胸部闭合伤的损伤严重度评估及临床意义

目的：探讨胸部闭合伤的临床特点及其损伤严重度评估的临床意义。方法：分析456例胸部闭合伤的致伤因素和死亡率,并按有无合并伤（分为单纯胸伤组,合并伤组）和结局（分为生存组,死亡组）分组进行创伤评分,分别比较不同组间的损伤严重程度。结果：致伤原因为交通伤发生率最高（60．97％）,其次为高处坠落伤（13．82％）。456例中288例合并其它部位损伤,占63．16％,死亡18例,死亡率3．95％,单纯胸伤组的格拉斯哥昏迷指(GCS),睡正创伤评分（RTS）和生存概率（Ps)较高,损伤严重评分（ISS）低于合并伤组,胸部简明损伤定级（AIS）评分两组间差别无显著性意义,死亡组和生存组比较,前者生理评分低,解剖评分高,生存概率亦低。结论：胸部闭合伤常合并全身多发伤,伤情判断困难,合理使用创伤评分有助于判断损伤严重度,指导临床救治。     

多发性骨折的诊断及早期救治

多发性骨折与关节损伤的诊治是创伤外科的一大难题,如何减少多发性骨折与关节致残率与死亡率,及时诊断与早期救治是治疗的关键。我院自１９８６年以来共救治９８例,现报告如下。１　临床资料１－１　一般资料　本组男性８０例,女性１８例,年龄最大６６岁,最小８岁,平均３７岁。受伤原因：交通伤４０例,坠落伤１０例,压砸伤３０例,机器伤１８例,致伤部位最少２处,最多６处,平均每例３处。骨折多为股骨干骨折、胫腓骨骨折、尺桡骨骨折、腰椎骨折、踝关节骨折、肱骨骨折等。合并伤：合并颅脑损伤６例（血气胸５例,肺挫伤１例）;…     

汽车驾驶员交通伤192例特点分析

目的分析交通事故类型与交通伤好发部位的关系。方法对我院自2000年1月-2004年12月共收治汽车驾驶员交通伤患者192例的临床资料进行回顾性分析。结果前部碰撞驾驶员受伤部位以头颅、四肢和胸部多见；尾部碰撞多为颈椎损伤，主要表现为颈椎骨折、寰枢关节半脱位，胸部、腹部、骨盆未见损伤；侧方碰撞以四肢和骨盆多见，骨折部位通常为车辆碰撞部位同侧，常为多发性骨折；车辆翻滚以头颅及四肢损伤为主，多数患者为多部位、多器官的复合伤，常伴有重度颅脑损伤、血气胸、腹腔脏器破裂、失血性休克等重症。结论交通事故类型与交通伤好发部位具有一定的关系，临床医师要引起注意。     

多发性骨折的诊断及早期救治

我院自1986年以来,救治98例多发性骨与关节损伤,其临床特点、诊断及治疗等报导如下。1　临床资料　　本组男80例,女18例;年龄8～66岁。致伤部位最少2处,最多6处。合并颅脑损伤6例;腹腔脏器损伤2例;血管及神经损伤20例;并发休克者25例;开放伤35例。2　治疗方法　　对25例合并创伤休克者,首先抢救休克;对18例脏器损伤中的10例在抢救休克的同时,对脏器损伤做了手术处理。在休克基本纠正后,进行彻底清创,对48例开放伤在清创的同时,38例进行了内固定手术。对45例闭合骨折在48小时以内给予内固定手术治疗。其早期处理主要骨干骨折达95处,对5例未涉…     

胫骨干骨折合并踝关节损伤的手术疗效分析

[目的]分析胫骨干骨折合并踝关节损伤的发生机制并探讨其手术方法及临床疗效。[方法]自2003年6月～2006年10月间共治疗胫骨干骨折合并踝关节损伤25例，男15例，女10例；年龄24～58岁，平均41．2岁。左侧16例，右侧9例。致伤原因：交通伤13例，高处坠落伤4例，重物砸伤3例，跌伤3例，扭伤2例。新鲜闭合骨折21例，开放骨折4例。胫骨干骨折采用带锁髓内钉内固定23例和AO外固定架结合有限内固定治疗2例，腓骨骨折采用1／3管状钢板内固定9例，内踝和后踝骨折均采用螺钉内固定。伤后至手术的时间平均为5．6d（1．5h～15d）。[结果]术后平均随访23个月（8～36个月）。25例均获骨性愈合，骨愈合时间平均为4．6个月。所有患者均采用Teey和Wiss系统进行主客观评估，优良率84％（21／25）。可16％（4／25）。并发症：浅表感染1例，切口缘皮肤坏死2例。本组无深部感染、骨外露、骨折不愈合和畸形愈合。[结论]胫骨干骨折合并踝关节损伤是相对特殊的多发性骨与关节创伤类型，其发生机制是小腿和踝部连续受到致伤因子的作用。早期明确诊断、适宜的手术时机、积极合理治疗（根据骨折类型选择固定方法，减轻术中创伤，完好的复位，稳定的固定）和重视术后康复指导对患者预后至关重要。     

