group were significantly lower than those in the non-deteriorating group [(1.11±0.32) vs. (1.76±0.51) ng/mL, P<0.001; (1.19±0.31) vs. (1.71±0.51) ng/mL, P<0.001], and the levels of miR-130a and miR-210 were significantly higher than those in the non-deteriorating group [(5.13±1.11) vs. (3.82±1.03) ng/mL, P<0.001; (3.96±0.76) vs. (2.78±0.50) ng/mL, P<0.001]. Multivariate logistic regression analysis showed that serum miR-141-3p and miR-29a-3p levels were protective factors for the occurrence of END in non-traumatic intracerebral hemorrhage patients [odds ratio (OR)=0.513, 95% confidence interval (CI) (0.330, 0.798), P=0.003; OR=0.582, 95%CI (0.380, 0.893), P=0.013], and serum miR-130a and miR-210 levels were independent risk factors for that [OR=2.046, 95%CI (1.222, 3.426), P=0.007; OR=2.377, 95%CI (1.219, 4.638), P=0.011]. The area under the receiver operating characteristic curve was 0.857 [95%CI (0.760, 0.954)] in predicting the END of non-traumatic intracerebral hemorrhage by the combined probability of the serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels obtained by logistic regression, and the sensitivity was 86.7%, the specificity was 94.7%, the positive predictive value was 79.6%, and the negative predictive value was 96.8% according to the cut-off value of the prediction probability of the combined test. Conclusion The combined detection of serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 has a high predictive value in the occurrence of END in non-traumatic intracerebral hemorrhage patients.
Objective To investigate the advance in the management of skeletal trauma of the extremities. Methods The literature at home and abroad was reviewed, and the research findings withclinical experience in the therapeutic methods for fracture of the extremities were summarized.Results The concept on fracture management was renewed, the minimally invasive surgery (MIS) was developed and popularized, the implantation was improved, the navigation technique with computerassisted surgery was applied, and the tissue engineering was developed. The fracture mana gement was changed from the anatomical reduction with absolutely rigid fixation to the biological osteosynthesis with protection of the fracture environment. The minimally invasive surgical techniques included the minimally invasive plate osteosynthesis, intramedullary nailing, external fixation, arthroscopic surgery,and computer-assisted surgery. In concordance with the MIS principles, the newimplants, such as the locking compression plate, and the less invasive stabilization system were well designed and put into clinical practice so as to provide effective therapeutic results in treating osteoporotic fractures and complicated articular and/or metaphyseal fractures. In treatment of the delayed union or nonunion offractures, more effective techniques were employed, including the application of bone substitutes, which are degradable and have properties of bone conduction and induction. In the repair of segmental defects of the long tubular bone, the bonetransport and the vascularized bone grafts could work well. The investigation of the bone engineering revealed its great potentiality.Conclusion Fracture of the extremities is a common problem and its management should emphasize the recovery of the extremity function of the patient in addition to emphasis on the replacement and fixation of the biological structures. The combination of bone engineering and microsurgery represents the development tendency inthis field.