The surgical management of facial trauma in British soldiers during combat operations in Afghanistan

IntroductionThe recent Afghanistan conflict caused a higher proportion of casualties with facial injuries due to both the increasing effectiveness of combat body armour and the insurgent use of the improvised explosive device (IED). The aim of this study was to describe all injuries to the face sustained by UK service personnel from blast or gunshot wounds during the highest intensity period of combat operations in Afghanistan.MethodsHospital records and Joint Theatre Trauma Registry data were collected for all UK service personnel killed or wounded by blast and gunshot wounds in Afghanistan between 01 April 2006 and 01 March 2013.Results566 casualties were identified, 504 from blast and 52 from gunshot injuries. 75% of blast injury casualties survived and the IED was the most common mechanism of injury with the mid-face the most commonly affected facial region. In blast injuries a facial fracture was a significant marker for increased total injury severity score. A facial gunshot wound was fatal in 53% of cases. The majority of survivors required a single surgical procedure for the facial injury but further reconstruction was required in 156 of the 375 of survivors aero medically evacuated to the UK.ConclusionsThe presence and pattern of facial fractures was significantly different in survivors and fatalities, which may reflect the power of the blast that these cohorts were exposed to. The Anatomical Injury Scoring of the Injury Severity Scale was inadequate for determining the extent of soft tissue facial injuries and did not predict morbidity of the injury.     

Traumatic stress symptoms after the November 13th 2015 Terrorist Attacks among Young Adults: The relation to media and emotion regulation

ObjectiveA major terror attack occurred in the Paris region on 13th November 2015. This event was widely showed, described, and commented in the media. Media consumption may lead to a widespread diffusion of trauma-related symptoms following a collective trauma. These effects may depend on the type of media and emotion regulation strategies used by the media consumer.MethodTrauma history, traumatic symptoms, media consumption, psychological distress, and emotion regulation strategies of 451 young adults were assessed by an online survey.ResultsFindings reveal the joint role of social networks use and dysfunctional emotion regulation strategies on anxiety, depression, and somatization symptoms and also on cognitive and emotional alteration among traumatic symptoms.DiscussionConsistent with the emotional contagion hypothesis, individuals who reported spending more time on social networks were also those who were experiencing more psychological distress.     

The effectiveness of exercise program after lumbar discectomy surgery

A lumbar herniation disc appears as a major cause of lumbar pain and sciatica. The purpose of the present systematic review is to examine the effectiveness of such exercise programs on pain, disability, quality of life, strength and the assessed time required to return to work/normal activities after undergoing lumbar discectomy surgery. PubMed, MEDLINE, and Google Scholar were used for the selection of randomized controlled trials (RCTs). The PEDro scale was chosen to assess the methodological quality of the included studies. Seven RCTS met the inclusion criteria. According to the evaluation of the PEDro scale, one was considered as « high quality», five as « moderate quality» and one as « low quality». The mean score of the studies was 5.14. The results showed that after such exercise there was an improvement in pain, disability, quality of life, muscle strength and in time required to return to work. The exercise programs have a positive impact on the reduction of pain, disability, time required to return to work/normal activities as well as an increase in quality of life and muscle strength in patients with lumbar discectomy surgery.     

Cambridge Polytrauma Pathway: Are we making appropriately guided decisions?

Addenbrooke’s Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion. It facilitates provision of best practice Early Appropriate Care, encompassing – multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries. Re-audit was conducted of 15 patients meeting selection criteria, admitted between 1st October 2014 and 31st March 2015. Significant improvements in recording of lactate and fibrinogen were demonstrated, both on admission (lactate – p < 0.000, fibrinogen – p = 0.015), and preoperatively (lactate – p = 0.003, fibrinogen – p = 0.030). Time to trauma CT was unchanged (p = 0.536) with a median time to CT of 0.53 h at re-audit (IQR 0.48–0.75). The number of patients receiving definitive orthopaedic intervention out-of-hours reduced from 8 to zero (p = 0.195). The approach of facilitating management decisions to be made at early daytime MDT meetings has been adopted. It is anticipated that this pathway will improve outcomes in orthopaedic polytrauma patients and it is recommended that either the GOS-E, or the EQ-5D scoring systems be introduced to assess this.     

经口咽前路控制性松解复位+后路枕颈融合内固定术治疗颅底凹陷症

目的：探讨经口咽寰枢关节控制性松解并短节段撑开复位+后路枕颈融合内固定术治疗颅底凹陷症的临床疗效。方法2011年3月至2014年4月我科共收治5例颅底凹陷症合并严重寰枢椎畸形女性患者,采取前路经口咽控制性松解短节段撑开复位齿状突+后路融合固定手术,年龄8.0~45.0岁,平均30.6岁。术前、术后测量齿状突顶点至Chamberlain线的垂直距离、寰齿间距( atlantodental interval,ADI)及延髓颈髓角(cervicomedullary angle,CMA)和/或斜坡枢椎角评估复位效果;应用日本骨科学会( Japanese Orthopaedic Association,JOA)神经评分标准评价临床症状改善情况。结果术后测量齿状突顶点至Chamberlain线的垂直距离值、ADI和斜坡枢椎角均恢复正常。平均随访18.3个月,JOA评分由术前平均8.8分提高到术后平均13.0分,所有病例均无并发症发生。结论采用前路经口咽松解通过控制齿突复位程度(一般不超过10 mm),结合后路固定融合术治疗颅底凹陷症具有复位效果好、能控制手术风险、并发症少的优点。     

