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Epimedium brevicornu Maxim (E. brevicornu) is a plant of Epimedium L. in Berberidaceae, which is widely distributed and has high medicinal value and many important clinical applications. In this experiment, a novel flavonoid compound (1) was isolated and identified the chemical structure from E. brevicornu. The extract of E. brevicornu was performed on normal silica column chromatography, ODS silica column chromatography, Sephadex LH-20 column chromatography and RP-HPLC system to be isolated and purified and obtained 1. The HR-ESI-MS and NMR spectrometer were used to measure the accuracy molecular weights and determine the chemical structure of 1. In conclusion, we isolated and purified compound 1 (15.4 mg) and determined its chemical structure.

Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.

Background:. Models to predict mortality in trauma play an important role in outcome prediction and severity adjustment, which informs trauma quality assessment and research. Hospitals in China typically use the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to describe injury. However, there is no suitable prediction model for China. This study attempts to develop a new mortality prediction model based on the ICD-10-CM lexicon and a Chinese database. Methods:. This retrospective study extracted the data of all trauma patients admitted to the Beijing Red Cross Emergency Center, from January 2012 to July 2018 (n = 40,205). We used relevant predictive variables to establish a prediction model following logistic regression analysis. The performance of the model was assessed based on discrimination and calibration. The bootstrapping method was used for internal validation and adjustment of model performance. Results:. Sex, age, new region-severity codes, comorbidities, traumatic shock, and coma were finally included in the new model as key predictors of mortality. Among them, coma and traumatic shock had the highest scores in the model. The discrimination and calibration of this model were significant, and the internal validation performance was good. The values of the area under the curve and Brier score for the new model were 0.9640 and 0.0177, respectively; after adjustment of the bootstrapping method, they were 0.9630 and 0.0178, respectively. Conclusions:. The new model (China Mortality Prediction Model in Trauma based on the ICD-10-CM lexicon) showed great discrimination and calibration, and performed well in internal validation; it should be further verified externally.

Background:. We aimed to describe and analyze the pre-hospital emergency medical service (EMS) in Beijing and provide information for the government and medical institutions to optimize EMS. Methods:. We collected all pre-hospital emergency data in Beijing from 2008 to 2017. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The sites’ administrative districts were determined through geo-encoding of addresses and then classified into four functional regions. We analyzed the demand for EMS, emergency response times (ERT), and disease spectrum for Beijing as a whole, and for each functional region. Results:. A total of 4,192,870 pre-hospital EMS cases met the inclusion criteria, with a significant increase (P

Background and purpose Metaphyseal fractures heal in a rapid fashion that is different from the bone shaft healing process. Animal studies have focused on diaphyseal fractures. We investigated the metaphyseal fracture-healing process in rabbits. Animals and methods 60 rabbits (divided into 12 groups) underwent proximal tibial osteotomy, anatomical reduction, and fixation with screws. After surgery, the proximal tibiae were harvested at different time points for histology. Results No obvious osteonecrosis or bone resorption were found 2 weeks after surgery. From day 5 to week 5, woven bone or new trabeculae formed. From week 2, remodeling into lamellar bone started and reached a peak at week 6. These 3 stages overlapped. Histomorphometry showed that the structure changed as a unimodal curve. Interpretation The healing process of metaphyseal fractures appears to differ from the commonly studied healing process in diaphyseal fractures. It is rapid, and can be divided into 4 histological stages: cellular activation and differentiation, formation of woven bone, transformation of woven bone into lamellar bone, and further remodeling.

Many studies have demonstrated a compensatory amplification phenomenon during nerve regeneration. When a relatively fine nerve is used as a donor to connect to a distal nerve after transection, the donor nerve regenerates more collaterals than its own fibers, which extend to the distal stump, grow into distal endoneurial tubes, and finally reach and dominate the target organs. This is known as the amplification phenomenon. In this study, we investigated the amplification phenomenon in rats treated with Modified Formula Radix Hedysari (MFRH) as adjuvant therapy for 12 weeks. The rats were divided into three groups at random (six animals in each group). In the model group and the treatment group, the proximal common peroneal nerve was used as a donor nerve to connect to the distal tibial nerve. Rats in the normal group did not undergo surgery. After surgery, the treatment group was administered MFRH as systemic therapy, while the model group and the normal group were not given treatment. The results demonstrated that the nerve conduction velocity, the fiber diameter, the axon diameter, the number of regenerating nerve fibers, and the amplification ratio were better in the treatment group than in the model group, suggesting that MFRH promoted the nerve amplification effect.

