Objective To analyze the risk factors for contralateral hip fracture after surgery for primary femoral intertrochanteric fracture in senile patients. Methods Clinical data of the senior patients (≥ 65 years of age) were reviewed who had been treated for femoral intertrochanteric fracture between December 2008 and February 2014 in our hospital. They were 89 males and 185 females, 65 to 100 years of age (average, 80.0 years). The left side was involved in 133 cases and the right 141. By AO classification, 70 cases were type 31-A1, 192 type 31-A2 and 12 type 31-A3. The patients who had suffered from contralateral hip fracture were put into group A while those who had not into group B. The 2 groups were compared in terms of general clinical data, postoperative rate of positive Trendelenburg sign, Singh index, Harris score at 6 months postoperation, and iliopsoas strength. Binary logistic regression was conducted for factors with P<0.05. Results Of all the patients, 274 obtained follow-up from 6 to 66 months (average, 30.1 months). Contralateral hip fracture occurred in 15 cases (6.2%). There were no significant differences between groups A (n=15) and B (n=226) regarding gender, age, laterality, fracture type, concomitant neural disorder, time from injury to surgery, internal fixation method, operative time, blood transfusion, time for hospital stay, postoperative rate of positive Trendelenburg sign, or Harris score at 6 months postoperation (P>0.05), but there were significant differences between the 2 groups regarding intraoperative blood loss, Singh index and iliopsoas strength (P<0.05). Binary logistic regression analysis showed Singh index (OR=0.325, P=0.026) and iliopsoas strength (OR=0.584, P=0.046) were risk factors for contralateral hip fracture after surgery for primary femoral intertrochanteric fracture in senile patients. Conclusions Osteoporosis is the pathologic basis for contralateral hip fracture after surgery for primary femoral intertrochanteric fracture in senile patients. The main cause for falling after surgery of intertrochanteric fracture is weakened hip function, the weakened strength of iliopsoas in particular. Therefore, anti-osteoporosis and rehabilitation of the strength of muscles around the hip, especially the iliopsoas, are essential to prevention of contralateral hip fracture following surgery for primary femoral intertrochanteric fracture in senile patients. Key words: Hip fractures; Osteoporosis; Fracture fixation, internal; Strength of muscle

目的:探讨电针足三里+阿是穴促进急性钝器伤后家兔腓肠肌生物力学属性恢复的作用和相关机制.方法:将60只新西兰大白兔随机分为正常组、自然愈合组、电针组,制作家兔腓肠肌急性钝器伤模型,电针组给予足三里+阿是穴穴位电刺激(0.4mA,2Hz,15min),自然愈合组不予针刺治疗,自然愈合.分别于损伤后各时间点(7d、14d、28d、42d)取材、进行腓肠肌的拉伸试验,检测腓肠肌极限载荷、屈服载荷、极限强度、屈服强度、杨氏模量等生物力学指标的变化.结果:与自然愈合组比较,在损伤后第28天电针组极限载荷、屈服载荷显著大于自然愈合组(P＜0.05),极限强度、屈服强度经治疗后也较自然愈合组更强(P＜0.05),基本接近于正常组(P＞0.05);杨氏模量是反映腓肠肌刚度性能的重要指标,电针组也明显大于自然愈合组(P＜0.05).结论:电针足三里+阿是穴能够有效促进家兔腓肠肌急性钝器伤后生物力学属性的恢复,损伤后治疗28天时效果最好.其机制可能与电针促进肌纤维再生、微观结构的恢复、促进毛细血管网的重建有关.

目的:探讨电针对家兔急性钝器伤后D-二聚体(D-Dimer)和凝血酶-抗凝血酶复合物(thrombin-antithrombin complex,TAT)的影响作用.方法:将18只新西兰大白兔随机分为3大组,即空白组、模型组、电针组;每组6只动物.电针组在常规治疗的基础上,于伤后24h开始电针治疗.在造模前、造模后第1天、第4天、第7天分别对各组动物进行耳中动脉采血,测定D-Dimer和TAT的含量.结果:造模后第1天,模型组和电针组的D-Dimer、TAT的含量高于空白组(P＜0.05);造模后第4天,模型组的D-Di-mer、TAT含量高于电针组(P＜0.05),而电针组又高于空白组(P＜0.05);造模后第7天,模型组和电针组的D-Di-mer、TAT的含量呈下降趋势,但仍高于空白组(P＜0.05).结论:电针弱刺激可以有效减少家兔急性钝器伤后D-Dimer和TAT的升高,防止高凝状态的形成.

