Objective: To explore the clinical ef-fects of external fixation associated with limited internal fixa-tion on treatment of Gustilo grade Ⅲ leg fractures.Methods: From July 2006 to December 2008, 40 cases of Gustilo grade Ⅲ leg fiactures were emergently treated in our unit with external fixation frames.Soft tissue injuries were grouped according to the Gustilo classification as ⅢA in 17 cases, ⅢB in 13 cases, and ⅢC in 10 cases.All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment.Limited internal fixation with plates and screws were per-formed on all the Gustilo Ilia cases and 10 Gustilo ⅢB cases at the first operation.But all the Gustilo ⅢC cases and 3 Gustilo ⅢB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD).Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation.Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved.Results: The first operations were completed within 90-210 minutes (170 minutes on average).The blood trans-fusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included).All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average.The lower limb function was evaluated accord-ing to the comprehensive evaluation standards of leg func-tion one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor.Conclusion: External fixation associated with limited internal fixation to treat Gustilo grade Ⅲ leg fractures can get satisfactory early clinical therapeutic effects.

Objective: To investigate the effect and clinical significance of Xuebijing injection on periph-eral T-lymphocyte subpopulations in patients with severe trauma.Methods: Thirty-three patients with severe trauma were randomly divided into a control group (n=16) and a treatment group (n= 17).The patients of two groups were all treated conventionally, and the only difference was that Xuebijing injection was given to patients of the treatment group.The CD_4~+ and CD_8~+ subpopulations of T-lympho-cyte in the peripheral blood were detected respectively on admission, 3rd and 5th days after trauma by double anti-body labeling and flow cytometry.Results: The CD_4~+ T-lymphocytes and CD_4~+/CD_8~+ ra-tio of peripheral blood in patients with severe trauma de-creased markedly on the 3rd and 5th days after trauma.Furthermore, compared with control group, the peripheral CD_4~+ T-lymphocytes and CD_4~+/CD_8~+ ratio of treatment group renewed obviously on the 5th day after trauma, and showed statistical differences (P<0.05).Conclusion: In the treatment of patients with severe trauma, the early use of Xuebijing injection is effective in correcting disorder or suppression of T-lymphocyte sub-populations regulating network, and promoting a more bal-anced profile of immunologic function.

Objective: To establish the device and model of motorcyclist ejection injury.Methods: Based on our laboratory devices, a motorcy-clist ejection injury simulation system was developed.A total of 18 pigs were approved by the local animal experi-mentation and ethics committee to serve as the motorcy-clist substitutes.In this ejection motion, the animal rode freely at the motor driver seat and was straightly acceler-ated by means of our custom motorcyclist ejection injury simulation system.When it was speeded up to the preset velocity (v=30, 40 or 50 kin/h) at the preset position, the animal was ejected forward.Pathological and dynamic analy-ses were conducted, accompanied with the high-speed photograph, acceleration/velocity signal test, gross obser-vation and light microscope examination as well as the ab-breviated injury score-injury severity score (AIS-ISS) scale.Results: The high-speed photograph indicated that during the ejection procedure the motorcycle was first ar-rested and decelerated suddenly, and then the motorcycle driver was ejected forward, accompanied with the rotation motion in the air.Finally, the head, shoulder and thorax of the ejected animal impacted directly on the hard ground.Varying degrees of injury focusing on the liver, heart, lung and spleen were found.There existed a significant positive, correlation between ISS and the ejection velocity of the motorcycle drivers (ISS=16.7+2.9 for 30 kin/h, 25.0±0.0 for 40 km/h and 37.3a=1.0 for 50 kin/h), The detailed injury char-acteristics were as follows: for the mildly injured animals, there were interlobar gaps or leaf gaps and lobar surface blood coagulation blocks in the liver, and mild lung hemorrhage; for the severely injured animals, there were liver comminuted laceration, moderate lung hemorrhage and heart injury.Animals suffering from the most severe injuries died half an hour later.Conclusion: The new injury model stated in this paper has a high stability and good repeatability, and is likely to be helpful to deeply investigate the injury mechanisms and protection countermeasures of motorcyclist ejection injury.