To analyze effects of fracture of processus styloideus ulnae on prognosis in the treatment of distal radial fracture of type C according to AO classification.This was a retrospective case-control study, and the information was got ten through case evaluation and follow-up, including sex, age, patient satisfaction, GartlandWerley score and radiographic score. There were 76 patient treated with open reduction and plate fixation in People's Hospital Affiliated to Peking University from July 2006 to July 2011. All the patients were divided into two groups: no combination with fracture of processus styloideus ulnae (group A, 56 cases), combination with fracture of processus styloideus ulnae (group B, 20 cases). The patients in group A and B were treated with open reduction and internal fixation; however the fracture of processus styloideus ulnae was not fixed. The indexes such as clinical data, bone grafting, joint movement, GartlandWerley score and radiographic score were compared between two groups.The ulnaris pain of patients in group B was more obvious than that in group A. The local VAS, palmar and dorsal flexion degree of wrist joint, motion VAS, patients satisfaction score, radial and ulnar deviation degree, pronation and supination of forearm degree, GartlandWerley score and radiographic score were separately 0.1 ± 0.1, (51.1 ± 1.9)°, (60.2 ± 1.9)°, 0.6 ± 0.1 (23.1 ± 0.9)°, (28.7 ± 1.3)° (81.5 ± 2.6)°, (68.2 ± 2.7)° 1.9 ± 0.3, 89.6 ± 12.3 in group A; and separately 0.3 ± 0.3, (51.4 ± 2.3)°, (66.6 ± 1.7)°, 0.5 ± 0.2, (24.5 ± 2.0)°, (26.9 ± 1.8)°, (80.3 ± 2.5)°, (70.3 ± 3.7)°, 1.2 ± 0.4, 92.5 ± 7.5 in group B; there were no statistical differences in above indexes between two groups.Whether the distal radial fracture with a concomitant unrepaired ulnar styloid fracture or not exerts no influence on mainly outcomes including function, radiography and motion of the wrist.

ATP-sensitive potassium channels (KATP) are involved in the regulation of potassium homeostasis in the nervous system, and they may play an important role in acute peripheral nerve and spinal cord injury. Here, the expression of the KATP genes was monitored by reverse transcription polymerase chain reaction (RT-PCR) in the rat dorsal root ganglion, spinal cord and cerebral cortex following acute sciatic nerve and spinal cord injury. Electrophoresis of the RT-PCR products showed that in comparison with the normal rats, the KATP mRNA expression level was up-regulated for the Kir6.2 subunit in the rat dorsal root ganglion 4 and 24 h after the acute sciatic nerve injury (142.7 ± 23.0 and 135.5 ± 21.0%, p < 0.05, vs. control, n = 3), and both Kir6.1 and sulphonylurea receptor 2 mRNA were increased in the spinal cord during the same time period after the acute spinal cord injury (266.5 ± 67.1 and 248.7 ± 67.7%; 145.1 ± 42.6 and 152.6 ± 44.3%, p < 0.05, vs. control, n = 3). No significant changes of KATP genes were observed in the cerebral cortex among both sciatic-nerve- and spinal-cord-injured animals. These results suggest that acute peripheral nerve and spinal cord injury provoke different regulations of KATP gene expression in the peripheral and central nervous system.

Peripheral nerve injury (PNI) is a common trauma in clinical practice. A number of techniques to deal with PNI repair have been designed in clinics. From these methods for nerve repairing shown to be effective in clinics, as well as related experiments, we formulated a hypothesis that PNI regeneration and functional repair are induced by terminal effectors. Regeneration of peripheral nerves is the process whereby the nerve fibers regenerated by the induction of terminal effectors establish connections with effector organs and induce the spinal cord and upper centers to recognize effector organs and to re-model them for effective innervations. The hypothesis has two major components: (1) after surgical repairing of the injured nerves, the functional localization of regenerated nerves is determined by the connected effector organs and (2) the upper nervous system enables structural remodeling and functional changes according to the functions of the effector organs.

To investigate the surgical treatment results of implant failure after clavicular fracture open reduction and internal fixation (ORIF).Fifteen cases from Jan. 2005 to Jan. 2013 were treated surgically according to fracture classification, time of implant failure and implant type. The fracture union, shoulder function and pain were evaluated postoperatively.All the patients had full follow-up for 5 to 101 months (mean: 43.8 months). All the fractures were united well. The constant scores to assess the shoulder function were 82 to 100 (mean: 93.3 in the fracture side) and were 85 to 100 (mean: 96.7 in the uninjured side); statistically significant difference of the constant scores between the two sides was found (P=0.02). Eight cases did not have shoulder pain in the fracture side, while the other 7 cases had mild pain, The visual analogue scale (VAS) scores to evaluate shoulder pain were 1 to 3 in the fracture side, which were statistically different from those in the uninjured side (P=0.03).Implant instability causes early implant failure after clavicular fracture ORIF and re-fixation with stable implant is effective. Fracture nonunion leads to late implant failure, and bridging fixation using locking plate associated with bony autograft with iliac crest is a successful method to treat atrophy clavicular nonunion. Surgical treatment can bring good results.

