某型榴弹静爆对生物杀伤效应的实验研究

目的研究爆炸性武器对生物致伤的特点和规律,为战伤早期救治提供一定的实验依据。方法通过某型榴弹实弹静爆致伤动物,测试破片速度、冲击波超压等致伤特征。结果爆炸性武器爆炸后主要是以破片和冲击波超压两种效应致伤生物。结论该型榴弹对生物所致的伤情严重而复杂,半数以上的动物于伤后6小时死亡,且破片伤往往复合冲击伤。破片伤和冲击伤的发生率分别为69．44％和50％。     

A conceptual model and detailed framework for stress-related,strain-related,and overuse athletic injury

A multitude of athletic injuries occur when the various tissues that make up the human body experience stresses and strains that exceed their material strength. The precise amount of stress and strain that any given tissue can withstand is determined by the mechanical properties and resultant strength of that particular tissue. These mechanical properties are directly determined by an individual’s physiology and acute regulation of these properties. A number of theoretical frameworks for athletic injury occurrence have been proposed, however, a detailed conceptual framework for injury aetiology that considers the interplay between the physiological and mechanical factors and outlines the causal pathways to tissue damage and injury is needed. This will guide injury research towards a more thorough investigation of causal mechanisms and understanding of risk factors. Further, it is important to take into account the considerable differences in loading patterns which can result in varying injury outcomes such as acute stress-related, strain-related, or overuse injury. Within this article a simplified conceptual model of athletic injury is proposed along with a detailed, evidence-informed, conceptual framework for athletic injury aetiology that focuses on stress-related, strain-related, and overuse injury.     

水下冲击伤后犬主要脏器的病理学改变

目的：观察动物水下冲击伤后主要脏器的形态学变化。方法：采用大体、光镜和电镜的方法观察犬水下冲击伤后肺脏、小肠及心脏的病理变化。结果：损伤动物大体解剖可见明显肺出血、水肿,光镜下可见肺出血、淤血,肺泡腔内有大量的红细胞及纤维蛋白渗出,电镜下可见肺泡壁毛细血管内皮细胞破坏严重,部分线粒体出现空泡变与髓鞘样结构。以出血为主的肠道损伤明显可见。可见少量心肌纤维断裂,心肌细胞肿胀。结论：严重的肺出血、水肿可能是水下冲击伤动物早期死亡的主要原因。动物伤情的严重程度与水下冲击波的正向冲量密切相关。肠道损伤也应引起足够重视。     

Epidemiology of injuries in gymnastics

A prospective one-year epidemiological study was carried out to determine the injury incidence and the injury mechanisms in different groups of gymnasts and to identify possible risk factors. A total of 115 gymnasts with a median age of 16 (8-25) were followed through a whole season of median 48 weeks (ranges 40–51). The overall injury incidence was 85 per 100 gymnasts per season, ranging from 27 in subelite males to 157 in subelite females. This high incidence is partly explained by the use of a sensitive injury definition, the high exposure time, and the large proportion of highly competitive gymnasts in the population. Considering the exposure time, however, the incidence is lower than in most other sports, 1.6 per 1000 h of gymnastic activity. Subelite female gymnasts were more commonly injured than other artistic gymnasts, in particular in relation to balance beam exercises and inadequate spotting. Injuries were predominantly localized to the lower extremities (64%) for the whole population of gymnasts. A siwcantly large proportion of the male artistic gymnasts, nevertheless, sustained upper extremity injuries corresponding to their apparatus performance. Most injuries were of mild or moderate severity, the recovery time was, however, considerable (median 30 days, ranges 1–365), and the injuries sustained during competition had a median recovery period of 180 days (7-270). Twenty-two per cent of the injuries resulted in a recovery period of more than 6 months. Re-evaluation of the criteria of the score system for dismount as well as an increased use of spotters during practice and high-risk events are possible measures to prevent serious injuries.     