交通事故伤930例临床分析

随着交通事业的发展,致伤率每年都呈递增趋势,且大多为复合伤。我院自1989年7月至1997年8月共收治各类创伤病人1620例,其中交通事故伤930例,占同期各类创伤病人的57.4％。现结合本组病人的伤情特点与救治措施总结如下: 临床资料 1.一般资料:男680例,女250例,年龄2～82岁。其中15岁以下86人(占9.2％),16～60岁790人(占84.9％),61岁以上54人(占5.9％)。就诊时间:8小时以内540例,8～24小时320例,24小时以上70例。致伤类型:汽车致伤328例,摩托车致伤216例,自行车致伤87例,火车致伤15例,拖拉机等致伤284人例,开放伤880处,闭合伤670处,死亡26人(包括来院已经死亡者),多发伤468例。 1.受伤部位:颅脑外伤118例,多发伤468例,四肢骨折695例,腹部伤87例,胸部伤65例,脊柱伤28例,大面积软组织撕脱伤9例,骨盆骨折65例,颜面部挫裂伤70例,其它42例。 3.伤情特点:伤亡人员中,男性多于女性,年龄以16～60岁居多,受伤部位多,且多发伤多,开放伤多于闭合伤,四肢伤最多,其次是颅脑损伤。 4.治疗:本组行手术治疗750例,保守治疗180例。其中:颅脑伤行手术86例。非手术治疗32例;四肢骨折行手术治疗(含骨牵引)625例,非手术治疗(石膏、小夹板、皮牵引等)70例;腹部伤87例,行手术治疗79例,保守治疗8例,骨盆骨折均行保守治疗,胸部伤     

手术治疗糖尿病患者骨关节损伤24例

我院自1988年7月至1993年12月共收治骨关节损伤的糖尿病患者24例,疗效较好,现报告如下.1 临床资料1.1 一般资料 本组男性15例,女性9例;年龄36岁～83岁,平均55.3岁.致伤原因:平地摔倒16例,车祸4例,重物砸伤3例,高处坠落伤1例.闭合伤19例,开放伤5例.骨折部位:股骨颈骨折5例;股骨粗隆间骨折8例;股骨干骨折2例;胫肼骨闭合骨折2例,开放骨折3例;腰椎骨折脱位合并截瘫3例(FrankelⅠ级);跖骨开放性骨折2例.     

多发伤骨折的及时诊断与早期救治

多发伤骨折的诊治多年来是创伤外科的一大难题,如何减少多发伤骨折的致残率与死亡率,及时诊断与早期救治是治疗的关键,作者根据蔡汝宾提出的"24个部位法"[1],对我院1985年以来救治的335例多发伤骨折中就其资料完整,有随访结果的238例,从其临床特点,诊断及治疗等方面情况讨论报道如下. 1 临床资料 1.1 一般资料:本组男性191例,女性47例,年龄最大76岁,最小7岁,平均38.5岁.受伤原因:交通伤69例、坠落伤53例、压砸伤72例、机器伤29例、其它伤15例.致伤部位:最少2处,最多6处,平均每例3处.     

多发性骨关节创伤60例治疗分析

目的探讨多发性骨关节创伤患者的治疗措施。方法回顾性分析急诊收治的60例多发性骨关节创伤患者的临床救治资料。结果经及时实施救治措施后,58例患者伤情得到有效控制,死亡2例。58例患者均获随访6个月,6例患者出现轻度关节功能障碍,余52例骨折愈合良好,未出现内固定物断裂,骨不连等并发症。结论多发性骨关节损伤,类型复杂且多合并颅脑、胸腹部损伤,及时正确做好伤情评估并实施治疗措施,可有效提高救治成功率,改善患者预后。     

颅脑交通伤合并胸部损伤65例分析

由于车祸致伤机制的复杂性,以及致伤暴力的不规则性与多重性,颅脑交通伤中部分伤病员可合并一定程度的胸部损伤.而颅脑损伤的症状与体征往往能掩盖胸部损伤的某些表现,故可引起漏诊与误诊,死亡率与伤残率高.本院自1996年1月至2000年12月期间,共收治颅脑交通伤合并胸部损伤65例.现就其临床特点及救治作一分析.     