To explore the protected effect of sensory baby-sitter in reverse end-to-side fashion on denervated muscle.The tibial nerve of twelve female adult Sprague Dawley rats was transected. Six animals served as controls. In the other rats, the end of the sural nerve was connected to the side of the distal tibial nerve stump. After twelve weeks, the wet weight, cross-sectional area, motor endplate perimeter from gastrocnemius muscle were examined.The difference in wet weight between the experimental group and the control group was statistically significant (39.2% ± 6.8% vs. 19.5% ± 4.3%, P0.05). Histological observation of the unprotected muscles displayed wide areas of atrophied fibers and considerable connective tissue hyperplasia, whereas the structure of the experimental rats was preserved and there was only a slight increase in connective tissue. The average cross-sectional area and motor endplate perimeter of muscle fibers were significantly larger in the experimental group than in the control group [(1 148.85 ± 547.18) μm² vs. (575.05 ± 140.51) μm², (102.84 ± 53.29) μm vs. (59.60 ± 26.71) μm, respectively].Sensory baby-sitter in reverse end-to-side neurorrhaphy preserves the structure of denervated muscle in rats.

To evaluate the current condition of urban road traffic injuries (RTIs) according to Beijing Emergency Medical Center (BEMC) from Jan. 1, 2004 to Dec. 31, 2010, analyze the social characteristics and explore the possible methods for prevention and improvement.Using data from the Beijing Emergency Medical Center, we collected 19 550 victims who were involved in RTIs in Beijing from Jan. 1, 2004 to Dec. 31, 2010. The personal information, time of the injury event, road user type and striking vehicle type, as well as the site and severity of injury, were analyzed using Excel 2007 and SPSS 17.0 software with ANOVA of variance and Chi-squared tests.The annual rate of RTIs was 120.0 per 100 000 people in Beijing, and the mortality rate was about 4.97 per 100 000 people. Male victims were more than female victims (11 737 persons vs. 7 618 persons).The mean age was (72.92 ± 5.67) years. Overall, RTIs in all the age groups happened in October commonly, and were inclined to daytime, especially at noon. But different age groups had their special hour distribution features of RTIs. Traffic collisions occurred most frequently in pedestrians and cyclists (7 588,38.81%;3 790,19.39%). Majorities of victims presented with head injuries and lower-limb injuries(8 343,42.68%; 6 828,34.93%). These collisions included car striking accidents (11 490, 58.77%). And most of the older adults were classified as medium in severity (11 718, 59.94%).The prevention and treatment of RTIs, should focus on targeted prevention solutions and standardized pre-hospital rescue, according to specific population, time interval and vehicle usage.

To study clinical-related characteristics of sociology of postoperative distal radius fracture patients.A multi-center retrospective research was conducted on the information of the case evaluation and follow-up, including the patients' gender, age, habits, history of chronic diseases, conditions of fracture, length of hospital stay and treatments. The epidemiology data were analyzed with SPSS15.0.Of the entire 143 patients, 52 were male (average age: 41), and 91 were female (average age: 61). The different gender and age groups had significant distinction in the characteristics of injury. The length of hospital stay was influenced by the energy of injury.To reduce the damage or incidence of distal radius fracture, we should avoid falling, strengthen protection awareness, treat internal medicine diseases or osteoporosis and so on. The knowledge of characteristics of sociology and injury of distal radius fracture is beneficial to the prevention and treatment.

Treatment of peripheral nerve injury is a major challenge in clinical practice. With advances in molecular biology and development of microsurgical techniques and tissue engineering, peripheral nerve repair procedures have been greatly improved. In the last 10 decades, most treatments for peripheral nerve injury in animal models have achieved histological and functional recovery, the treatments in humans, however, produce insufficient recovery, especially for proximal nerve injury. Increasing attention has been paid to the Traditional Chinese Medicine (TCM) for promoting peripheral nerve regeneration, since these remedies often display effective clinical outcome, minor side effects and effectiveness for multiple targets. Although TCM has complex ingredients and the specific pharmacological mechanisms for their effectiveness are still unclear, an effective clinical outcome is welcomed by many clinicians. In the past 20 years, we have made a series of detailed studies including the toxicity tests, pharmacodynamic tests, pharmacological experiments etc, about a new traditional formula which mainly contains the Radix hedysari, Epimedium etc. RESULTS have shown that this formula is safe to be used in both animals and humans with no toxicity and adverse effect, and systemic administration of this formula could enhance the peripheral nerve regeneration.