36例颅颌面部火器伤的诊治

目的　探讨颅颌面部火器伤后的早期诊断、治疗。方法　回顾性总结 1975年 1月～ 2 0 0 2年 6月收治的 36例颅颌面部火器伤病例的病历资料。本组病例入院时GCS 5～ 12分。闭合伤 3例 ,穿透伤 33例。结果　本组达到临床治愈标准 2 0例 ,好转 7例 ,自动出院 2例 ,死亡 7例。死因分别为原发伤过重、颅内感染、失血性休克。结论　对颅颌面部火器伤诊治应重视病史及生命体征变化 ,处理原则先急后缓 ,保守治疗应严格筛选。合并面神经损伤不宜早期缝合 ,延期微创手术是有效的方法。     

破片对冲击伤伤情的影响

目的　探讨破片对冲击伤伤情的影响。方法　成年杂种狗 36只 ,依据破片和冲击波的物理参数分别复制轻度冲击伤、中度冲击伤、肢体高速破片伤 ,高速破片与轻度和中度冲击伤复合的复合伤 ,低速破片与中度冲击伤复合的复合伤。冲击组用BST I型生物激波管致伤 ,用 0 .4 8g三角形破片致肢体破片伤 ,用BST I生物激波管致伤后立即行破片致伤制作复合伤。观察伤后 2 4小时形态学和肺体指数改变。结果高速破片对中度冲击伤具有加重作用 ,加重效应主要发生在肺脏 ,伤情可加重一个等级 ;高速破片对轻度冲击伤和低速破片对中度冲击伤未见加重效应。结论　肢体高速破片对中度肺冲击伤具有加重作用 ,这对爆炸伤伤员的液体复苏可能有一定的指导意义     

大鼠颅脑合并胸部撞击伤后血浆IL-6、IL-10含量变化及意义

目的　建立一种伤情稳定、满足实验需要的颅脑合并胸部撞击伤动物模型 ,并探讨损伤早期血浆IL 6、IL 10含量变化及意义。方法　采用自行研制的小型生物撞击机 ,选择合适的撞击参数制作大鼠颅脑合并胸部撞击伤动物模型 ;酶联免疫法动态检测伤后血浆IL 6、IL 10含量变化。结果　成功建立了大鼠颅脑合并胸部撞击伤动物模型 ;伤后早期IL 6、IL 10含量显著升高 ,伤后 6、2 4、72小时的含量分别为(5 11.81± 6 5 .6 8)pg/ml、(10 3.36± 9.4 5 )pg/ml;(32 2 .16± 33.0 8)pg/ml、(79.2 3± 10 .2 6 )pg/ml;(138.0 5±6 8.75 )pg/ml、(49.2 8± 6 .2 1)pg/ml。结论　本动物模型伤情稳定、重复性好 ,能满足多发伤实验研究需要 ;伤后早期血浆IL 6、IL 10含量升高 ,在炎症反应和继发性损伤的发生过程中起重要作用 ,其含量变化与伤情严重程度密切相关。     

犬冲击伤复合高速破片伤时内皮素的变化及其意义

目的探讨犬高速破片伤对冲击伤伤情的影响。方法成年杂种狗21只,依据冲击波和高速破片的物理参数,分别复制中度冲击伤、肢体高速破片伤、中度冲击伤复合高速破片伤,观察伤后肺动脉压、致伤后24小时肺形态学、肺含水率和肺体指数,同时测定血浆和肺组织内皮素含量。结果致伤后,犬肺动脉压升高,血浆和肺组织内皮素含量升高。高速破片可加重中度冲击伤,其效应主要发生在肺脏,伤情可加重1个等级。结论肢体高速破片伤对中度肺冲击伤具有加重作用,其机制与致伤后血浆和肺组织内皮素含量升高有关。     

腹部撞击伤时压力的传播及肝脏损伤的病理特点

通过撞击载荷对动物下腹部撞击致伤，测量了动物腹内压力衣腹主动脉、肝门静脉、肝动脉等血管内血流压力的变化，观察了肝脏等脏器损伤的病理特点，实验结果表明和肝门静脉内血流压力的增加最为显著，肝脏因血流压力的剧增所致的损伤以点片状出血性损伤为主，在此基础上，初步分析和讨论了腹部撞击伤时压力在不同介质内的传播对肝脏间接性损伤的作用。     

Competitive bass anglers: a new concern in sports medicine

Objective: Competitive bass angling involves sport fishing against other anglers while targeting a species of fish known as the black basses. Due to the rapidly growing popularity of high school competitive bass angling in Alabama and the nature of the casting motion similar to that of overhead athletes, we sought to examine the prevalence of sports type injuries in this population.