Orthopedic injuries related to snowmobile use

OBJECTIVES: To document the locations of injury, frequency of associated injuries, and need for operative intervention in patients presenting to a tertiary medical center after sustaining an orthopedic injury related to snowmobile use. DESIGN: Retrospective review. SETTING: Tertiary care center with level I trauma designation in southern Minnesota. PATIENTS/PARTICIPANTS: Seventy-eight patients who sustained orthopedic injuries from snowmobile accidents between January 1985 and December 1996 were treated at our institution. Information regarding patient demographics and injury characteristics was collected. These data were stratified into patient populations presenting directly to the emergency department (n = 47) and those referred from outside hospitals (n = 31). RESULTS: A total of 209 injuries (118 fractures, 31 orthopedic soft-tissue injuries, and 60 nonorthopaedic injuries) were diagnosed within the study population. Tibia (n = 20), radius (n = 14), ulna (n = 12), and spine (n = 14) fractures accounted for half of the fractures reported. There were 13 open fractures. Twenty-four fractures were treated operatively. Ligament injuries to the knees (n = 7) and compartment syndrome of the lower extremity (n = 5) represented the most common orthopedic soft-tissue injuries. The acromioclavicular joint was the most frequently dislocated joint (n = 4). Associated injuries commonly involved the head (n = 17), abdomen (n = 13), and chest (n = 9). As compared to patients presenting directly to the emergency department, referred patients on average had a statistically greater number of total injuries, total operations, and operations for fractures. CONCLUSION: Snowmobile accidents represent a frequent cause of orthopedic injuries in northern regions. An understanding of these injuries may help emergency departments prepare for patients injured on these machines. Recognition of the most common orthopedic injuries may help in the design of safer snowmobiles.     

Study on characteristics of fractures from road traffic accidents in 306 cases

OBJECTIVE: To investigate the characteristics of bone fractures from road traffic accidents and analyze their injury mechanisms so as to provide reference for the research and medical care of traffic trauma. METHODS: Three hundred and six patients with fractures from road traffic accidents were included into this study. A total of 507 fractures were identified and the injury mechanism, location distribution and frequency were analyzed. RESULTS: The most common location of fractures was the lower extremities, followed by the upper extremities, skull and maxillofacial region, and the rarest was the spine. A total of 56% of the patients suffered from multiple fractures. The fractures of the patella, femur and pelvis and the fractures of the olecranon, humerus and shoulder often happened simultaneously. CONCLUSIONS: The injury mechanisms can be classified into four types: impact, incoordinate movement, stretch injury and crush and extrusion. The fractures from traffic accidents have the following characteristics: centrifugal distribution of the injuries, multiple fractures, force transmission and ipsilateral occurrence.     

Hand injuries as an indicator of other associated severe injuries

The purpose of this study was to investigate the incidence of disabling or life-threatening injuries in patients with hand injuries. Retrospective data were collected from a level 1 trauma center registry. A total of 472 patients with hand injuries were admitted to the trauma unit between January 2000 and March 2004. Forty-four per cent of patients with hand injuries had life-threatening injuries. Fifty-one per cent of them had motor vehicle crash-related injuries. Motorcycle crashes were the next most common cause followed by explosions, falls, gunshots, machinery, stabs, bites, crushes, and so on. Frequency of associated injuries was as follows: head injuries, 31 per cent, including skull fractures, 22 per cent; spine injuries, 18 per cent, including spine fractures 18 per cent; chest injuries, 36 per cent, including rib fractures, 15 per cent; and abdominal injuries, 13 per cent. The authors focused on the incidence of disabling or life-threatening injuries in patients with hand injuries. Motor vehicle crashes were most common cause of hand injuries. The most common organs to be injured were chest and head. The most common head injury was skull fracture. Other injuries in decreasing order were spine and rib fractures. These data may be helpful in assessing ambulatory patients in the emergency room, in those hand injuries maybe indicative of other simultaneous life-threatening or disabling injuries.     

Diaphragmatic injuries: recognition and management in sixty-two patients.