To evaluate the effect to the fixation stability of central screw placement during scaphoid fracture surgery.We designed oblique osteotomies for 32 identical sawbone scaphoids and fixed each specimen with a cannulated screw. Sawbone scaphoids were divided into 4 groups, according to position of the osteotomy (distal waist portion or proximal waist portion) and the position of the screw (central or eccentric). We performed Computed Tomography scanning to one specimen, and then the central zone of the scaphoid was established from volume data by using the preoperative planning system software (VxWork 4.0). The position of the osteotomy plane, the entrance and exit points of the screw guide pin were designed on the software as well. We placed the specimens under the increasing load of a pneumatically driven plunger to compare the load to failure and the distance at failure between the central and eccentric screw groups.In general, we found the statistical differences of the load to failure and the displacement of fracture between the groups (F=31.485,P=0.001; F=33.328,P=0.018). The average load to failure and fracture displacement was more statistically different in the central group [(80.82 ± 15.63) N, (2.3 ± 0.5) mm] for proximal waist fracture than in the eccentric group [(58.32 ± 17.18) N, (3.1 ± 0.5) mm]. As to the distal waist fracture, the average load to failure and fracture displacement was better in the central group [(76.83 ± 14.54) N, (2.2 ± 0.7) mm] than in the eccentric group [(70.38 ± 13.32) N, (2.5 ± 0.6) mm] without significant difference.In this biomechanical model of an unstable oblique scaphoid fracture, we find that higher stability of fixation has been achieved with a screw placed centrally in the scaphoid, compared with a screw peripherally placed.

To generate peripheral nerve animal model of pure motor nerve fibers/pure sensory nerve fibers, and identify them.The SPF SD rats were adopted in this study, and divided into 3 groups. In group A, we ablated L2-L4 ventral roots (VRs) to generate peripheral nerve animal model of pure sensory fibers. In group B, we ablated L2-L4 dorsal root ganglions (DRGs) to generate peripheral nerve animal model of pure motor fibers. Two time end-points were set as 2 weeks and 4 weeks. Neuron cells in lumbar spinal cords were detected by immunohistochemical staining with antibody of neuronal nuclei (NeuN). Motor neuron cells in lumbar spinal cords of pure motor fiber animal models and sensory neuron cells in lumbar spinal cords of pure sensory fiber animal models were counted respectively, and then compared to that of normal animals. Femoral nerves distal to the furcation were stained in osmium tetroxide, and then myelinated nerve fibers in the muscle branch and cutaneous branch of femoral nerve were counted respectively.The mean numbers of sensory neuron cells and motor neuron cells in normal lumbar spinal cords were 62.57 ± 1.02 and 29.73 ± 3.03 per 10 × 20 visual field respectively. For different end-points, the mean numbers of sensory neuron cells after ablating vental foots were 62.12 ± 1.77 (2 weeks), 62.15 ± 1.32 (4 weeks) per 10 × 20 visual field respectively; the mean numbers of motor neuron cells after ablating DRGs were 30.12 ± 0.44 (2 weeks), 30.00 ± 1.87 (4 weeks) per 10 × 20 visual field respectively. In group A, motor axons in muscle branch were degenerated as the sensory axons in muscle branch and cutaneous branch were not changed. The senory axons in femoral nerve for the two end-points were 1 558.17 ± 50.14 (2 weeks) and 1 544.00 ± 47.42 (4 weeks). In group B, sensory axons in muscle branch were degenerated as the motor axons were reserved. The motor axons in muscle branch for the two end-points were 387.67 ± 48.50 (2 weeks) and 393.50 ± 27.86 (4 weeks). There was no statistically significant difference in these mean numbers for the two end-points. The degenerating axons and myelin sheath had not been totally eliminated by the endpoint of 2 weeks.Peripheral nerve animal model of pure motor fibers can be generated by ablating L2-L4 DRGs; peripheral nerve animal model of pure sensory fibers can be generated by ablating L2-L4 ventral roots. The degenerating axons and myelin sheath have been totally eliminated by the end-point of 4 weeks. Ablating the ventral roots does not influence the survival of sensory neuron cells; and ablating the DRGs does not influence the survival of motor neuron cells.

