澳门镜湖医院救治道路交通伤3648例分析

目的 探讨澳门地区道路交通伤的一些流行病学特点。方法 回顾性统计分析澳门镜湖医院１９９４年１月～１９９８年１２月救治３６４８例道路交通伤病案。结果 道路交通意外致伤３６４２例，死亡６例；轿车和摩托车是造成人员伤亡的主要车型，分别占机动车所致交通伤的４９．８％和３９．１％；机动车与行人碰撞是道路交通伤的主要类型，占５１．８％，儿童组占爱伤行人的４６．４％；大部分交通伤造成的人员损伤较轻微，擦伤、挫裂     

交通事故伤与碰撞类型的关系

对５１１例交通事故伤住院病人的损伤模式和碰撞类型进行了流行病学分析。伤员构成为：摩托车人员占３６．０％、行人占３４．２％、自行车人员占１８．２％和汽车内人员占１１．６％。不同碰撞类型颅脑损伤发生率明显不同（Ｐ＜０．０１）：行人被摩托车撞颅脑损伤发生率高于行人被汽车撞；摩托车人员自身事故颅脑损伤发生率高于骑摩托车被汽车撞者；德国人员颅脑损伤发生率高于摩托车人员。笔者指出各种碰撞类型的交通事故伤原因及     

多发伤定义？

多发伤（polytrauma mulitiple trauma）的含义目前国内外尚无统一标准，但均指有危及生命的严重损伤，在损伤程度、抢救治疗、并发症及预后等都有特殊性。但没有明确的损伤解剖部位及损伤严重度的统一量化标准，无法进行比较，且争议较多。1993年10月中华创伤学会首届全国多发伤学术会议对多发伤定义讨论达成以下共识：（1）多发伤是与单发伤（isolated injury）相对而言；（2）单一致伤因素造成的2个或2个以上解剖部位的损伤称为多发伤；（3）多发伤严重程度：视ISS值而定，凡ISS〉16者定为严重多发伤，如此既有解剖部位的规定又有严重程度的量化标准；（4）单一解剖部位的多处损伤不应使用“多发伤”一词，必须冠以解剖部位命名，如“腹部多脏器伤”、“多发骨关节损伤”等。     

312国道甘肃省境段2004年度交通事故伤流行病学分析

目的探讨312国道甘肃省境段2004年度公路交通事故伤流行病学特征。方法收集312国道甘肃省境段2004年度发生的交通事故资料，并进行统计分析。结果伤亡人员以男性为主，年龄21-50岁；个体户、农民及农民工和交通运输人员是交通事故发生的高危人群；乘车者、行人、自行车和摩托车驾驶员为交通事故的最大受害者；机动车司机的过失是导致事故的最主要原因；损伤部位以头部和多部位伤最多。结论加速公路建设；加强交通管理，严禁违规行车；提高驾驶员和行人安全意识；对交通环境进行综合治理等，是降低交通事故伤害的主要措施。     

昆明市366例道路交通伤特点

目的研究道路交通伤的损伤机制、特点及其法医学意义，为创伤急救提供依据。方法对2004年昆明市366例道路交通伤死亡患者的法医病理鉴定资料进行回顾性研究。结果车内人员挤压伤与砸压伤高于车外人员。机动车驾驶员面骨骨折为行人的2．3倍。货车与拖拉机造成开放性脑损伤为其他车辆的3—5倍，碾压伤是其他车辆的1—2倍。轿车导致颅脑损伤比例高于其他车辆，颅骨、面骨骨折的比例低于其他车辆。结论不同车辆导致损伤的机制、特点不同；货车与拖拉机造成的多发伤多于其他车辆；轿车造成颅脑损伤比例高于其他车辆，颅骨、面骨骨折比例低于其他车辆。     

