汶川、玉树、芦山地震伤员伤情分析与救治比较

目的分析比较汶川、玉树、芦山地震伤员的伤情特点及治疗方法,总结经验,为应急救治提供参考。方法首先对后送的406例伤员进行损伤分类,成立以骨科为主的医疗小组,请专家会诊手术,优先处理急、危重伤员,制定综合治疗措施。结果所有救治的伤员均未死亡,汶川地震中10例(11肢)行截肢术,3例截瘫,无严重并发症发生。结论汶川、玉树、芦山地震因地震强度、地域差异及发生时间的不同导致伤情不同,但治疗策略相同,根据伤员自身特点制定其具体治疗方案,疗效满意。     

汶川地震后送伤员的伤情调查分析

目的：调查分析汶川地震后送伤员的伤情。方法：对汶川地震后2周转来长海医院的34例地震伤员伤情进行调查，重点对伤员伤情、分类、救治方法进行分析。结果：受伤现场伤员急救、分类与转送，对合并软组织损伤的骨折伤员选择性应用外固定支架、积极修复软组织损伤，辅以积极的心理评估与干预，能有效地提高地震伤治愈率，减少并发症的发生。结论：总结汶川地震后送伤员的伤情特点与救治经验，为地震伤员的救治提供了初步依据和方法。     

四川大学华西医院在汶川地震和芦山地震中收治的伤员伤情对比分析

摘要：目的了解不同震级的地震对地震医学救援中三甲医院所收治伤员伤情的差异,为地震医学救援决策的制定和医疗资源的配置提供参考。方法回顾性分析2008年“5·12”汶川地震和“4·20”芦山地震中四川大学华西医院收治的住院地震伤员的临床资料,比较两次地震伤员的性别、年龄、来院时间、受伤机制、伤情分类和治疗转归。结果共纳入汶川地震伤员1856例,其中男974例、女882例,年龄（45．8±22．7）岁;芦山地震伤员316例,其中男174例、女142例,年龄（43．0±23．1）岁。两次地震伤员的性别与年龄差异均无统计学意义（P〉0．05）。但汶川地震伤员来院的高峰明显后移,持续时间明显延长;汶川地震中,重物砸伤和掩埋伤所占比例明显高于芦山地震,伤情也明显较重,住院死亡率明显较高;与汶川地震伤员相比,芦山地震伤员中胸外、颅脑外伤的患者比例明显较高,四肢外伤的比例有所下降。结论（1）地震时地质物理破坏程度将会对地震伤员的受伤机制产生明显影响,高震级的地震,重物砸伤和掩埋伤的患者比例将会明显增高,相应的,高处坠落伤和跌伤的患者比例会下降,导致患者病情更重,死亡率更高。（2）地震时地质物理破坏程度将会明显影响到地震伤员的后送,越高震级的地震后,伤员来院的高峰会越往后推迟,甚至无明显的高峰出现,但病员流的时间会明显延长,对医院工作的影响较持久。相应的,在伤员后送影响不大的较低震级地震中,伤员来院的高峰会明显提前,病员流的持续时间不会太长,对医院日常工作的影响持续较短。（3）伤员后送的障碍将会影响到患者的及时处理,从而影响到胸外、颅脑外伤患者的预后,最后影响到到院伤员胸外和颅脑外伤的构成比例。与震级较高的地震相比,在较低震级的地震后,应更加加强胸外科、神经外科的救治力量,以保证对此类伤员的及时救治。     

5.12汶川8.0级地震伤员的四肢放射学表现分析

目的分析5．12汶川8．0级地震中伤员四肢损伤类型和影像表现。方法回顾分析自2008年5月13日-5月27日在绵阳市中心医院放射科就诊的1121例地震伤员中四肢检查的671伤员的放射学资料，其中平片检查668人，约1200处投照部位，CT检查19人23个部位。结果446例伤员放射学检查为阳性，总阳性率约为66．47％，其中四肢单部位损伤为355例（52．91％），多个四肢损伤为91例（13．56％）。共有558个部位损伤，按发生率高低排列，依次为胫腓骨142例（25．45％），足踝113例（20．25％）、髋关节及股骨112例（20．07％），肘关节及尺桡骨54例（9．68％）、肱骨47例（8．42％），手腕38例（6．81％），肩关节36例（6．45％），锁骨16例（2．87％）；按照骨折类型，粉碎性骨折317例（56．81％），横行骨折102例（18．28％），关节脱位37例（6．63％），斜行骨折37例（6．63％），螺旋形骨折31例（5．56％），线形骨折17例（3．05％），嵌插骨折13例（2．33％），骺分离4例（0．72％）。结论地震造成四肢损害以下肢为主，骨折类型以粉碎性骨折及横行骨折为主。     

