Objective To explore the early diagnostic value of single photon emission computed tomography(SPECT), thoracic computed tomography(CT),and chest X-ray for closed chest trauma. Methods To establish the animal model of unilateral chest impact trauma,to adopt SPECT, thoracic CT, and chest X-ray for early diagnosis of closed chest trauma,and to compare these findings with postmortem examination. Results Thirty minutes after blunt chest trauma, the region of interesting (ROI) between traumatized lung and the heart (ROI2/ROI1) immediately increased to the peak six hours after trauma; on the contralateral lung, the ratio (ROI3/ROI1) increased slowly and reached the peak after six hours, these ratio was still smaller than that of the traumatized lung. These differences were significant (Plt;0.01). Conclusions Chest X-ray is still the most fundamental diagnostic method of chest trauma,but it was thought that the patients of severe chest trauma and multiple injuries should be examined early by thoracic CT. Radionuclide imaging have more diagnostic value than chest X-ray on pulmonary contusion. The diagnostic sensibility to pulmonary contusion of thoracic CT is superior to conventional radiograph,but thoracic CT is inferior to SPECT on exploring exudation and edema of pulmonary contusion. Thoracic CT is superior to conventional radiograph on diagnosis of chest trauma,therefore patients of severe chest trauma and multiple injuries should be adopted to thoracic CT examination at emergency room in order to be diagnosed as soon as possible.
OBJECTIVE: To study the management of extensive closed internal degloving injury (CIDI). METHODS: From September 1987 to October 1999, 18 cases of CIDI were retrospectively reviewed. Of 18 cases, there were 7 cases in thigh, 6 cases in legs and 5 cases in pelvis, ranging from 15 cm x 12 cm to 38 cm x 25 cm in size. Various managements were adopted according to the severity of the injury, including vacuum drainage and adjuvant compression in 5 cases, regrafting of defatting fenestrated full-thickness skin by non-resection in 8 cases, and skin grafting with transfer of myocutaneous flap in 5 cases. Among them, there were 11 cases of bone and articular fixation or repair, 4 cases of principal vessels repair. All of the cases were evaluated clinically and followed up for 6 months to 3 years. RESULTS: In the 8 cases repaired by regrafting of defatting fenestrated full-thickness skin, only one case of skin necrosis, 5 cm x 2 cm in size, recovered after skin grafting; the others healed well. All of the patients recovered normal life and had normal limbs. CONCLUSION: It’s crucial to make a careful assessment about the injury severity of CIDI, to stress on importance of management of both CIDI and deep injury, and to choose proper options after comprehensive assessment of the injury.
Objective To set up and to evaluate an acute closed brain injury model in rats. Methods The acute closed brain injury was produced in rats by using an impactor consisting of a stand, a guide tube, a weight and a footplate. Ninetysix SD rats were divided into a control group(n＝32, no impact), a mild injury group(n＝32, impact once at force level of 400 g·cm) and a severe injury group(n＝32, impact once at force level of 800 g·cm) to elucidate the physiological responses, the pathophysiological changes and brain edema after brain injury at different injury levels. Results In the mild injury group and the severe injury group, a sudden rise or reduction of blood pressure, deep and fast breath apnea, and pain reflects inhibition were observed. The responses were more obvious in the severe injury group than in the mild injury group. The water content of the brain increased after 6 hours of injury. The pathological contusion and edema of brain were noted or above the impact force level of 800 g·cm. When the impact force rose to or over 1200g·cm, the animals died of persistent apnea mostly. Conclusion Although the established closed brain injury model with different biomechanical mechanisms as the clinical brain injury, it is in conformity with pathological changes and pathophysiological characteristics of acute clinical brain injury, it can be utilized extensively because of its convenient and practice.