昆明地区1538例儿童急诊创伤患者流行病学分析

目的 研究昆明市儿童急诊创伤患者流行病学特征,为降低儿童创伤发生率以及合理制定医疗方针提供依据.方法 回顾性分析2019年9月—2020年8月昆明市儿童医院收治的1538例创伤儿童患者的临床资料,从儿童年龄、性别、致伤原因、主要损伤部位及创伤严重程度等方面进行分析,将致伤原因分为跌倒伤、道路交通伤、高处坠落伤、机械锐器伤、呼吸道异物致伤、烧烫伤、其他伤等,统计儿童年龄、性别、构成比及受伤部位;再根据致伤原因分析损伤严重度,制成直观统计表,按轻微创伤、严重创伤分组进行组间比较和数据分析.结果 1538例创伤儿童中,男性1047例,女性491例,男女比例为2.13:1;致伤原因主要为跌倒伤(54.42％)、道路交通伤(15.54％)、高处坠落伤(9.82％)、烧烫伤(8.45％)、呼吸道异物致伤(6.96％)、机械锐器伤(2.47％)、其他伤(2.34％);6岁以下儿童损伤部位以头部为主,6岁以上以四肢为主;损伤严重度评分(ISS)>16分的致伤原因主要为道路交通伤和高处坠落伤;头部损伤是导致严重损伤的主要原因(P<0.001).结论 昆明地区儿童创伤主要原因为跌倒伤和道路交通伤,道路交通伤和高处坠落伤所致创伤严重.因此,应加强对儿童的防跌倒保护,提高交通安全意识,以降低创伤发生率;交通事故和高处坠落为儿童严重创伤和死亡的主要原因,应重点防范.     

睾丸交通伤24例临床分析

目的：总结睾丸交通伤的诊治体会。方法：24例睾丸交通伤，年龄18－61岁。其中20例合并其他部位损伤；10例行阴囊B超检查；11例立即手术治疗，13例保守治疗。同时，与同期睾丸非交通伤30例进行对照分析。结果；手术治疗11例中，3例发现睾丸破裂行睾丸切除术，其余8例采用血肿清除术；保守治疗13例中，5例延期手术。睾丸交通伤的主要特点：（1）睾丸损伤程度重；（2）合并伤多；（3）容易漏误诊；（4）临床表现严重而复杂。结论：睾丸交通伤应早期手术，但当合并其他部位损伤时，应根据患者伤情程度及局部情况等决定。早期诊断，及时治疗是治愈本病的关键。     

多发伤的急救处理

多发伤是指同一致伤因素所引起人体两个以上解剖部位或脏器的严重损伤。其特点是：（1）伤情复杂、生理紊乱严重、失血量多、往往并发休克；（2）死亡率、致残率高；（3）发生率随交通及工业发展日渐增高；（4）不允许过多检查、容易漏诊；（5）各部损伤的治疗应有先后顺序并依伤情变化而调整。多发伤的急救，一方面是判断伤情的轻、重、缓、急；另一方面进行心、肺、脑的复苏。治疗的基本原则是缩短休克持续时间，防止不可逆休克的发生。多发伤的急救处理应在统一指挥下，在综合判断的同时，由多科医生共同进行治疗，但首先应治疗对生命危…     

302例汽车驾驶员交通伤特点分析

汽车驾驶员交通伤因车辆碰撞部位不同 ,伤情复杂。笔者总结我院收治的30 2例汽车驾驶员交通伤伤情特点 ,报告如下。资料与方法我院交通伤急救中心 1995年 7月～ 1999年 7月共收治汽车驾驶员交通伤30 2例 ,其中男 2 6 6例 ,女 36例 ;年龄 2 0～48岁。按所驾驶汽车被碰撞部位分为前部碰撞、尾部碰撞、侧方碰撞和车辆翻滚。对不同碰撞类型驾驶员受伤部位和损伤程度进行比较分析。损伤严重度采用Ｂａｋｅｒ等[1 ] 提出的ＩＳＳ评分法进行评估。损伤严重度分为Ⅲ度 :轻度损伤 ,ＡＩＳ≤ 2 (ＩＳＳ≤ 8分 ) ;中重度损伤 ,ＡＩＳ =3(ＩＳＳ 9～ 15…     