To discuss the change of blood pressure involved by pressor agents after the implantation of cement in hip replacement.A total of 172 cases of femoral neck fracture underwent hip replacement in Department of Orthopedics and Trauma, Peking University People's Hospital between July 2008 and July 2013 were involved in this retrospective study. The blood pressure and usage of pressor agents were recorded before and after bone cement implantation. The data of blood pressure and usage of agents were collected according to anesthesia records. All the cases were divided into four groups by the application of pressor agents: Free of using agent group (Free-agent group), agents used before implantation of cement group (Pre-agent group), agents used after implantation of cement group (Post-agent group) and agent used beforeafter implantation of cement group (Pre and Post-agent group). Further statistic analysis was then performed.Free-agent group's mean systolic blood pressure decreased for (4.0 ± 10.3) mmHg. The decreasing was significant (t=3.660, P=0.000). Free-agent group's mean diastolic blood pressure decreased (1.3 ± 7.5) mmHg. The decreasing was not significant (t=2.286, P=0.149). Pre-agent group's mean systolic blood pressure decreased for (0.5 ± 20.2) mmHg. The decreasing was not significant (t=0.114, P=0.911). Pre-agent group's mean diastolic blood pressure increased (0.7 ± 10.2) mmHg. The increasing was not significant (t=-0.316, P=0.756). Post-agent group's mean systolic blood pressure decreased for (6.9 ± 15.0) mmHg. The decreasing was significant (t=3.195, P=0.002). Post-agent group's mean diastolic blood pressure decreased (3.6 ± 7.4) mmHg. The decreasing was significant (t=3.407,P=0.001). PrePost-agent group's mean systolic blood pressure decreased for (5.0 ± 12.2) mmHg. The decreasing was not significant (t=1.667, P=0.115). PrePost-agent group's mean diastolic blood pressure increased (1.3 ± 8.5) mmHg. The increasing was not significant (t=-0.656, P=0.521).Implantation of cement in hip replacement surgery causes blood pressure decreasing. The application of pressor agents before cement implantation can stabilize blood presure and shorten the period of hypotension.

To explore the pain sensation recovery discipline of 2 mm small gap biological conduit tubulization and epineurial neurorrhaphy in rat sciatic nerve multilation model.Based on the rat sciatic nerve multilation model, 2 mm small gap biological conduit tubulization and epineurial neurorrhaphy were applied and the 50% paw withdrawal threshold was observed after 2, 4, 5, 6, 8 and 12 weeks. The data were analyzed by two-way ANOVA and chi-square criterion.Obvious hyperalgesia was observed in week 2 in both experimental group and control group, and 50% paw withdrawal threshold was improved significantly even to 15 g. The 50% paw withdrawal threshold began to decline week 4 and the 50% paw withdrawal threshold of small gap tubulization group was obviously lower than that of control group, which may imply that the pain sensation recovery of small gap tubulization group was earlier than that of control group. The 50% paw withdrawal threshold of small gap tubulization group began to increase to the plateau period [week 5: (12.70 ± 5.64) g; week 6: (12.20 ± 3.26) g; week 8: (12.31 ± 4.19) g; week 12: (13.95 ± 2.58) g]. The 50% paw withdrawal threshold of control group declined gradually [week 5: (10.47 ± 7.02) g; week 6: (9.42 ± 6.86) g; week 8: (8.50 ± 7.15) g; week 12: (8.06 ± 5.93) g]. The difference was statistical significant between small gap tubulization group and control group in 12th week.Compared with the traditional epineurial neurorrhaphy for peripheral nerve multilation, 2 mm small gap biological conduit tubulization can improve the 50% paw withdrawal threshold during peripheral nerve regeneration process and reduce the pain incidence.

To investigate the clinical outcome of minimal invasive internal fixation with U-shaped break-off pedicle screws through paraspinal muscle sparing approach to treat thoracolumbar fractures, and to discuss its advantages.From August 2010 to June 2012, we had 40 thoracolumber fractures patients (27 males and 13 females). Their ages ranged from 22 to 60 years. Of the 40 cases, 4 were T11 fractures, 13 T12 fractures ,17 L1 fractures,6 L2 fractures. According to Denis classification,all of them were burst fractures, with vertebral canal compromise less than 1/3. According to AO classification they were type A or type B1 injuries. All the cases had no nerve injury. The patients were randomly divided into two groups. With Group A (20 cases) we took the method of minimal invasive internal fixation with U-shaped break-off pedicle screws to fix one level above and below the injured vertebra through the parespinal muscle sparing approach. With Group B (20 cases), we took the traditional posterior midline approach and open procedure. Then we compared the two groups by operation time, blood loss, drainage, Visual Analogue Scales and X-ray exposure.Minimal invasive group had obvious advatages in operation time, bleeding control and early pain relief of post-operation. The X-ray exposure and long-term follow-up outcome were almost the same.Through paraspinal muscle sparing approach minimal invasive internal fixtation with U-shaped break-off pedicle screws to treat thoracolumber has more advantages than traditional procedure in blood control and quick recovery. The method needs no special instruments and don't increase X-ray exposure.