Objective To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Methods Between March 2011 and September 2015, 8 cases (8 sides) with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years (range, 22-58 years), injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm (mean, 3.3 cm). The time from injury to operation was 2-12 days (mean, 4.1 days). With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. Results The operation time was 70-135 minutes (mean, 99 minutes); the intraoperative blood loss was 5-30 mL (mean, 15.6 mL). All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months (mean, 30.5 months). There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activity of ankle joint dorsiflexion reduced 0-6° (mean, 3°); plantar flexion reduced 1-5° (mean, 2°). At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. Conclusion Laminated bevel suturing technique is simple for repairing acute closed Achilles tendon rupture without the need of special surgical instruments. It provides enough tensile strength for early rehabilitation exercise to rapid and good recovery.
【Abstract】 Objective To discuss the techniques and advantages of closed reduction and intramedullary nail ing intreating femoral shaft fracture without cannulated femoral reamer. Methods From January 2006 to June 2007, 24 cases offemoral shaft fracture were treated with closed reduction and intramedullary nail ing. Among them, there were 14 males and 10 females, with the average age of 38.3 years (ranging from 18 years to 63 years), with 7 left legs and 17 right legs. The average course of the disease was 7.6 days (ranging from 3 days to 20 days). According to the AO typing, there were 5 cases of type A, 6 of type B, 7 of type C1, 2 of type C2 and 4 of type C3. Closed reduction was achieved with manipulation and reaming of femoral canal was instructed by fluoroscopy. Results The operation time lasted from 100 minutes to 170 minutes, with the average time of 128.3 minutes. One patient was given a transfusion of 400 mL, and others were not. Twenty cases were followed up with the average time of 13.1 months (ranging from 6 months to 24 months). A mild to large amount of bony callus was showed on X-ray films 6 to 12 weeks postoperatively. Walking without crutches began at the average week of 22.2 (ranging from 15 to 30) postoperatively. Range of motion of the knee was 0° to 145.5°. No infection or break of the internal fixator occurred. Myositis ossificans with pain and insufficient flexion of hip (120°) happened in 1 case and the pain disappeared after non-steroid anti-inflammatory drugs were taken. Nonsymptomatic myositis ossificans occurred in 2 cases and no treatment was needed. Conclusion Closed reductionand intramedullary nail ing can help to protect the blood supply of fracture fragments and provide central fixation. The operation process will be more compl icated if cannulated femoral reamer is not available.
ObjectiveTo evaluate the short-term effectiveness of the short incision and non-end-to-end suturing system in the treatment of acute closed Achilles tendon rupture. MethodsBetween September 2011 and September 2013, 22 patients with acute Achilles tendon rupture were treated with self-designed minimally invasive non-end-to-end suturing system. There were 16 males and 6 females, aged from 22 to 55 years (mean, 32.6 years). The left side was involved in 12 cases and the right side in 10 cases. The causes included sports injury in 16 patients, violent injury in 4 patients, and falling injury in 2 patients. MRI revealed that the distance from the ruptured site to the calcaneal tuberosity ranged from 40 to 70 mm (mean, 35 mm). The duration from injury to surgery ranged from 0.5 to 7 days (mean, 4.2 days). The incision of 4 cm in length was made at the initial point of Achilles tendon, and minimally invasive non-end-to-end suturing system was used to hold the Achilles. The ruptured tendon was sutured with two non-absorbed thread. The limb was fixed with plaster for 6 weeks. ResultsThe incision all healed by first intention without complications of sural nerve damage and infection. All patients were followed up 8-14 months (mean, 11 months). According to the Arner-Lindholm functional score criteria, the results were excellent in 19 cases and good in 3 cases. No Achilles tendon rupture happened again during follow-up. ConclusionThe small incision with non-end-to-end suturing system is an effective operation strategy for treatment of acute Achilles rupture. The patients can do function exercise at early-stage with satisfatory short-term effectiveness.