道路交通伤院内死亡分析

目的 探讨道路交通伤院内死亡原因和流行病学特点。方法 统计分析１９８１年１月￣１９９６年１２月我院收治路交通伤院内死亡病例的致伤方式,部位和创伤严重等特点,对死亡时间与原因的关系行Ｒｉｄｉｔ分析,结果 交通伤院内死亡伤员年龄较大,农民所占比例明显上升;致伤方式多为机动车肇事;颈椎和腹部致伤比较常见;死亡原因依伤后时间不同而有明显区别,据此可将其病程分为脑损伤休克期（急性期）、过渡期,感染期和多脏器     

Pediatric pedestrian versus motor vehicle patterns of injury: debunking the myth

INTRODUCTION: Mechanism of injury has been widely used to enhance the ability of EMS providers to recognize predictable injury patterns. One such pattern, referred to as "Waddell's triad," identifies a triad of injuries associated with pedestrian/motor vehicle collision (MVC), including trauma to the head, abdomen, and lower extremities. We questioned this choice as a common injury pattern for this mechanism. METHODS: A retrospective chart review of 4444 pediatric trauma patients admitted to a regional pediatric trauma center between 1992 and 1996. The source of this information was the medical center's trauma registry. RESULTS: Four-hundred-sixty-five patients suffered a pedestrian/MVC and were included in the study; 231 suffered head injury, and 78 experienced a combination of head and leg injury. Only 11 patients (2.4%) suffered the predicted "triad" of head, leg, and abdominal injury as a result of pedestrian/MVCs. Two of these children suffered minor head injury, and only one patient (0.2%) suffered injury as originally described by Waddell. CONCLUSION: Although the concept of Waddell's triad is logical, and a high index of suspicion should be maintained, the incidence of this predictable injury pattern is low. Educational emphasis should be placed on other aspects of mechanism of pedestrian injury.     

Reconstruction of the dynamic in a fatal traffic accident with prolonged dragging of the victim

The post-mortem examination of victims of fatal road crashes and the reconstruction of the dynamic of traffic accidents are fundamental in vehicular homicides, where the degree of negligence/careless of the driver has to be established. Here we present a case in which a pedestrian was dragged along an SUV for 3.5 km, until the vehicle was parked at the house of the driver, arising the suspect of vehicular manslaughter and failure to provide assistance.On the basis of death scene investigation, analysis of video recording from a surveillance camera, post-mortem computerized tomography (PMCT) and complete post-mortem examination, including gross and microscopical findings, the accident was reconstructed as a frontal collision between the right portion of the bumper and the right side of the body of a standing pedestrian, with deformation of the bumper and production of a metal sheet hook; secondary run-over the right feet, cranio-facial trauma against the bodywork of the vehicle and hooking of the right hand of the victim to the metal sheet; prolonged dragging of the pedestrian over the road surface and severe bleeding.A multidisciplinary-multimodal methodology, including PMCT, allowed to assess the cause of death as hemorrhagic shock, suggested that the victim would have likely survived if the vehicle had stopped, and is increasingly recommendable in fatal road accidents.     

Patterns and mechanisms of pedestrian injuries induced by vehicles with flat-front shape

To clarify the difference between flat-front vehicles and bonnet-front vehicles with regard to the patterns and mechanisms of vehicle-induced pedestrian injuries, we investigated 101 cases of pedestrians who were struck by the front of a vehicle. There were 33 flat-front vehicle collision cases and 68 bonnet-front vehicle collision cases. The frequency of chest injuries in flat-front vehicle collisions (30.3%) was significantly higher than that in bonnet-front vehicle collisions (11.8%). Lower leg fractures were more common in bonnet-front vehicle collisions than in flat-front vehicle collisions. Although head injuries were common in both cases, the mechanisms of these injuries differed. The pedestrians who were struck by flat-front vehicles tended to sustain more severe injuries at lower impact speeds. All of these results stem from the difference in the front shape of the two types of vehicle. Pedestrians who are struck by the front of flat-front vehicles receive the impact force to the trunk, particularly the chest, at the initial impact and are thrown out forward after the impact, because the front of these vehicles is perpendicular to the road.     

