Lower limb injuries caused by improvised explosive devices: Proposed ‘Bastion classification’ and prospective validation

Background

Complex lower limb injury caused by improvised explosive devices (IEDs) has become the signature wounding pattern of the conflict in Afghanistan. Current classifications neither describe this injury pattern well, nor correlate with management. There is need for a new classification, to aid communication between clinicians, and help evaluate interventions and outcomes. We propose such a classification, and present the results of an initial prospective evaluation.

Patients and methods

The classification was developed by a panel of military surgeons whilst deployed to Camp Bastion, Afghanistan. Injuries were divided into five classes, by anatomic level. Segmental injuries were recognised as a distinct entity. Associated injuries to the intraperitoneal abdomen, genitalia and perineum, pelvic ring, and upper limbs, which impact on clinical management and resources, were also accounted for.

Results

Between 1 November 2010 and 20 February 2011, 179 IED-related lower limb injuries in 103 consecutive casualties were classified, and their subsequent vascular and musculoskeletal treatment recorded. 69% of the injuries were traumatic amputations, and the remainder segmental injuries. 49% of casualties suffered bilateral lower limb amputation. The most common injury was class 3 (involving proximal lower leg or thigh, permitting effective above-knee tourniquet application, 49%), but more proximal patterns (class 4 or 5, preventing effective tourniquet application) accounted for 18% of injuries. Eleven casualties had associated intraperitoneal abdominal injuries, 41 suffered genital or perineal injuries, 9 had pelvic ring fractures, and 66 had upper limb injuries. The classification was easy to apply and correlated with management.

Conclusions

The ‘Bastion classification’ is a pragmatic yet clinically relevant injury categorisation, which describes current injury patterns well, and should facilitate communication between clinicians, and the evaluation of interventions and outcomes. The validation cohort confirms that the injury burden from IEDs in the Helmand Province of Afghanistan remains high, with most casualties sustaining amputation through or above the knee. The rates of associated injury to the abdomen, perineum, pelvis and upper limbs are high. These findings have important implications for the training of military surgeons, staffing and resourcing of medical treatment facilities, to ensure an adequate skill mix to manage these complex and challenging injuries.     

某部官兵社会认知偏离与人格特质的关系

目的：探讨某部官兵社会认知偏离与人格特质的关系。方法采用社会认知偏离量表（ SCBS）、明尼苏达多项个性测查问卷（MMPI）和卡特尔16项人格因素问卷（16PF）对某部653名军人进行调查,并进行相关性和回归分析。结果 SCBS各因子与 MMPI多个维度呈明显相关性（P〈0.01）,其中除与说谎（L）和校正（K）呈负相关外,与其他维度均呈正相关;SCBS社会认知偏离总分、社会抑郁、社会焦虑均与精神衰弱（ Pt）相关度最高,社会攻击与精神分裂（Sc）相关度最高。SCBS各因子与16PF多个维度呈弱相关（P 〈0.05,P 〈0.01）。K 对社会认知偏离总分、社会抑郁、社会焦虑的贡献最大,MMPI的诈病（ F）对社会攻击贡献最大。结论社会认知偏离与人格特质存在一定程度的相关性,且异常人格与认知偏离相关性更强。     

某部驾驶训练士兵抑郁发生情况及心理训练的效果

目的：调查某部驾驶训练士兵抑郁发生情况,探讨心理训练对其的影响。方法某部384名士兵分为驾驶训练组176名,心理训练组164名,非驾驶训练组44名,采用Zung抑郁自评量表（ SDS）在训练前期、中期、后期对3组士兵进行测试,观察 SDS评分变化及抑郁发生情况。结果训练中、后期驾驶训练组 SDS评分高于非驾驶训练组和心理训练组（P〈0.05）。非驾驶训练组 SDS评分随训练时间延长而下降（P 〈0.05）;驾驶训练组训练中期 SDS 评分高于训练前期和训练后期（ P 〈0.05）,心理训练组 SDS 评分随训练时间延长而下降,训练后期下降更明显（ P 〈0.05）。结论驾驶训练可能是士兵抑郁发生的因素之一,心理训练有助于降低其抑郁水平。     

