52例严重骨盆型多发伤的救治

目的 总结严重骨盆型多发伤的救治经验和救治程序,以期进一步提高其救治水平.方法 2003年1月～2007年7月对52例严重骨盆骨折进行损伤严重度评分(AIS-ISS)和全身炎症反应综合征 (SIRS)评分,抗休克治疗, 骨盆外固定器固定 下肢骨牵引,创伤重症监护室(ICU)监护和稳定后骨盆切开复位内固定.结果 全部病例当天血压恢复正常,无死亡.优19例,良18例,优良率达71%;可12例,差3例.结论 严重骨盆型多发伤的院内救治应遵循损害控制原则,按照特定的救治程序进行,并强调骨盆外固定支器 下肢骨牵引的应用.     

严重多发伤时损伤控制骨科应用41例

目的 探讨严重多发伤时损伤控制骨科（DCO）应用的可行性和疗效。方法对1995年1月-2005年12月应用DCO方法救治严重多发伤41例的临床资料进行回顾性分析。结果29例严重多发伤伴骨盆骨折大出血，均行髂内动脉断血术，其中双侧髂内动脉结扎21例，双侧髂内动脉栓塞术8例，早期骨盆外固定支架使用10例。10例严重多发伤伴开放性股骨骨折初期仅行清创和简单外固定。2例脊柱骨折伴脊髓压迫行简单椎板减压。均在ICU复苏治疗后，再做确定性内固定手术。本组死亡率12％（5／41），死亡组损伤严重度评分（ISS）平均值41．4分，主要死于休克和合并伤。共发生并发症7例，合并急性呼吸窘迫综合征（ARDS）3例，右髂总动脉血栓形成1例，2例膈下脓肿，1例下肢深部感染，均痊愈。结论迅速准确的诊断和一体化治疗，是提高严重多发伤生存率的关键，合理应用DCO是安全有效的方法。     

严重多发伤骨盆环不稳定骨折的损害控制治疗

目的探讨采用损害控制技术治疗不稳定骨盆骨折合并严重多发伤的疗效。方法回顾性分析我院自2005年1月～2009年12月收治的17例不稳定骨盆骨折合并严重多发伤的临床资料,均采用骨盆外固定支架固定等损害控制措施救治。结果本组17例中1例死亡,16例抢救成功。15例进入ICU救治,在ICU治疗时间平均6.2天。16例中有12例获得随访,其中4例返回原工作岗位,5例生活自理,3例还需进一步治疗。结论采用骨盆外固定支架固定等损害控制措施可提高骨盆不稳定骨折合并严重多发伤的救治成功率。     

合并骨盆骨折严重多发伤的一体化救治

目的探讨合并骨盆骨折严重多发伤的治疗方法。方法回顾性分析2002年3月～2008年12月间通过院前急救、院内创伤专业化诊治的一体化救治模式救治89例合并骨盆骨折严重多发伤的临床资料,分析我院一体化救治特点和提高疗效的关键因素。结果本组髂内动脉栓塞14例、结扎27例,骨盆填塞2例;腹腔脏器手术64例;胸腔闭式引流及呼吸支持29例;开颅手术5例;脊柱四肢骨折内固定42例;软组织修复26例。死亡率5.6%(5/89),死因为多器官功能障碍综合征(MODS)。最终骨盆内固定72例,外固定12例。并发症:骨折深部感染5例,深静脉血栓5例,脂肪栓塞综合征3例,肺不张8例,黏连性肠梗阻4例,Ⅰ型呼衰8例,急性肾功能衰竭2例。84例平均随访12.6个月,按刘利民等评价标准:优53例,良21例,中7例,差3例;优良率88.1%(74/84)。结论院前急救与院内创伤专业化诊治的一体化救治及并发症处理是提高合并骨盆骨折严重多发伤疗效的关键。     

损伤控制骨科技术在严重多发伤合并骨折治疗中的应用

目的 探讨严重多发伤时损伤控制骨科(damage control orthopedics,DCO)技术应用的可行性、适应证和疗效.方法 对1998-2008年应用DCO方法救治的31例严重多发伤合并骨折患者的临床资料作回顾性分析.结果18例严重多发伤伴骨盆骨折大出血,早期双侧髂内动脉结扎17例,早期骨盆外固定支架使用12例.11例严重多发伤伴开放性股骨骨折初期仅作清创和简单外固定,后期确定性内固定手术.2例脊柱骨折伴脊髓压迫,早期经后路行简单椎板减压.ICU治疗时间为1～11 d,平均4.3 d.本组患者死亡1例,其余30例全部生存.结论DCO更符合外伤后患者的病理生理特点,早期针对性控制处理及后期的一体化治疗是提高严重多发伤生存率的关键.     