汶川与玉树地震伤员伤情分析及医疗救治的比较

目的 分析比较汶川与玉树地震中收治伤员的伤情特点与治疗策略,总结救治经验,为改进应急医疗提供参考.方法 采集在两次地震中收治伤员的临床资料,分析伤情及救治特点并比较.结果 两次地震后伤员在伤情特点上存在明显差异,医疗策略基本相同,但在具体实施上存在差异.结论 在两次地震后送伤员医疗救治中能根据病情特点制定相应的治疗策略和实施方法,疗效满意.应进一步总结经验,建立完善的应急医疗救援预案.     

汶川地震陇南灾区份隋调查与分析

目的：调查分析汶川地震甘肃陇南伤情情况，进一步讨论如何采取措施应对突发灾害。方法：采用问卷调查、访谈等方法，对甘肃陇南地震受灾人口进行抽样调查，重点对伤员伤情、致伤原因、救治方法进行统计学分析。结果：在此次地震伤抽样调查中共有1652例，死亡16例，四肢骨折患者750例，占45．4％，精神、神经方面40例，占2．4％。通过有组织的及时救助伤员，减少了并发症的发生，降低了死亡率。结论：加强地震伤的预防与救治，从而有效地减少致死率和致残率。     

汶川地震陇南灾区伤情调查与分析

目的：调查分析汶川地震甘肃陇南伤情情况，进一步讨论如何采取措施应对突发灾害。方法：采用问卷调查、访谈等方法，对甘肃陇南地震受灾人口进行抽样调查，重点对伤员伤情、致伤原因、救治方法进行统计学分析。结果：在此次地震伤抽样调查中共有1652例，死亡16例，四肢骨折患者750例，占45．4％，精神、神经方面40例，占2．4％。通过有组织的及时救助伤员，减少了并发症的发生，降低了死亡率。结论：加强地震伤的预防与救治，从而有效地减少致死率和致残率。     

玉树地震骨折伤员的伤情分析

目的 分析玉树地震所致骨折伤员的伤情特点,为合理调配、使用医疗资源,更好实施地震灾区的医疗救援提供参考. 方法 对2010年4月14至21日收治的582例玉树地震骨折伤员的临床资料进行整理,分析性别、年龄、民族构成,伤情分布,以及骨折特点(骨折部位、骨折类型、合并伤)与性别和年龄的关系. 结果 582例骨折伤员中男性占48.3％ (281/582),女性占51.7％ (301/582).不同年龄段所占比率大小依次为成人(81.6％,475/582)、老年(12.4％、72/582)、儿童(5.8％,34/582)、婴儿(0.1％,7/582).骨折伤员中85.1％ (495/582)为藏族、汉族其次(12.0％,70/582).最常见的是下肢骨折(26.3％,153/582),其次是骨盆、髋臼骨折(21.6％,126/582),最少见的是手外伤(5.0％,29/582).骨盆、髋臼骨折伤员中女性例数多于男性,差异有统计学意义(p=0.001);而其他骨折部位、骨折类型、合并伤的男女例数差异均无统计学意义(P＞0.05).骨折部位、骨折类型、合并伤在不同年龄段分布差异均无统计学意义(p＞0.05). 结论 玉树地震骨折伤员中成年人占绝对多数,男女比率相当;骨折特点与伤员的年龄和性别无关系;地区特殊的房屋结构决定了开放骨折和合并挤压综合征的伤员比率相对低.     

河北省经治汶川地震172例伤员的流行病学分析

目的 探讨汶川地震转运至河北省172例伤员的临床流行病学特征.方法 调查172例汶川地震伤员,统计其性别和年龄构成、致伤原因、损伤部位、并发症及漏诊率等项目,并进行分析. 结果地震伤员男性多于女性,男女性别比为1.26:1,中老年人居多.致伤原因以砸伤和摔伤为主,损伤部位以胫腓骨、胸部和足踝为多见.主震和余震中伤情分布不同.地震直接导致的损伤漏诊率达21.5%,以头、胸部损伤漏诊为主.深静脉血栓发生率达3.5%,肌间血栓发生率为16.9%. 结论本调查提示了汶川地震转诊伤员的部分流行病学特征,为地震伤员的救治和分诊以及大样本地震伤员的流行病学调查提供了参考.     