ObjectiveTo evaluate the clinical efficacy of central venous catheter closed drainage of pleural cavity combined with negative pressure suction in the treatment of spontaneous pneumothorax. MethodsThe randomized controlled trials(RCTs) on central venous catheter closed drainage of pleural cavity combined with negative pressure suction in the treatment of spontaneous pneumothorax were searched in PubMed, OVID, CNKI, Wangfang database, Super Star Digital Library, CMB, Baidu and Google search engines. The searching time was from the time of building database to September 15, 2014. Two searchers selected studies based on the included criteria strictly. The quality of RCTs was appraised by the criteria of Cochrane Collaboration. RevMan5.3 software was used for data analysis and management. ResultsA total of 18 RCTs including 1 549 patients were identified. There were no statistical differences in time of lung recruitment (SMD=0.01 and 95%CI -0.23 to 0.25, P=0.95), time of hospital stay (SMD=-0.42, 95%CI -1.81 to 0.97, P=0.55), curative resection rate (RR=1.04 and 95%CI 1.00 to 1.08, P=0.07) between the two groups. The rate of complications in the central venous catheter group was less than that in the conventional pleural cavity closed drainage group with a statistical difference (RR=0.31, 95%CI 0.23 to 0.43, P<0.000 01). ConclusionThe treatment of central venous catheter closed drainage of pleural cavity combined with negative pressure suction for spontaneous pneumothorax is a simple and safe operation. However, the quality of studies included is not high and some sample size is small. RCTs with large sample of high quality are still needed for further confirmation.
Objective To determine the effect of closed tracheal suction system versus open tracheal suction system on the rate of ventilator-associated pneumonia in adults. Methods We searched The Cochrane Library (Issue 1, 2007), PubMed (1966 to 2006) and CBM (1980 to 2007), and also hand searched relevant journals. Randomized controlled trials involving closed tracheal suction system versus open tracheal suction system for ventilator-associated pneumonia in adults were included. Data were extracted and the quality of trials was critical assessed by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2.8 software was used for data analyses. Result Five randomized controlled trials involving 739 patients were included. Results of meta-analyses showed that compared to open tracheal suction system, closed tracheal suction system did not increase the rate of ventilator-associated pneumonia (RR 0.83, 95%CI 0.50 to 1.37) or case fatality (RR 1.05, 95%CI 0.85 to 1.31). No significant differences were observed between open tracheal suction system and closed tracheal suction system in the total number of bacteria (RR 0.83, 95%CI 0.50 to 1.37), the number of SPP colony (RR 2.87, 95%CI 0.94 to 8.74) and the number of PSE colony (RR 1.46, 95%CI 0.76 to 2.77). There was no significant difference between the two groups in the duration of ventilation and length of hospital stay. Conclusion Open or closed tracheal suction systems have similar effects on the rate of ventilator-associated pneumonia, case fatality, the number of SPP and PSE colonies, duration of ventilation and length of hospital stay. However, due to the differences in interventions and statistical power among studies included in this systematic review, further studies are needed to determine the effect of closed or open tracheal suction systems on these outcomes.