严重交通伤与坠落伤救治结局比较和创伤急救模式探讨

目的 进一步提高严重交通伤（ＲＴＴ）与坠落伤（ＦＩ）的救治水平。方法 为重庆急救中心１９９６年８月～１９９７年７月救治的严重ＲＴＴ和ＦＩ（ＩＳＳ≥１６或ＡＩＳ≥３）结局进行比较分析。结果 ＲＴＴ２１９例,ＦＩ１１７例。严重多发伤组的致死率及其死亡及其死亡组ＩＳＳ值ＦＩ显著高于ＲＴＴ（Ｐ〈０．０５）,其腹部和（或）盆腔脏器伤、上肢伤、下肢和（或）骨盆伤、脊柱的发生率ＦＩ显著高于ＲＴＴ（Ｐ〈０．０１或     

骨关节型严重多发伤的损害控制治疗

目的探讨损害控制在骨关节型严重多发伤救治中的作用。方法回顾性分析损害控制在26例骨关节型严重多发伤救治中的经验,研究骨科损害控制的方法、时机。结果本组26例全部生存,19例返回原工作岗位,7例生活自理,其中3例尚需继续治疗。结论(1)严重多发伤的ISS_(90)≥17分,骨关节型严重多发性损伤中,则以骨与关节损伤为主的ISS_(90)≥16分。(2)骨科损害控制有利于提高骨关节型严重多发伤的救治。特别是对四肢和骨盆骨折,外固定器临时固定能有效地控制损害。     

进一步提高骨关节创伤的治疗水平

骨关节创伤是最常见的创伤，我国近20-30年来就其治疗取得了巨大的进步，主要有：（1）脊柱脊髓损伤的预防宣传和院前急救运送技术的提高，早期使用大剂量的甲基强的松龙治疗方案，脊柱三柱学说和影响学诊断水平的提高，脊柱骨折固定技术的提高；（2）尽早固定不稳定骨盆骨折以控制出血和休克，多学科协同救治伴有重度骨盆骨折的多发伤，手术复位和固定有明显移位的不稳定型骨盆环骨折；（3）四肢骨关节损伤治疗从“AO”到“BO”的转变，骨外固定技术的发展，多发骨折救治的损害控制性处理。     

严重开放性骨盆骨折损害控制手术策略探讨

目的探讨严重开放性骨盆骨折合并毗邻脏器损伤的术中损害控制外科（DCS）程序。方法回顾性分析2002年1月～2011年12月收治的21例严重开放性骨盆骨折的临床资料。初期行髂内动脉结扎19例,选择性髂内动脉造影栓塞2例;伤道和腹膜后填塞止血11例;膀胱造瘘7例,膀胱修补加尿道会师2例;腹膜内结直肠伤I期修补4例,造瘘1例;腹膜外直肠伤结肠造口13例,远近端钳夹留待Ⅱ期手术3例;骨盆外固定支架固定14例;其他合并伤予相应处理。确定性骨盆整复内固定及结直肠和后尿道重建术留待后期。结果死亡6例（29％）,死因为大出血致严重休克5例,腹腔盆底严重感染致多器官功能衰竭（MODS）1例。并发症7例次：直肠膀胱瘘3例,腹腔间隙综合征（ACS）2例,髂血管血栓形成截肢1例,截瘫1例;除截瘫外,其余均非手术治疗临床治愈。结论髂内动脉结扎加填塞是治疗严重开放骨盆骨折出血的重要手段;合并膀胱结直肠损伤时应完成初期改道术;应常规安置骨盆外固定支架。     

多发伤中肾脏损伤的诊治

目的：探讨在多发伤中肾脏损伤的诊治。方法：对1992-2000年间收治的560例多发伤肾损伤进行回顾性分析。多发伤（ISS16-40）肾损伤合并脾破裂158例，肝破裂74例，骨盆及四肢骨折92例，脊柱骨折102例，胸外伤26例，膈肌破裂7例，颅脑损伤101例。肾脏损伤：I类肾挫伤233例，II类肾挫裂伤174例，肾包膜下血肿44例，III类肾实质破裂103例，IV类肾蒂撕裂伤6例。血尿554例。结果：行肾切除34例（占肾手术的63％），肾修补20例（37％）；保守治疗506例，除18例严重损伤死亡外，其余救治成功。结论：多发伤的治疗首先是抢救生命，对肾损伤仍以保守治疗为主。术前来不及行相关检查而行剖腹探查术是肾切除率增高的原因之一。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.