芦山地震中合并胸部外伤和骨科相关伤员院前处理措施的对比分析

目的探索芦山地震后现场救援队伍及一线医院对胸部外伤伤员院前处理措施的重视程度,为以后灾害救援应急预案的制定、技术培训、物资和人力准备提供参考依据。方法回顾性分析“4·20芦山地震”期间华西医院共收治的365例伤员的临床资料,其中合并胸部外伤63例,男40例（63．5％）、女23例（36．5％）,年龄（49．08±19．10）岁。骨科相关伤员244例,男133例（54．5％）,女111例（45．4％）,年龄（41．59±22．74）岁。将合并胸部外伤伤员和骨科相关伤员在院前所接受的专科处理和一般处理进行比较分析。结果合并胸部外伤需要院前接受专科处理伤员51例,但实际只有10例（19．6％）在院前得到专科处理,骨科相关伤员中需要院前接受专科处理伤员220例,但实际有162例（占73．6％）在院前得到专科处理,二者差异有统计学意义（P〈0．05）。合并胸部外伤伤员与骨科相关伤员院前一般处理措施中接受镇痛和抗感染处理情况的差异无统计学意义（P〉0．05）。结论此次震后院前救援中,胸部外伤伤员在院前处理中受重视程度低于骨科相关伤员。希望在以后的灾害救援中提高对胸部外伤伤员院前处理措施的重视程度。     

伴月骨周围不稳定的舟骨骨折

目的：探讨日本名古屋地区伴月骨周围不稳定舟骨骨折的发生率、相关因素、诊断和治疗。方法：对11例经腕关节镜检查确认系伴月骨周围韧带损伤的病例进行了回顾性研究，分析其临床特点、治疗方法和疗效。结果：舟骨骨折中，合并舟月或月三角韧带损伤的发生率为20．4％，其韧带损伤与左腕受伤显著相关，63．6％合并近排腕骨背伸不稳定（dorsal intercalated segment instability,DISI), 仅有1例可见明显的舟月分离。通过对应治疗，其疗效与单纯舟骨骨折相比无明显差别。结论：伴月骨周围不稳定的舟骨骨折并不罕见，腕关节镜检查可提高其检出率，积极治疗可取得较好的疗效。     

2016年至2018年河北医科大学第三医院骨盆骨折住院患者的特征分析

目的探讨2016年至2018年间河北医科大学第三医院骨盆骨折住院患者的流行病学特征。 方法利用医学影像计算机存档与传输系统及病案查询系统,收集2016年1月至2018年12月期间诊治的所有骨盆骨折患者资料,分析患者的人口统计学、基本社会学资料、外伤因素、手术因素等情况。 结果共收集357例骨盆骨折住院患者,2016年至2018年骨盆骨折住院患者逐年递增。男234例,女123例,男女比为1.90：l。男性、女性患者骨折高发年龄段为41~50岁（39.7%）。农民（166例,46.5%）、农村（290例,81.2%）及春季患者（104例,29.1%）所占比例较高。交通伤（169例,47.3%）及高能量损伤（284例,79.6%）患者所占比例最高。骨盆骨折行手术治疗患者居多（287例,80.4%）,其中行内固定手术（266例,74.5%）、钢板固定（190例,71.4%）及切开复位患者居多（209例,72.8%）,麻醉方式多采用局麻（176例,49.3%）或全麻（155例,43.4%）。 结论本研究提示骨盆骨折多见于农民,春季多发,41~50岁患者居多,交通伤等高能量损伤为主要的致伤原因,切开复位内固定为临床主要手术方式;近3年来我院骨盆骨折患者呈上升趋势。     

Contributing factors influencing the functional outcome of floating knee injuries