Between 1979 and 1989, 62 patients were treated for traumatic injury of the diaphragm. Forty-five had penetrating injuries following stab wounds or gunshot wounds, and 17 had diaphragmatic tears from motor-vehicle and auto-pedestrian accidents. Forty-one patients sustained left-sided injuries; 20 patients sustained right sided injuries; and one patient sustained bilateral ruptures. All patients underwent exploratory laparotomy and diagnosis was confirmed at surgery. Diaphragmatic injury was suspected in only 17 (27%) patients preoperatively. The chest radiograph showed nonspecific abnormalities in 48 (77%) patients and was diagnostic in 15 (24%) patients. Six patients had diagnostic peritoneal lavage; five were positive and one was negative. Computerized tomography (CT) of the lower thorax and abdomen was performed on 11 (18%) patients, but not one scan was diagnostic. Fluoroscopy in two patients was helpful. All patients had other associated injuries. The liver, spleen, or stomach were frequently injured in association with penetrating diaphragmatic lacerations. Bony fractures, splenic injuries, and head trauma were more commonly found with blunt diaphragmatic ruptures. The average hospital stay for the penetrating injuries was 11 days and for blunt trauma was 16 days. The operative mortalities was 2 per cent for penetrating injuries and 12 per cent for blunt injuries.     

Spinal injuries in pedestrians struck by motor vehicles

STUDY DESIGN: Retrospective study of consecutive patients that were struck by motor vehicles and sustained spinal injuries over a 6-year period from 1997 to 2003. OBJECTIVE: To determine spinal injury patterns and associated injuries in pedestrians struck by motor vehicles. SUMMARY OF BACKGROUND DATA: Motor vehicle accidents involving pedestrians are associated with high morbidity and mortality rates. METHODS: All injured patients admitted to Level I Trauma and Regional Spinal Cord Injury Center were reviewed retrospectively to identify those who were struck by motor vehicles and sustained injury to the spinal column. Before 2001, clearance of the thoracolumbar (TL) spine was performed by plain radiographs. Beginning in 2001, such clearance was performed by helical truncal computed tomography of the chest/abdomen/pelvis (CT/CAP) that was performed to evaluate potential visceral injuries. RESULTS: Of the 1672 patients who were struck by motor vehicles, 135 patients (8%) were found to have spinal injuries. Cervical injuries were found in 35%, thoracic in 19%, lumbar in 37%, and sacral injuries in 27%. Associated injuries were present in 99% of the patients. By relative risk analyses, there were no regional associations between injuries of the TL spine and injuries to the chest and abdomen. Patients frequently had combinations of injuries in distant locations, presumably from a "double-impact" injury mechanism. Before initiation of the CT/CAP protocol to clear the TL spine, 7% of patients had injuries initially missed by TL radiographs. CONCLUSIONS: Spinal injuries in pedestrians struck by motor vehicles are more evenly distributed throughout the spinal column and more often coexist with injuries to remote organs compared with car occupants and motorcyclists where regional tendencies and isolated spinal injuries are more frequent. A systematic approach to both diagnosis and treatment is, therefore, necessary. Helical truncal CT, performed to evaluate visceral injury, effectively screens for TL fractures.     

Humeral shaft fractures as predictors of intra-abdominal injury in motor vehicle collision victims

To assess the utility of humeral shaft fractures as predictors of organ injuries and skeletal injuries in multiply injured patients involved in motor vehicle collisions (MVCs). A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score (ISS) greater than 12 admitted to a level I regional trauma centre during a 102-month period (January 1992 to June 2000) was reviewed to assess skeletal and organ injuries associated with a humeral shaft fracture. The effect of occupant location within the vehicle, the point of collision, and the use of a seat belt restraint was also examined to identify trends in injury patterns. Data from 1070 motor vehicle occupants - 65 with concomitant humeral shaft fractures and 1005 without humeral shaft fractures - revealed that 63% of motor vehicle occupants who sustained humeral fractures were drivers, compared with 77% in the non-humeral fracture group. Those patients who sustained a humeral shaft fracture had a significantly greater number of liver injuries (p = 0.022), forearm/hand fractures (p < 0.001), tibial fractures (p < 0.01) and femoral fractures (p < 0.01) compared with controls. A lateral collision impact showed a trend towards increased splenic and hepatic injuries within the humeral shaft fracture group. The presence of a humeral shaft fracture in a multiply injured patient involved in a MVC is significantly associated with an increased incidence of both upper and lower extremity fractures and liver injury. Moreover, humeral shaft fractures may serve as a predictor of potential intra-abdominal pathology in multiply injured trauma patients involved in MVCs.     

Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography

BACKGROUND: We assessed acute phase multidetector computed tomography (MDCT) findings of Lisfranc fracture-dislocations in patients with multiple trauma referred to a Level I trauma center over a 29-month period. METHODS: Two hundred and eighty two patients (208 male and 74 female) between the ages of 13 and 89 (mean 42) years had, at the request of emergency room physicians, MDCT of the foot and ankle after acute injury. RESULTS: A total of 21 Lisfranc fracture-dislocations were found in 19 (7%) patients. Two main injury mechanisms were established: falling from high places in 10 injuries (48%) and traffic accidents in five (24%). Primary radiographs were available in 17 (81%) feet, and four (24%) had false negative radiographic results when compared to MDCT. In all Lisfranc fracture-dislocations MDCT showed the joint anatomy and the extent of dislocation better than primary radiographs, and in six (46%) of 13 true positive primary radiographs, MDCT revealed additional occult fractures in the Lisfranc joint. Multidetector CT revealed additional occult fractures in other parts of the foot and ankle in six (35%) of 17 feet. CONCLUSIONS: Standard radiography remains a primary diagnostic modality in acute foot and ankle trauma. Multidetector CT with high-quality multiplanar reconstruction (MPR) is recommended as a complementary examination in high-energy injury in patients with multiple trauma or in patients in whom radiographic images are equivocal. This may reveal Lisfranc fracture-dislocations, show the extent of the fracture-dislocation, and reveal occult fractures in other parts of the foot and ankle.     

Lower extremity fracture fixation in head-injured patients.

Compared with nonsurgical management or delayed repair, early fracture fixation can reduce the incidence of pulmonary complications in patients with long-bone fractures of the lower extremities. Blunt trauma victims often have multiple nonskeletal injuries that might influence the risk of pulmonary complications, and when head injuries are present it has been a common practice to delay nonemergent operations for several days to protect the injured brain. We conducted a retrospective review of 114 patients with multiple trauma whose injuries included head trauma and a fracture of the neck or shaft of the femur or shaft of the tibia to determine if delayed stabilization of lower extremity fractures increased the risk of pulmonary complications or reduced the risk of cerebral complications. Forty-six patients underwent surgical fixation of their fractures within 24 hours of injury (early fixation), 26 patients had their fractures repaired more than 24 hours after injury (late fixation), and 42 patients did not undergo surgical fracture fixation. The risk of pulmonary complications was not related to the timing of surgical fracture fixation but was strongly influenced by the severity of injuries to the head and to the chest (p less than 0.001). Furthermore, a delay in fracture fixation did not protect the injured brain; the risk of CNS events was determined by the severity of the head injury (p less than 0.0001). Early fracture fixation in patients with head injury may be appropriate because it simplifies patient care and does not seem to worsen the head injury, but it does not prevent pulmonary complications in these high-risk patients.     

Scapular fractures and concomitant injuries

Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized.Few studies have investigated this presumed association...     

Incidence and risk factors of knee injuries associated with ipsilateral femoral shaft fractures: A multicentre retrospective analysis of 429 femoral shaft injuries

A femoral shaft fracture is usually a high-energy injury and, thus, is likely to be accompanied by an injury of adjacent joints such as a knee ligament injury. However, these associated injuries are often neglected because of severe pain and deformity. The purpose of the current study is to evaluate the incidence, type and risk factors of ipsilateral knee injuries associated with femoral shaft fractures.A total of 429 femoral shaft fractures were included in this study from January 2010 to September 2015. There were 320 males and 109 females, with mean age of 40.7 years (range, 15–88). Exclusion criteria were skeletally immature patients and patients with metabolic bone disease such as osteoporosis, atypical femoral fractures, and pathologic fractures. The incidence and type of knee injury were identified, and the injury mechanisms, AO/OTA classification of the femoral shaft fractures, were analysed for assessment of risk factors for knee injuries combined with femoral shaft fractures.Knee injuries were found in 131 cases. Knee ligament injuries were identified in 87 cases. There were 20 posterior cruciate ligament injuries, 11 anterior cruciate ligament (ACL) injuries, 16 medial collateral ligament (MCL) injuries, 8 lateral collateral ligament (LCL) injuries, and 32 multi-ligament injuries. In 24 cases, ligament injuries were not detected before internal fixation of femoral shaft fractures. Average time of diagnosis for ligament injury after fixation in these neglected cases was about 10.6 weeks (range, 1–32).Fractures around the knee joint were identified in 69 cases; there were 32 patellar fractures, 14 distal femoral intra-articular fractures, 14 tibia plateau fractures, 3 proximal fibular fractures, and 6 combined fractures.Male sex, type C fracture of AO/OTA classification, and motor vehicle accidents were identified as risk factors for associated ipsilateral knee injuries in femoral shaft fractures.Knee injuries were identified in approximately 30% of femoral shaft fractures. About 30% of ligament injuries were not detected before internal fixation of femoral shaft fractures. Care should be taken since knee injuries can be accompanied by ipsilateral femoral shaft fractures.