首次夏秋季入伍新兵情绪社交孤独感调查

目的了解首次夏秋季入伍新兵情绪社交孤独感的状况。方法应用情绪-社交孤独问卷(ESLI)和症状自评量表(SCL-90),对某部队2013年564名入伍新兵进行整群抽样测试研究,然后对其进行t检验和方差分析。结果①ESLI各因子与SCL-90各因子均存在显著性相关;②新兵SCL-90各因子得分均显著低于国内青年常模(t=9.48,8.5,15.39,14.88,8.57,11.94,8.59,13.96,6.90,6.96;P0.01)、军人新兵常模(t=19.53,14.29,19.07,19.89,18.14,13.13,21.72,23.68,23.91,13.11,21.47;P0.01);③不同性别的新兵孤独感各因子存在显著性差异(t=3.516,4.392,3.481,3.855;P0.01),是否独生子女对孤独感影响无显著性差异;④不同的文化程度对情绪孤立与社交孤立有显著性影响(F=3.746,6.241;P0.05),进一步多重比较表明,高中组新兵得分明显高于中专组;不同的文化程度对情绪孤独、社交孤独没有显著性影响。结论2013年入伍新兵的孤独感较低,心理健康状况较好;新兵的孤独感受性别、文化程度等因素的影响,男兵和高中文化的新兵更容易感受到孤独感。     

军医大学任职教育学员学习动机强度调查

目的调查军医大学任职教育学员学习动机强度,为相关教育管理部门加强引导提供依据。方法应用学习动机简易评定量表,调查军医大学任职教育学员学习动机强度,并和该校本科生、研究生进行比较。结果任职教育学员总体学习动机处于中等水平(动机一般的占62.5%),强度介于本科生和研究生之间(χ2=159.836,P=0.000);不同性别、专业、学历、职称的学员之间学习动机没有差异。结论任职教育学员学习动机具有以下特点:强度适中,以中等为主;水平较高,低于研究生而高于本科生;性质稳定,不受性别、专业等因素的影响。同时对如何加强任职教育学员学习动机提出了对策。     

军事医学研究生创新能力各维度分析

目的探讨军事医学研究生创新能力在各个维度上的分布特征。方法以某军医大学研究生为例,应用威廉斯创造力倾向测量表,比较研究生总体、不同群体之间挑战性、好奇性、冒险性、想象力4个维度得分的差异。结果 1研究生创新能力各维度的得分有统计学差异(F=66.365,P=0.000),得分最高的是挑战性(75.566±10.316)和好奇性(75.012±10.807),其次是冒险性(72.839±10.070),最后是想象力(69.211±11.685);2不同群体研究生创新能力各个维度之间的比较,只有不同学历研究生在想象力方面有差异(F=4.381,P=0.037),博士研究生想象力(67.712±12.175)低于硕士研究生(69.643±11.500)。结论军事医学研究生创新能力的各个维度都在中上水平,挑战性和好奇性较高;不同群体之间的差别不大;相对而言,想象力匮乏,尤其是博士研究生。     

论非战争军事行动中的军医伦理问题

非战争军事行动纷繁复杂的现实处境与高度敏感的社会关联性造就了军医特殊的伦理处境。这给军医带来全新的伦理道德困惑与伦理情感冲击。非战争军事行动中军医伦理原则包括：社会主义人道主义原则、最大生命效益原则、生物一心理一社会的整体观原则。非战争军事行动中军医伦理规范包括：履行军医宗旨，全力抢救伤员、区别救治对象，关怀脆弱人群、加强协同合作，勇于承担风险、谨慎创新并举，提升技能保障、改善生存条件，提高生命质量。并就此提出若干的伦理原则与伦理规范，以期为军医的医疗实践提供一定的伦理指导。