The purpose of the present study was to retrospectively review the floating knee injuries treated at our institute and to determine various factors, such as severity of soft-tissue or skeletal injuries, site of fractures, and treatment methods that may significantly influence the final functional result in these injuries. Between 1986 and 1996, 65 patients with 66 floating knee injuries were treated in our institution. Among 66 fractures of the femur, 19 (29%) were open. There were 43 open tibial fractures. Fifty cases were Fraser type I floating knee fractures, 7 were type IIa, 2 were type IIb, and 7 were type IIc. In 63 cases (95%), both bones had been surgically stabilized with interlocked nails, Ender pins, plates, screws with/without pinning, or external fixations. Final functional results were evaluated according to Karlstr?m and Olerud's criteria. Satisfactory results were rated as cases with excellent or good results. The mean follow-up time was 16.6 months range, (12-50 months). We assessed various factors influencing functional results, including Fraser type, severity of open injury grade (Gustilo) in both fractures, combination of open/closed injuries, fracture types (AO/ASIF type), existence of multiple trauma, neurovascular injuries, polyskeletal trauma, and stabilizing method or operation timing of both fractures. Satisfactory rates in Fraser type I and type II were 64% and 25%, respectively (P= .02). The satisfactory rate in closed, grade I+II, and grade III injuries of the femoral fractures was 53.2%, 81.8%, and 25%, respectively (grade I+II vs. grade III: P < .03). There were no significant correlations between the functional result and the following factors: soft-tissue injuries of the tibia; the fracture pattern of both fractures; the combination of open/closed injuries in each fracture; injury severity score; the existence of neurovascular injuries and double femoral fractures; treatment methods; and operation timing. Severity of damage to the knee joint and open injuries in the thigh were found to be significant factors contributing to the functional outcome in floating knee injuries.     

后环内固定加前环外固定治疗不稳定性骨盆骨折

目的探讨骨盆后环内固定术加前环外固定支架固定术治疗不稳定性骨盆骨折的疗效。方法 2005年1月至2008年7月共治疗不稳定性骨盆骨折17例,男14例,女3例,年龄16~57岁,平均34岁。腹股沟处骨折端外露1例,合并盆腔脏器损伤5例,股动脉损伤后血栓1例,腰骶神经损伤5例,下肢骨折4例,胸部外伤1例。均行快速复苏,12例同时行骨盆骨折外固定支架外固定术,复苏后行后环切开复位内固定术、继续前环外固定支架固定治疗;5例复苏后行后环切开复位内固定术、同时行前环外固定支架固定治疗。结果随访6~48个月,平均20.6个月,按照Co le等骨盆骨折效果评分表进行功能评价,17例中功能恢复优12例,良3例,可2例,差0例,优良率88.2%。无死亡病例,无切口感染,有2个钉道感染,无医源性损伤,腰骶神经损伤完全恢复3例,部分恢复2例。结论采取后环内固定术加前环外固定支架固定术治疗骨盆不稳定性骨折,可以获得稳定固定,疗效可靠,且手术操作简单、安全,创伤小、并发症少。     

颈椎横突孔骨折合并椎动脉损伤

目的：研究颈椎横突孔骨折患者椎动脉损伤的发生率及椎动脉损伤的临床特征。方法：选择2000年8月-2003年6月，CT证实的25例急性颈椎横突孔骨折患者进行颈部动脉磁共振血管造影(MRA)检查。结果：12例患者发生椎动脉损伤(48％)，其中8例为单侧损伤，4例为双侧损伤；椎动脉损伤的发生率在横突孔骨折伴小关节绞锁脱位组与横突孔骨折无小关节绞锁脱位组之间有统计学差异(P=0．03)。2例椎动脉损伤患者出现椎基底动脉缺血症状。结论：急性颈椎横突孔骨折患者椎动脉损伤的发生率较高，尤其伴小关节绞锁脱位者；大多数椎动脉损伤患者无特异性临床表现。     

Fractures of the dens and risk of pseudarthrosis

Summary This study deals with 49 fractures of the dens treated at the Orthopedic Department of Athens University during the past 17 years. These fractures represent 14.2% of all cervical fractures treated during the same period at our department. Forty-one cases have been reviewed and analyzed, the average follow-up time being 10 years (1–16). Pseudarthrosis was found to be present in seven cases (17%), and its relationship to different factors was examined. The type of fracture and particularly the direction of the fracture line were found to be major factors leading to pseudarthrosis. Many other factors, such as displacement, traction, the stability obtained, the presence of associated injuries, and the time elapsed till treatment was started, as well as the age of the patients, seem to play — alone or in combination — important roles in the development of pseudarthrosis. These factors have been classified according to their importance and graded. With a total of 10 points or more a dens fracture is characterized as a fracture at risk of pseudarthrosis, i.e., a fracture with a higher possibility of developing a pseudarthrosis. This knowledge may contribute to proper and earlier management of such an injury.     