Background: Our preliminary studies indicated that electroacupuncture (EA) at the ST36 and Ashi acupoints could promote regeneration of the rabbit gastrocnemius (GM) by improving microcirculation perfusion, promoting the recovery of myofiber structures, and inhibiting excessive fibrosis. However, the effects of EA on recovery of the electrophysiological properties of the GM after contusion are not yet clear. Thus, the purpose of this study was to investigate the effects of EA at the Zusanli (ST36) and Ashi acupoints with regard to recovery of the electrophysiological properties of the rabbit GM after contusion.Methods: Forty-five rabbits were randomly divided into three groups: normal, contusion, and EA. After an acute GM contusion was produced (in rabbits in the contusion and EA groups), rabbits in the EA group were treated with electrostimulation at the ST36 and Ashi acupoints with 0.4 mA (2 Hz) for 15 min. The contusion group received no EA treatment. At different time points (7, 14, and 28 days) after contusion, we performed surface electromyography (EMG) and measured the nerve conduction velocity (NCV) of the GM and the GM branch of the tibial nerve. We also examined acetylcholinesterase (AchE) and Agrin expression in the neuromuscular junction (NMJ) via immunohistochemistry.Results: Compared with the contusion group, the EMG amplitude and NCV in rabbits in the EA group were significantly higher at all time points after contusion. AchE and Agrin expression in the EA group were significantly higher than those in the contusion group.Conclusions: Our results showed that EA at the ST36 and Ashi acupoints effectively promoted recovery of the electrophysiological properties of the rabbit GM after contusion. The effects of EA were realized by promotion of the regeneration of myofibers and nerve fibers, as well as acceleration of NMJ reconstruction by upregulation of AchE and Agrin expression in the motor endplate area.

Objectives: To observe the paravertebral major vessels and its relationship with lumbar spine, and to provide a theoretical basis for posterior lumbar surgery. Methods: 50 cases underwent enhanced ab-dominal CT in our hospital, and there were 34 males, with an average age of 53 years, an average height of 174cm, an average weight of 68kg, and 16 females, with an average age of 54 years, an average height of 167cm, an average weight of 63kg. The relationship and distance between lumbar vertebral anterior region and abdominal aorta, inferior vena cava, iliac vein and their branches were measured at the disc plane with PACS 11.0 software system. Meanwhile, the relationship and distance between lumbar vertebral posterior re-gion and abdominal aorta, inferior vena cava, iliac vein and their branches were measured. The relationship between lumbar vertebral (anterior and posterior region) and paravertebral vessels for male and female was measured also. Results: In L1/2-L5/S1, the distance form paravertebral artery to lumbar vertebral anterior border and posterior border was 35.86±7.84mm and 46.48±8.51mm in male, respectively; while in female, the distance was 32.15±6.03mm and 41.57±6.72mm, respectively; the relationship between paravertebral artery and lumbar vertebral anterior and lumbar vertebral posterior region was 10.87°±27.54° and 7.61°±19.12° in male,respectively; while in female, it was 15.16°±31.85° and 10.87°±22.48°, respectively. The distance form par-avertebral vein to lumbar vertebral anterior and posterior region was 35.86 ±7.84mm and 46.48 ±8.51mm in male, respectively; while it was 32.15±6.03mm and 41.57±6.72mm in female, respectively; the relationship be-tween paravertebral vein and lumbar vertebral anterior and lumbar vertebral posterior region in male was 10.87°±27.54° and 7.61°±19.12°, respectively; while in female, it was 15.16°±31.85° and 10.87°±22.48°, re-spectively, which showed significant differences between male and female, with male having greater distance of form paravertebral venous to lumbar vertebral anterior border and posterior border than female. However, there was no sex-related significant difference of the relationship between paravertebral venous and lumbar vertebral anterior and posterior region. Abdominal aortic bifurcation in 12 patients (24%) at the lower half of L4, and 32 cases(64%) at the level of L4/5 disc; 29 cases(58%) had llliac artery bifurcation sited at the L5/S1 disc, and 12 cases(24%) at the upper half of the S1 vertebra; 42 cases(84%) had illiac vein confluence sited at the upper half of the L5 vertebra; internal and external iliac vein confluence in 16 patients(33%) located at the L5/S1 disc, and 27 cases(53%) at the lower half of the L5 vertebra. Conclusions: Bifurcation of lumbar paraspinal vascular varies greatly, especially in female. Paravertebral vascular should be paid attention when performing posterior discectomy.

BACKGROUND:Several studies, including those done in China, report that paravertebral vascular injury during posterior spinal surgery can greatly harm patients, though it is a relatively rare complication. However, few studies have examined their course and anatomic relationship to the spine. The aim of this study was to measure the course of the major paravertebral vessels and their positional relationships to the vertebral bodies in Chinese subjects using computed tomography.METHODS:We studied a total of fifty subjects who underwent thoracolumbar computed tomography from T1-S1 at our institution. We measured the theoretical distance, actual distance, theoretical angle, and actual angle of the paravertebral vessels at each thoracolumbar intervertebral disc.RESULTS:The paravertebral artery actual angle at T4-L4 ranged from -11.41 to 79.75° and the actual distance from 16.98 to 52.53 mm. The actual angle of the inferior vena cava at L1-L5 intervertebral disc ranged from -40.75 to 34.50° and the actual distance from -36.63 to 61.69 mm. There was no significant difference in the actual angle of the paravertebral vein or in the actual distance in the thoracic segments according to gender (P > 0.05). However, the actual distance in the lumbar segments were significantly different according to gender (P < 0.05).CONCLUSIONS:The major paravertebral vessels' course is closer to the mid-sagittal plane as they move posterior along the vertebrae, and the actual distance of the paravertebral artery and azygos vein increase, while the actual distance of the inferior vena cava decreases. The course of the lumbar paravertebral vessels varies, especially at L4/L5, and may be more prone to intraoperative injury in female subjects.