To discuss the operation effect of comminuted clavicle shaft fractures with provisional intramedullary K-wire fixation and bridging plate internal fixation.From Mar. 2008 to Jul. 2012, 22 cases of comminuted clavicle shaft fractures was treated with open reduction, and provisional intramedullary K-wire fixation and bridging plate internal fixation. The fracture healing was investigated through X-rays. The 22 cases were followed up to evaluate the function of the affected shoulder with Constant score.Through the follow-up for average 15 months, all the fractures healed and the average healed time was 14.6 weeks. The average Constant score of the affected shoulder was 95.3. There were 13 excellent cases, 7 good cases, and 2 fair cases. The fineness rate was 90.9% (20/22). Soft tissue problem resulting from plate tilting occurred in 2 cases. At last, they accepted second operation to remove the implant.Applying provisional intramedullary K-wire fixation and bridging plate internal fixation in comminuted clavicle shaft fractures, makes procedure simple, improves healing rate and decreases the complications.

Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing's geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using χ(2) tests and Logistic regression analysis.The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 (P0.001). The mean age was (72.92 ± 5.67) years, and 911 (53.40%) of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%). Our statistical analysis found three factors for injury severity: abdominal injuries (P0.001), number of injury sites (P = 0.027), and head injuries (P = 0.034). The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the severity of RTIs also decreased.This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

Outgrowth of collateral sprouts from axons is a natural process that arises during development of and regeneration in the peripheral nervous system. Our previous study showed that if there are enough distal endoneurial tubes into which the proximal regenerative axons can grow, one axon can support three to four collaterals, at most. Here, the proximal half tibial nerve was fixed to the distal stump and served as the donor nerve. The number of myelinated axons was calculated after 4 months. The ratio of distal regenerative myelinated axon number to proximal donor nerve axon number was 1.83 with the tibial function index and the nerve conduction velocities of - 48.6 ± 6.8 and 27.8 ± 5.3 m/s. The regenerated collaterals were isolated and observed to sprout from the node of Ranvier with almost the same features of normal fibers, but with different electrophysiological characteristics. This finding shows the evidence of one-axon trunk several-collateral model in peripheral nerve regeneration and suggests that such multi-collateral regeneration model may be useful in peripheral nerve reconstruction.

To surgically treat proximal humeral fracture involving metaphysis and humeral shaft with long locking plate osteosynthesis.In the study, 9 proximal humeral fracture cases [6 male patients and 3 female, with an average age of (48.9±11.5) years and the average postoperation follow-up duration of 21.3 months from 12-46 months] treated with locking plate and with complete follow-up observation from May 2008 to April 2011 were recruited. Visual Analogue Score (VAS), Constant-Murley Score and shoulder range of motion (forward elvation, abduction, internal rotation) were used to evaluate postoperation shoulder joint function.All the cases got union of their fractures, without nonunion or delayed union. The complications were 2 cases with humeral head varus deformity, 1 with wound superficial infection and 1 with postoperation radius nerve paralysis. The last follow-up functions were that the average VAS was 0.22 (0-1), Constant-Murley score 79.7±6.5 (71-91), the average range of shoulder joint anteflexion 118°±20° (90°-160°), abduction 95°±14° (75°-120°) and internal rotation L1.Treatment of proximal humeral fracture with the fracture line implicating upper humerus metaphysis and humeral shaft is difficult because the medial cortex is injured and the longitudinal fracture line involves bone shaft. A good selection of operative approach and careful operation guarantee postoperative function restoration.

To analyze the clinical curative effect of carpal tunnel syndrome (CTS) combined with cervical nerve root compression and to explore the differences between CTS combined with cervical nerve root compression and simple CTS in the clinical manifestations, diagnosis and treatment.From February 2004 to October 2010, 93 cases (120 sides) were selected among the patients (21 males and 72 females) adopted to our department and primarily diagnosed as CTS, of whom 29 had cervical nerve root compression. Neurolysis of peripheral nerve was conducted in the 93 cases, and the mean follow-up period was 16 months.The results of the improvements of symptoms and signs after operation were evaluated by the British Medical Research Council (BMRC). According to the BMRC scores, we divided the patients into three stages: excellent, good and none. In the 93 patients, 29 were with visible nerve root compression in radiograph or magnetic resonance imaging, in whom the excellent rate was 86.21%, and the good rate 13.79%, meanwhile in the patients without nerve root compression, the excellent rate was 90.63% and the good rate 9.37%.In the case of CTS combined with cervical nerve root compression, our findings are as follows: Firstly, neurolysis of peripheral nerve has an accurate curative effect; Secondly, neurolysis of peripheral nerve may decline the symptoms of nerve root compression; Thirdly, patients with nerve root compression are obviously more common in men, therefore, we should pay attention to the double crash when it comes to the male patient.