Objective: In recent years, oxidative stress has been implicated in a variety °enerative pro-cess and diseases, including acute and chronic inflamma-tory conditions such as wound healing.Green tea polyphe-nols have shown anti-oxidant property.The present study discussed the application of chitosan green tea polyphenol complex on the wound healing.Methods: The wound healing effect ofchitosan green tea polyphenol complex was studied in ten-week-old healthy male Sherman rats weighing 150-180 g by two wound models.The rats were randomly chosen and divided into four groups (n=5), administered with distilled water in Group A as con-trol group, epigallocatechin-3-gallate (EGCG) in Group B, chitosan-EGCG complex in Group C and chitosan-green tea polyphenols complex in Group D, respectively.In rats'incision wound model, two straight paravertebral inci-sions were made and skin tensile strength was measured using continuous water flow technology on the 10th day.In rats'excision wound model, wound contraction and pe-riod of epithelization were measured.The polyphenols re-lease from the complex was continuously monitored by an elution technique in aqueous solution at different pH val-ues (pH=4, 5, 6, 7).Results: The treatment groups showed significantly enhanced the breaking strength in incision wound (328±4.5) g and (421±18.5) g compared with control (264±16.7) g.In the excision wound model, the wound contraction percentage in treatment groups was relatively increased during the re-covery period.Respectively, the percentage of wound contraction ranged from 47.60%±2.15% on day 4 to 107.98% ±1.26% on day 16 compared with control group (8.46%±5.42% to 59.80%±4.47%).The complex demonstrated a gradual in-crease in the release rate from the initial stage and slow increase at different pH values.The release rate approxi-mated 0.6-0.7 in the complex and remained stable 6 hours after injury, which may be the end of the release process.Conclusions: In our study, chitosan polyphenol com-plex has enhanced the healing of incision wounds by in-creasing the breaking strength of the wounds.In excision wound model, the complex hastens the period of epithelialization.The study on the optimal release of com-plex among various pH values could be applied in the wound test, which can lead to a gradually active substance (polyphenols) release and efficient coverage of epithelial layers found in the healing of incision and excision wound.

Objective: To get morphologic param-eters of Chinese adults through observation and measure-ment on axial laminas, to evaluate the feasibility of placing axial laminar screws and to introduce the technique.Methods: Relative parameters of 28 sets of fresh Chi-nese adults' axial specimens, including distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas, superior, middle, infe-rior thickness and height of the axial laminas, length and angle of the axial laminar screw trajectories, distance from the entry points of axial laminar screws to the transverse foramen and central points of the inferior articular process, were measured with a digital caliper and a goniometer.Data were statistically analyzed.Results: Averagely, distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas was 5 mm and 9 ram, superior, middle, inferior thickness and the height of the axial laminas were 3.2 mm, 6.7 ram, 5.5 nun and 12.8 mm respectively, and the length of the superior and inferior axial laminar screw trajectories was 26.2 mm and 25.5 mm, respectively.Conclusions: It is feasible and reliable to apply poste-rior laminar screw fixation techniques to the axes of Chinese adults.Also the C_2 laminar screw fixation technique can be taken as a supplementary to conventional posterior screw fixations of C_2.

Objective: To evaluate the clinical ap-plication of the medial approach for repairing popliteal ar-tery injuries.Methods: From 2002 to 2008, 11 cases ofpopliteal artery injuries had been repaired via the medial approach.Of these cases, 8 had limb fractures, 1 had knee dislocation, and 2 had visceral injuries.Ten popliteal arteries were anas-tomosed directly while one was repaired with a great saphe-nous vein graft.Results: The operation time ranged from 3 to 4 hours (averaging 3.6 hours).All the injured limbs survived.At the follow up, 8 legs recovered the full function, 2 had minor contracture, and 1 serious Volkmann's contracture without amputation.Conclusion: The medial approach for repair of the popliteal artery is effective, applicable, and more advanta-geous to the management of multi-injures.

Objective: To determine the nature and extent of Iranian casualties by ballistic missile attacks dur-ing the eight years of the Iraq-Iran war.Methods: The data collected about Iraqi missile strikes on Iranian cities included the following: date and time, num-ber and type of missiles, cities targeted, and injuries and deaths resulting from impacts of missiles in civilian areas.The data were extracted from a database that was con-structed by the army staff headquarters based on daily re-ports of Iranian army units during the war.Results: Over a period ofeight years (1980-1988), Iraqi army fired 533 ballistic missiles at Iranian territories.From those, 414 missiles (77.7%) landed on Iranian cities.The impacts of these missiles caused the deaths of 2 312 civil-ians and injured 11 625 others.Three types of ballistic mis-siles were used: FROG-7, Scud, and AI-Hussein (a modified version of the Scud missile).Twenty-seven cities in Iran were struck by Iraqi ballistic missiles.The highest mortali-ties from ballistic missiles were in Dezful and Tehran.Iraqi missile attacks continued for 90 months (2748 days).Conclusion: Our results point to the necessity of investigating the psychological consequences of Iraqi bal-listic missile attacks among survivors in 27 Iranian cities during the eight years of the Iraq-Iran war.