单边外固定器治疗股骨髁上髁间复杂性骨折

目的探讨应用单边外固定器治疗股骨远端复杂骨折的适应证及治疗效果。方法21例股骨髁上髁间粉碎性骨折患．先采用膝前内侧切口。行股骨髁间骨折复位，解剖复位关节面，于股骨外髁部定位直视下用特制外固定螺纹针加压固定两髁部骨折。透视下闭合牵引复位髁上骨折，并撬拨整复游离骨折片，于骨折近端定位置人外固定针。安装紧固外固定器行骨折固定。结果随访时间8～24个月。平均13．2个月。骨折在4～7个月内全部愈合，并去除外固定器。2例患外固定针道感染，经去除固定针局部换药后愈合。根据Rasumssen评分(总分30分，膝关节活动功能0～6分)评价患膝关节功能恢复情况，优良16例(76．2％)，一般4例(19％)，差1例(4．8％)。结论单边骨外固定器治疗股骨髁上髁间复杂性骨折，具有创伤小。血运破坏少。骨折复位满意，可以早期功能练习等优点。尤其适用于应用内固定难以处理的长节段股骨髁上髁间粉碎性骨折，外固定器可多向、多部位调节，对骨折起到牵引、复位和固定的作用。     

Paediatric pelvic ring fractures and associated injuries

Introduction

Paediatric pelvic fractures have been infrequently reviewed. The study was performed to highlight the unique features of pelvic fractures in children.

Patients and methods

A 14-year retrospective study was undertaken of all patients treated for a pelvic fracture at our institute.

Results

Thirty-nine children were included. The mean Injury Severity Score (ISS) was 17.1 (range 4–75). Simple ring fractures were the most common type (46%), dominated by pedestrian versus motor vehicle trauma (58.9%). A pelvic fracture was evident on the initial plain radiographs of all 39 children. Further radiographic investigations (12 CTs and 1 MRI) were undertaken in 13 (33%) of the children. Additional posterior ring fractures were identified in 9. A total of 32 children (82%) sustained one or more associated injuries. Head injuries accounted for 25% and orthopaedic/skeletal injuries for 33% of all associated injuries. Fourteen children required a total of 24 acute surgical procedures. Mean out-pateint clinical follow-up was for 27 months (range 3–85). There was one mortality in this series. Eight children (20%) suffered long term sequale.

Conclusion

Paediatric pelvic fractures differ from their adult counterpart in aetiology, fracture type, and associated injury pattern. They represent a reliable marker for severe trauma. Prospective studies are required to define optimal treatment guidelines, particularly in older children.     

Morphologic characteristics of the posterior malleolus fragment: a 3-D computer tomography based study

Objectives

The objective of this study was to evaluate the morphological characteristics of the posterior malleolus fragment (PMF) based on 3-D computed tomography scans, and evaluated the variability in different types of injuries (ankle fracture, spiral tibial shaft fracture and pilon fracture).

Methods

A retrospective analysis of 3-D computed tomography data of PMF from June 2011 to February 2012 was conducted in a level 1 trauma centre. The cross angle (α), fragment length ratio (FLR), fragment area ratio (FAR), sagittal angle (θ), and fragment height (FH) were measured as morphologic assessments in the Picture Archiving and Communication System (PACS).

Results

Based on the definition of the PMF, 144 cases were brought into this study. And the PMF was described with a mean α of 25.0°, a mean FAR of 17.66 %, a mean θ of 16.1° and a mean FH of 23.06 mm. Besides, this study showed a significant difference on FAR amongst the three injuries with the FAR was 30.31 % (P < 0.05) in pilon fracture group. Respectively, although the mean θ (16.1°) indicated a vertical fracture pattern, yet no significant difference was shown amongst the three groups.

Conclusions

Although the PMFs appear to be highly variable, most of the PMFs were located on the posterolateral of the distal tibia, and showed features with vertical nature. The information obtained from this study will be helpful for fracture models in a future biomechanical study and for determining appropriate surgical approaches.