多种术式在脊柱结核外科治疗中的临床应用研究

目的 研究不同术式在脊柱结核外科治疗中的应用效果.方法 2006年1月～2011年2月期间收集148例入住某院外科手术治疗的脊柱结核患者临床资料并随访疗效,分析不同术式在脊柱结核外科治疗中的应用效果,对各指标计量资料比较采用组间t检验,计数资料采用组间x2检验,检验水平P=0.05.结果 148例脊柱结核患者,行脊柱结核切开引流术42例,前路脊柱结核清除椎间植骨融合内固定术56例,后路脊柱结核清除椎间钛网植骨椎弓根螺钉固定术50例.148例患者总结核病灶治愈率85.8％ (127/148)、植骨融合成功率88.7％ (94/106)、术后并发症率8.8％ (13/148)、术后复发率4.1％.B组与C组相比较,手术时间短、术中出血量小,差异有统计学意义,P＜ 0.05;但是其后凸Cobb角纠正率、植骨融合成功率低于C组,差异有统计学意义,P＜0.05.B组与C组相比,结核病灶治愈率、植骨融合成功率、术后并发症率、术后复发率差异无统计学意义,P＞ 0.05.结论 脊柱手术需根据患者脊柱结核侵犯的部位、病变特点、脊柱稳定性破坏程度等特点,选择适合个体病例实际情况的术式,最大程度地发挥各种术式的优势,更好地服务于患者.     

从外科技术及生物力学角度评价内锁式人工颈椎间体系统

目的:从外科技术及生物力学角度评价内锁式人工颈椎间体系统的可行性.方法:在人尸体颈椎标本上应用内锁式人工颈椎间体,从外科技术角度评价内锁式人工颈椎间体系统;在离体新鲜的羊颈椎标本应用内锁式人工颈椎间体,进行生物力学测试,并采用Caspar plate with unicortial screw作对照,从生物力学角度评价内锁式人工颈椎间体系统.结果:内锁式人工颈椎间体固定3个椎体节段,其外科手术操作简单,使用方便,能自动提供强大的撑开力,使压缩椎体复位,具有自动加压内锁作用.其抗旋转负荷强度优于Caspar钢板,抗侧屈及屈曲负荷与Cas-par钢板持平.结论:内锁式人工颈椎间体手术操作简单,能自动提供强大的撑开力,从椎体内部支撑骨折椎体,防止骨折椎体塌陷.设计符合颈椎的解剖学特点,生物力学上能有效稳定颈椎.特别适应陈旧的屈曲压缩骨折及颈椎后突畸形矫形.     

强直性脊柱炎后凸畸形的301分型

目的 :建立强直性脊柱炎(ankylosing spondylitis,AS)后凸畸形新的分型方法———301分型,并对其可信度和可重复性进行检验分析。方法:根据后凸顶点位置不同将AS后凸畸形分为4种类型:腰椎型(Ⅰ型)、胸腰椎型(Ⅱ型)、胸椎型(Ⅲ型)及颈椎或颈胸交界型(Ⅳ型),除Ⅰ型外其他各型分为2个亚型:腰椎尚存在前凸为A亚型,腰椎出现后凸为B亚型。依据该分型方法对309例在我院接受脊柱截骨术治疗的AS后凸畸形患者进行分型,统计各型所占比例。由5位脊柱外科医生分别根据该分型标准对随机抽取的30例AS后凸畸形患者的影像资料进行分型,2周后此5位医生对打乱秩序的相同资料再次进行分型,收集分型结果,计算Kappa值检验一致性。结果:按照301分型方法将AS后凸畸形分为4型共7个亚型,309例患者中,Ⅰ型52例(16.8%);Ⅱ型223例(72.2%),其中ⅡA型153例,ⅡB型70例;Ⅲ型33例(10.7%),其中ⅢA型25例,ⅢB型8例;Ⅳ型1例(0.3%),为ⅣB型。观察者间可信度为73.3%~86.7%,Kappa系数为0.761~0.847,可重复性为83.3%~93.3%,Kappa系数为0.821~0.925。结论 :应用301分型方法对AS后凸畸形分型简单易行,其可信度和可重复性较好。     

Tinnitus in children without hearing impairment

ObjectiveTinnitus is not an uncommon symptom in the pediatric population and, despite its incidence, is still an unrecognized problem, particularly in normal hearing children. As tinnitus is frequently described by adults without evidence of ear disease, reports of tinnitus can be obtained also from a group of children without otological pathology. The present review has been performed in order to emphasize the great importance to try to identify children suffering from tinnitus and to recognize the difference between the tinnitus characteristics in children with ear pathology and those one without otological problems.MethodsA review of the literature regarding the nature of pediatric tinnitus and the practical diagnostic approach to this symptom has been carried out.ResultsChildren rarely complain spontaneously of tinnitus but are able to describe it when questioned. In our experience the total percentage of children with tinnitus rises from 6.5% (tinnitus reported spontaneously), to 34% when children are specifically questioned.Most children, more than 50%, have normal hearing; in those with hearing impairment, no particular type or severity of hearing loss has been found.An important point that must be considered much more seriously is tinnitus sequela following head injuries to which children are particularly exposed during their daily activities.Due to the serious consequences that may be caused by tinnitus, it is of great importance to identify and analyze it, so as to minimize its damage, utilizing a protocol of study of pediatric tinnitus which allows to collect interesting informations about tinnitus characteristics.ConclusionsIn considering that tinnitus in children exists and may provoke serious consequences, even in absence of ear pathology, it is necessary to investigate and understand more about this symptom in children. From this viewpoint, it is very important to recognize the value of a global evaluation of a child suffering from tinnitus.There is no reason why such an important symptom well reported in adults should not be investigated in the pediatric population in which it seems to be as frequent as in the adult one.It is reasonable to believe that also in children tinnitus may have significant implications for medical and rehabilitative management.