Objective: To study epidemiological characteristics and influential factors of in-hospital patients struck by the Wenchuan earthquake disaster.Methods: The clinical data of 196 cases were collected from 2 hospitals of Chongqing city, including age, sex, occupation, injury site, dwelling and injury severity score.Results: In this series, 31.63% victims' age was over 60 years, and 54.08% were farmers.Multiple trauma ac-counted for 35.71%, and lower limb injury for 33.67%.There was no significant difference on injury severity score be-tween city dwellers and rural ones (P>0.05).Conclusion: The earthquake injury is influenced by many factors.More attention should be paid to the treat-ment at first 5 days after injury and high risk population.

Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases.In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare.We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house.He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury.On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed.A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture.Cer-vical computed tomography (CT) with contrast medium re-vealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture.However, sagittal magnetic resonance imaging (MRI) revealed an anterior longitudinal ligament (C levels)injury.We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascu-lar injury around the injured ligament.Therefore, we recom-mend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgehography and CT reveal no evidence of injury.

Bilateral hip dislocation rarely occurs.In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic acci-dent is reported.Both hips were emergently reduced under general anaesthesia.Acetabular reconstruction was done bilaterally due to the unstable hips.The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty.The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was aug-mented by tendon transfer.Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time.To the best of our knowledge, this kind of injury has not been reported in the English .language literature.

Palmar plate fixation is becoming a well recognized treatment for distal radial fracture.Tendon rup-tures or irritations have been reported after this procedure.Inadvertent retention of angled drill guides useful for easy placement of locking screws in proper direction in volar plating can represent a high risk of secondary tendon rupture.In this case, we presented our experience in one patient in whom drill guides removal could be delayed for one year and summarized our techniques to prevent the aforementioned complications.

Compartment syndrome after an adder bite is extremely rare, whose effects are only secondary to the cytotoxic and hemorrhagic effects of venom.Here we reported a case of compartment syndrome in the upper limb following an adder bite in the thenar eminence.Elevated compartment pressure was documented and immediate sur-gical fasciotomy was practiced.The patient achieved com-plete recovery with a good functional result.We discussed the controversies on fasciotomy and non-invasive measures in such a situation, and recommended intracompartmental pressure monitoring during the management of compart-ment syndrome following adder bites.

Brain edema leading to an expansion of brain volume has a crucial impact on morbidity and mortal-ity following traumatic brain injury as it increases intracra-nial pressure, impairs cerebral perfusion and oxygenation,and contributes to additional ischemic injuries.Classically,two major types of traumatic brain edema exist: "vasogenic"and "cytotoxic/cellular".However, the cellular and molecu-lar mechanisms contributing to the development/resolution of traumatic brain edema are poorly understood and no ef-fective drugs can be used now.Aquaporin-4 (AQP4) is a water-channel protein expressed strongly in the brain, pre-dominantly in astrocyte foot processes at the borders be-tween the brain parenchyma and major fluid compartments, including cerebrospinal fluid and blood.This distribution suggests that AQP4 controls water fluxes into and out of the brain parenchyma.In cytotoxic edema, AQP4 deletion slows the rate of water entry into brain, whereas in vasogenic edema, AQP4 deletion reduces the rate of water outflow from brain parenchyma.AQP4 has been proposed as a novel drug target in brain edema.These findings sug-gest that modulation of AQP4 expression or function may be beneficial in traumatic brain edema.

Fibrocytes are bone marrow-derived mesenchymal progenitors that co-express hematopoietic cell antigens and markers ofmonocytic lineage as well as fibro-blast products.During wound healing, fibrocytes have been found to possess the ability of antigen-presentation to naive T cells in the inflammatory phase.Moreover, they can pro-mote the endothelial cell proliferation, migration and angio-genesis by secreting several proteins.Fibrocytes can fur-ther differentiate into mature mesenchymocyte lineage, suchas fibroblasts, myofibroblasts and adipocytes, and they may represent the systemic source of myofibroblasts that exert a contractile force required to close tissue wounds.A deep understanding of the mechanism involved in fibrocyte mi-gration and differentiation may lead to the development of a novel theory of normal physiology and pathology.