Current role of lateral cervical spine radiograph: a case report

We report a case showing the classic features of a Hangman's cervical spine fracture following a motor vehicle collision. Because this injury was not diagnosed at ED presentation, this case also illustrates the select subset of trauma patients for whom the almost obsolete lateral cervical spine radiograph remains an important part of the radiographic trauma series.     

Predicting driver from front passenger using only the postmortem pattern of injury following a motor vehicle collision

This study aimed to establish whether post-mortem injury patterns can assist in distinguishing drivers from front seat passengers among victims of motor vehicle collisions without regard to collision type, vehicle type or if safety equipment had been used. Injuries sustained by 206 drivers and 91 front seat passengers were catalogued from post-mortem reports. Injuries were coded for the body region, depth and location of the injury. Statistical analysis was used to detect injuries capable of discriminating between driver and passenger. Drivers were more likely to sustain the following injuries: brain injury; fractures to the right femur, right posterior ribs, base of skull, right humerus and right shoulder; and superficial wounds at the right lateral and posterior thigh, right face, right and left anterior knee, right anterior shoulder, lateral right arm and forearm and left anterior thigh. Front passengers were more vulnerable to splenic injury; fractures to the left posterior and anterior ribs, left shoulder and left femur; and superficial wounds at the left anterior shoulder region and left lateral neck. Linear discriminant analysis generated a model for predicting seating position based on the presence of injury to certain regions of the body; the overall predictive accuracy of the model was 69.3%. It was found that driver and front passenger fatalities receive different injury patterns from motor vehicle collisions, regardless of collision type. A larger study is required to improve the predictive accuracy of this model and to ascertain its value to forensic medicine.     

Abdominal aortic injury associated with “seat belt syndrome”

Flexion–distraction spinal injuries and intra-abdominal visceral injuries have a well-recognized association with the use of passive restraints during motor vehicle collisions. Abdominal aortic injury due to blunt trauma is rare. However, there is a reported association of this injury with seat belt use. We report a case of a restrained passenger in a motor vehicle collision who sustained this triad of injuries, with the abdominal aortic injury not initially suspected.     

Gastric rupture following multiple blunt trauma

Gastric injury due to trauma is a rare complication that occurs in approximately 0.04%-1.2% of all instances of abdominal trauma. When imaging trauma cases, certain areas can be obscured by several inevitable reasons. Despite its rarity, the high mortality rate of a gastric injury requires an early and accurate diagnosis. We present the case of an 18-year-old male who suffered a gastric rupture of the greater curvature following a road traffic collision before providing a brief review of the literature.     

Analysis of 47 road traffic accident admissions to BMH Shaibah

OBJECTIVE: To analyse road traffic accident (RTA) admissions to British Military Hospital (BMH) Shaibah with respect to seatbelt usage, position in vehicle, age, type of injury and mechanism of injury. METHOD: Retrospective analysis of discharge summaries and hospital notes of all service personnel admitted to BMH Shaibah due to RTA, from August 2003 to January 2004. Results During the study there were 315 reported RTA, 3 fatalities, and 47 inpatient admissions. 87% of admissions were male; in 32% of cases the vehicle had rolled and 28% of individuals admitted had been ejected from the vehicle. 85% of individuals had not been wearing their seatbelts and none of the ejected individuals had been restrained. 92% of those ejected were travelling in the rear of the Land Rover. Of those ejected, 38% suffered more than one type of injury, and 62% suffered a fracture, (accounting for 50% of all fractures admitted). 34% of admissions had sustained a fracture, and were evacuated to the UK. CONCLUSIONS: These figures correlate well with previous evidence showing the likelihood of serious injury is increased by more than 300% if the patient is ejected. Those travelling in the rear of a Land Rover would appear to be in the most dangerous position. Seatbelts are the single most effective means of reducing fatal and non-fatal injuries in motor vehicle accidents. Standing orders states that seatbelt use mandatory, but compliance is poor. This may be due to misconceptions on the relative dangers faced by soldiers in Iraq. Education and enforcement needs to be more effective if the Army is to reduce the number and seriousness of injuries attributable to RTA.