Objective To compare the cl inical results of two plating osteosynthesis techniques, open reduction and plating ostosynthesis (ORPO) and minimal invasive plating osteosynthesis (MIPO), in surgical treatment of mid-distal humeralshaft fractures. Methods From March 2004 to October 2006, 40 cases of closed unilateral mid-distal humeral shaft fractures were surgically treated with MIPO or ORPO. In the MIPO treated group (n=19), there were 14 males and 5 females, with a mean age of 39.05 years. Fractures involved in middle humeral shaft in 10 cases and distal fragment in 9 cases. According to OTA classification, there were 3 cases of type A, 13 cases of type B and 3 cases of type C. Four cases compl icated by radial nerve palsies. In the ORPO treated group (n=21), there were 13 males and 8 females with a mean age of 39.05 years, including 14 cases of type A and 7 cases of type B fractures according to OTA classification. The fractures involved in middle humeral shaft in 13 cases and distal fragment in 8 cases. Five cases compl icated by radial nerve palsies. The time from injury to operation in both groups were 2 to 14 days. For patients in the MIPO group, fractures were closely reduced and fixated with an anterior placed plate inserted through two small incisions made at the anterior side of arm, away from fracture sites. The radial nerves were not exposed. For patients in the ORPO group, fractures were exposed, reduced, and fixated with an anterolateral or a posterior positioned plate after careful dissection and protection of radial nerve through an anterolateral or a posterior approach. The operation time, the occurrence of iatrogenic radial nerve palsy and the bone heal ing time were recorded. The functions of the affected shouldersand elbows were evaluated with UCLA end-result score and Mayo elbow perform index (MEPI), respectively. Results All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in the MIPO group after surgery; however, 5 cases of transient iatrogenic radial nerve palsies were identified in the ORPO group after surgery, and the function of radial nerve recovered in these cases at the last follow-up. Eighteen cases were followed up 14-44 months (mean 25.44 months) in MIPO group, and 19 cases were followed up 13-48 months (mean 32.11 months) in ORPO group. The mean bone heal ing time was 17.06 (12-32) weeks in MIPO group and 16.11 (8-58) weeks in ORPO group, showing no significant difference between two groups (P gt; 0.05). There was no nonunion and hardware failure in both groups. The mean forward flexion of the shoulder was 166.94° (150-170°) in MIPO group and 164.74° (130-170°) in ORPO group. The mean UCLA shoulder score was 34.78 (33-35) points in MIPO group and 34.42 (30-35) points in ORPO group. The mean range of motion of the elbow in MIPO and ORPO groups was 133.33° (120-140°) and 136.7° (120-140°), respectively. The MEPI in these two groups was 99.44 (90-100) and 99.74 (95-100) points, respectively. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion The good results could be obtained when ORPO and MIPO technique are appl ied to treat mid-distal humeral shaft fractures. MIPO technique has advantages to not expose the radial nerve and to decrease the occurrence of iatrogenic radial nerve palsies.
ObjectiveTo study intraoperative reduction strategy in treatment of femoral neck fracture using cannulated screw fixation and the relationship between excellent and good rate of reduction and postoperative effectiveness. MethodsA retrospective analysis was made on the clinical data of 174 cases of femoral neck fracture treated between August 2005 and March 2015. There were 78 males and 96 females with an average age of 53.8 years (range, 23-75 years). The injury causes were falling in 85 cases, traffic accident in 61 cases, and falling from height in 28 cases. According to Garden typing, there were 35 cases of type I, 56 cases of typeⅡ, 47 cases of typeⅢ, and 36 cases of typeⅣ. The time from injury to operation was 1-7 days (mean, 2.74 days). Based on reduction strategy, closed 3 hollow compression screws were used; evaluating standards for fracture reduction effect were also established. Harris score was used for effectiveness evaluation. ResultsAll the cases received follow-up of 12-42 months (mean, 36.5 months). Bone healing was obtained in 152 cases at 6-12 months (mean, 9 months). Non-union and internal fixation failure occurred in 9 and 3 patients respectively, who underwent hemiarthroplasty; femoral head necrosis occurred in 6 patients after removing internal fixator at 15-26 months (mean, 18.5 months) after operation, who underwent total hip arthroplasty; 4 patients with non-union received vascular pedicle iliac flap transplantation. No other serious complications were observed. At last follow-up, the excellent and good rate of reduction was 94.29% for Garden type I, 91.07% for typeⅡ, 87.23% for typeⅢ, and 75.00% for typeⅣ, with a total excellent and good rate of 87.36%; the excellent and good rate of Harris score was 97.14% for Garden type I, 78.57% for typeⅡ, 68.09% for typeⅢ, and 50.00% for typeⅣ, with a total excellent and good rate of 73.56%. ConclusionTo obtain high Harris score in fixation of femoral neck fractures by using hollow screws, surgeons not only need reasonable technology, but also follow correct and good reduction strategy and assessment, fracture complexity is inversely proportional to excellent and good rate of reduction. Higher excellent and good reduction rate of complexity fracture should be obtained as much as possible in order to achieve good prognosis.