To establish a stable animal model for studying the effect of traumatic brain injury on bone fracture healing.Eighty adult male Sprague-Dawley rats were randomly divided into fracture combined brain injury group (A) and simple fracture group (B). Animals of the two groups were killed 6 hours, 1 week, 2 weeks, 1 month and 2 months after trauma, respectively. Their brain histopathology changes were observed and neurological severity scores (NSS, 0 through 25 from no injury to severe injury) determined to measure the brain injury after head trauma, and fracture-healing was assessed by measuring callus volume and X ray examination at the scheduled time points after trauma. The callus volumes were compared between the groups using independent-samples t test 1 week, 2 weeks, 1 month and 2 months after trauma respectively. A value of P0.05 was considered statistically significant.Ninety percent of the rats of group A presented with hemiplegia and the mortality rate was 10% (4/40) . The survived rats developed decorticated flexion deformity of the forelimbs, with behavioral depression, and lost some reflexes and muscle tone. The NSS were 10.83±1.94, 9.33±0.82, 8.17±1.17, 7.83±0.75 and 8.07±0.82 with 6 hours, 1 week, 2 weeks, 1 month and 2 months after trauma, respectively. It showed that the animals received moderate head injury, which tended to be stable from 2 weeks after trauma. Brain pathology showed that blood brain barrier was destroyed, and neurons were degenerative and necrotic at and around the trauma sites. The callus volumes(unit: mm(3)) of the two groups 1 week, 2 weeks, 1 month and 2 months after trauma were 60.03±28.05 and 32.80±11.04, 78.54±15.16 and 51.36±23.02, 93.01±10.65 and 72.38±20.38, 115.26±40.00 and 60.30±13.34, respectively. The callus volumes of the two groups 2 weeks, 1 month and 2 months after trauma were statistically and significantly different (P values were 0.036, 0.006 and 0.01 respectively), and there was no difference 1 week after trauma (P=0.065).This model is capable of producing accurately quantified brain injury. The animal model is credible, stable and reproducible, so it is an effective platform for studying the effect of traumatic brain injury on fracture.

To review the experience with clinical and imaging characteristics of giant cell tumor (GCT) of the hand as well as the surgical outcomes.Between 2000 and 2010,16 cases of GCT of the hand were admitted to our department. There were 10 male and 6 female patients with a mean age of 41.3 years (age range: 24 to 65 years) with Campanacci's grade I ( n = 0), Grade II (n=12), and Grade III (n=4). Eight cases occurred in metacarpal bone and 8 cases in phalanx. All patients had the symptoms of pain,swelling and restricted range of motion in the affected joint.The average time from the onset of the symptom to the first visit of the patients was 12 months( range: 5 to 15 months).Radiographic changes showed osteolytic lesions occupying at least half of the diaphyseal region in most of the cases. Four grade III patients underwent tumor resection and bone graft or serial amputation, while 12 Grade II patients extensive curettage and bone graft.Twelve patients'clinical and radiographic diagnosis at admission was endochondroma, while postoperative histopathology reported all the lesions as GCT. Twelve patients were followed up for a mean of 58.8 months (range: 24 to 140 months). Immediate relief of pain was observed postoperatively in all patients. No complications, such as infection or joint stiffness, were observed in any patient. The average healing time of bone graft was 3.3 months (range: 3 to 5 months).Ten gradeII patients were followed up for at least 2 years and 3 of them had local recurrence 8 to 16 months after first resection. En bloc resection was then performed, and no second reccurence was reported. Two gradeII patients were followed up for at least 2 years and none of them had local recurrence. No malignancy, multiple center lesion or lung metastasis was reported. Active range of motion in the patients without joint arthrodesis was maintained during the follow-up period.GCTs of the hand are relatively rare, and tend to be misdiagnosed as endochondroma. The results of the present study suggest that extensive curettage provides favorable local control and satisfactory functional outcomes.