Methods: In spring 2016, an anonymous survey was distributed across two large scale competitive high school fishing tournaments, allowing for a broad sampling of anglers throughout the state of Alabama. Survey items included demographic information, relevant past medical history, and various pains associated with the shoulder, elbow and wrist. Results were recorded and analyzed electronically using Microsoft Excel and IBM SPSS statistical software.

Results: A total of 257 surveys were recorded. The response rate was 61%. The mean age of participating anglers was 15 ± 1.61 years. The majority (42%) of anglers fished year round. On average, anglers casted nearly 1,000 more times while competing versus fishing recreationally. Approximately 15% of anglers experienced shoulder, elbow, and wrist pain. The most common factors associated with pain included higher tournament cast counts, number of competitive years, number of tournaments/year, number of tournaments, and use of light weight lures.

Conclusion: A large portion of high school competitive anglers experience upper extremity pain. Knowledge of angling factors associated with pain allow for the creation of a modifiable routine to help reduce pain in affected anglers and prevent pain in healthy anglers.     

Aging is only significant factor causing CPR-induced injuries and serious injuries

BackgroundCardiopulmonary resuscitation (CPR) sometime cause severe injuries and can affect quality of life, lead to long-term disabilities or death of the patient. The aim of this study is to identify the risk factors causing CPR-induced injuries and those of serious injuries.MethodsThis was a retrospective forensic autopsy study in a single institution. Among 885 forensic autopsies undertaken between 2011 and 2018, those in which the victim had undergone CPR immediately after cardiac arrest were recorded. ‘Serious injuries’ were defined as an Abbreviated Injury Scale (AIS) score ≥ 3. CPR-induced injuries were evaluated by three experienced forensic pathologists. With the background and history of the patient, the circumstances of cardiac arrest and risks of causing CPR-induced injuries were determined by multivariate analyses.ResultsSeventy-five victims comprised the study cohort. CPR-induced injuries were found in 52 victims (69.3%). Rib fracture was the most common (60.0%), followed by sternal fracture (37.3%), heart injury (21.3%) and liver injury (8.0%). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced injuries (odds ratio [OR], 1.07, P < 0.001). Thirty-six victims had 39 serious injuries in the chest or abdomen: fracture of ≥ 3 ribs (35 cases), aortic dissection (two), lung contusion (one) and rupture of the heart (one). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced serious injuries (OR, 1.09; P < 0.001).ConclusionAging was the significant factor causing CPR-induced injuries and serious injuries.     

儿童与成人坠落伤致伤规律及特点的比较研究

目的研究成人与儿童坠落伤致伤规律及特点的差异，为坠落伤的预防、诊断及救治提供依据。方法对５６６例成人及１６８例儿童坠落伤病例进行分析，所得数据经统计学处理，计数资料行χ２检验，计量资料行ｔ检验。结果两组在损伤环境、坠落高度、着地姿势、损伤类型、伤情程度等方面具有明显的不同，统计学检验其差异有高度统计学意义（Ｐ＜０．００１）。结论不同年龄段坠落伤的发生情况存在一定差异，儿童与成人坠落伤之间的致伤规律及伤情特点具有明显的不同     

Epidemiology of physical activity‐related injuries in Chinese university students

Knowledge gaps of the physical activity‐related injury (PARI) problem among general undergraduates exist. We conducted a study in four universities, where 1421 students graded 1‐3 were interviewed face‐to‐face during April and May after their completion of the baseline survey in March and April 2017, aiming to describe the incidence and characteristics of PARI. PARI experience and physical activity (PA) participation in the past 12 months were collected. Injury incidence density (IID) and risk, and injury characteristics were evaluated for the overall sample and by gender. Pearson chi‐square or Fisher's exact tests and independent‐sample t tests were used to test between‐group differences. We found that 486 PARIs were reported totally by 289 participants , with an overall IID of 0.57 per 1000 hours of exposure (males: 1.07, females: 0.45) and an injury risk of 0.34 injuries/student/y (males: 0.52; females: 0.28) . Higher IIDs were found in roller skating, football, and basketball. The majority of injuries occurred outdoors and involved the lower extremities, with sprain and strain being the primary injury types. Moreover, most injuries were new, acute, and happened in non‐contact situations. Of all injuries, 52.1% required medical attention and 64.6% resulted in inactivity of one or more days. Some significant differences were observed between males and females. Our study indicates that PARI is a public health concern among Chinese university students, which can provide direction for targeted prophylactic interventions to underpin the sex‐specific injury mechanism to reduce PARI.     