To observe the clinical effect of biodegradable conduit small gap tublization to repair peripheral nerve injury.In the study, 30 cases of fresh peripheral nerve injury in the upper extremities were recruited. After formally informed and obtaining the consent, the recruited patients were divided into the degradable chitin conduit tublization group (experimental group: 15 cases) and traditional epineurial neurorrhaphy group (control group: 15 cases). Their nerve functional recovery conditions were clinically observed according to the standard score methods provided by SHEN Ning-jiang and British Medical Research Council. The excellent and good rates of the overall nerve functional recovery were calculated. The electrophysiologic study was carried out after 6 months.Of the total 30 cases, 28 were followed up, and there were 14 cases in the degradable chitin conduit tublization group and traditional epineurial neurorrhaphy group. The operation procedure was very simple, and the mean suture time [(8.0±0.8) min] was 20% shorter than that of the traditional epineurial neurorrhaphy group [(10.0±0.6) min]. All the wounds in the degradable chitin conduit tublization group healed as expected without rejection, hypersensitive reaction or anomalous draining. Electrophysiology examination results after 6 months displayed that the sensory nerves conduction velocity recovery rate was 77.37% of the normal value, and motor nerve conduction velocity recovery rate was 70.09% in the degradable chitin conduit tublization group. The sensory nerves conduction velocity recovery rate was 61.69% of the normal value, and motor nerve conduction velocity recovery rate was 56.15% in the traditional epineurial neurorrhaphy group. The exact propability methods was applied in the comparison of sensory and motor nerve conduction velocity recovery rate, and there was no statistically significant of two groups(sensory nerve conduction velocity recovery rate P=0.678;motor nerve conduction velocity recovery rate P=0.695). The combinated functional recovery excellent and good rates after repair in the degradable chitin conduit tublization group were 78.57%, while 28.57% in the traditional epineurial neurorrhaphy group. The Fisher's exact probabilistic method was applied in the comparison of combinated functional recovery excellent and good rates, and there was statistically significant of two groups(P=0.021).The operation procedure of the degradable chitin conduit tublization is very simple and the clinical recovery effect is much better than that of the traditional epineurial neurorrhaphy. The biodegradable conduit small gap tublization methods to repair peripheral nerve injury has the possibility to substitute the traditional epineurial neurorrhaphy.

To analyze the obvious and hidden blood loss before and after operations in the inter-trochanter fracture patients treated with proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) to provide the data support for clinical perioperative period treatment.The clinical data of 216 cases of inter-trochanter fracture patients treated with PFNA and 168 cases of inter-trochanter fracture patients treated with DHS from Dec. 30, 2001 to Sep. 30, 2010, and the obvious, hidden blood loss and blood transfusion before and after operations were retrospectively analyzed, using SPSS 13.0 statistical package.The PFNA group: The mean blood loss of (48.9±2.8) mL was found in 216 cases of inter-trochanter fracture patients during operation. The mean obvious blood loss was (62.3±3.8) mL while the hidden blood loss was (385.0±6.2) mL. The DHS group: The mean blood loss of (124.9±7.8) mL was found in 168 cases during operation. The mean obvious blood loss was (73.9±4.7) mL and the hidden blood loss was (243.4±6.3) mL after operation. The blood loss during operation and obvious blood loss after operation of DHS was larger than that of PFNA, while the hidden blood loss of DHS was smaller than that of PFNA. The gross total blood loss and the hidden blood loss of group PFNA was bigger than that of DHS group.There were much hidden blood loss in both PFNA and DHS group for inter-trochanter fracture internal fixation after operation. This reminds surgeons to monitor the life vital signs after PFNA or DHS internal fixation operation in order to decrease the complication.

To investigate the surgical treatment results of periprosthetic femur fracture after hip arthroplasty.In the study, 10 patients from Oct. 2006 to Jan. 2012 were treated surgically according to Vancouver classification, and their fracture union, hip function, pain in fracture site and lower extremity length were evaluated postoperatively.All the patients had full follow-up for 6 to 69 months (mean time: 35.1 months). All fractures were united well with good alignment and no prosthesis loosing or internal fixation failure was discovered. Harris scores to assess hip function were 71 to 90 (mean: 79.8) and the excellent and good rate was 70%. VAS scores to evaluate pain in fracture site when walking were 0 to 3 (mean: 1.4). The lengths of injured lower extremity were shorter by 0 to 2.5 cm than those of the contralateral side preoperatively [mean (1.6±0.9) cm]. The shortened lengths were reduced to 0 to 1.8 cm postoperatively [mean (0.6±0.6) cm], which were statistically different from those of preoperation (P=0.002).Although treatment of periprosthetic femur fracture after hip arthroplasty is a hard work, we can make individual therapy regiment based on the patient's age, general condition, function demand and Vancouver classification. Surgical treatment can bring good results.