A manual therapy technique for chronic adductor-related groin pain in athletes: a case series

The objective was to retrospectively examine whether a manual therapy technique is effective in the treatment of chronic adductor-related groin pain in athletes. Thirty-three athletes with chronic adductor-related groin pain were approached. Thirty patients gave their consent to participate in the study. Patient satisfaction, return to activity and numeric pain score were recorded. Patients were treated after prewarming of the muscles; one hand is used to control the tension in the adductor muscles and the other hand is used to move the hip into abduction and external rotation. This flowing, circular motion stretches the adductor muscle group. The movement is repeated three times in one treatment session. Twenty-five out of 30 (83%) athletes reported a good or excellent satisfaction. Twenty-seven out of 30 (90%) athletes had resumed sport at (15/30) or below (12/30) their previous level of activity. The pain score for during or after activity decreased significantly from 8.7 to 2.2 after the treatment ( P <0.01). This study shows that the manual therapy treatment might be a promising treatment for chronic adductor-related groin pain in athletes.     

爆炸性四肢软组织战伤特点及其早期修复的研究进展

爆炸性武器已大量应用于现代战争以及恐怖袭击,造成巨大人员伤亡,而体表软组织往往首先波及。与一般火器伤相比,爆炸伤在致伤机制、致伤特点和救治原则上均有所不同。本文从战场背景下的四肢软组织爆炸伤的特点及其缺损的早期修复方面着眼,简要综述其研究进展。     

胸部撞击致肺损伤的研究进展

撞击伤是平时意外事故,特别是交通事故中的常见伤类。胸部撞击伤因其损伤的多发性、严重性、隐匿性和死亡率高等特点而成为该领域中主要研究课题之一。本文综述近年来有关胸部撞击伤的发生机制和继发性肺损伤的研究进展,重点对肺挫伤、对冲型肺损伤和局部与全身炎性反应在继发性肺损伤中的作用进行论述。     

氧化应激在大鼠肢体缺血/再灌注心肌损伤中的作用

目的观察大鼠肢体缺血／再灌注（LIR）后心肌组织的损伤性变化并探讨氧化应激在其发生机制中的作用。方法用健康雄性Wistar大鼠制备LIR动物模型，采用生物化学方法及比色法测定心肌组织丙二醛（MDA）、髓过氧化物酶（MPO）、ATP、乳酸（LD）含量及ATP酶（ATPase）活性；测定血浆肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）水平，光镜观察心肌组织的形态学变化。结果与对照组比较，再灌注后心肌组织ATP储备减少，LD含量增加，各型ATPase活性下降，血浆CK、CK-MB及心肌组织MDA、MPO含量均增高（P〈0．05或P〈0．01）。镜下可见再灌注后心肌组织炎性细胞浸润，部分心肌横纹不清晰，少数心肌细胞变性。结论LIR可对心肌组织造成一定损伤，这与体内的氧化应激状态有密切关系。     

腹部脏器损伤的CT诊断

目的：介绍腹部实质性脏器损伤中的CT诊断作用及其表现。材料和方法：42例腹壁损伤合并内脏损伤者，其中30例为单一脏器损伤，12例为多脏器损伤。受伤脏器分别为脾15例、肝8例、肾7例、胰2例．全部病例均在受伤后8小时内进行CT平扫检查。结果：CT易发现腹内实质脏器不同类型破裂和不同程度出血。对并发的腹壁、腹腔及后腹膜腔、脊柱、肋骨等损伤也能同时检出。结论：CT对腹部实质性脏器损伤是一种高效、迅速、方便、准确的检查方法，对确定手术方案更是必须的。     

56例脑弥漫性轴索损伤的临床分析

目的 探讨脑弥漫性轴索损伤（ＤＡＩ）与脑挫裂伤、原发性脑干伤和脑震荡的关系。方法 分析５６例ＤＡＩ病人的临床资料和影像学特点,与原发性脑损伤的特征进行比较。结果 ５６例ＤＡＩ伤者中６６％为交通伤,多次暴力致伤比较常见（６１％）。伴脑挫裂伤者４０例（７１％）。ＣＴ／ＭＲＩ发现出血灶者４５例。结论 ＤＡＩ是常见的弥漫性脑损伤,脑震荡和原发脑干伤被包含其中,且常常与脑皮质挫裂伤伴发。将原发性脑损伤分为局