地震救援中实施远程医疗服务:把最好的医学专家送到灾区人民身边

目的和方法 总结解放军总医院远程医疗会诊系统在2013年“4·20”四川芦山地震救援中发挥其远程医疗服务的经验,探讨远程医疗会诊系统在灾难救援中的作用.结果和结论 在2013年4月20日四川芦山地震后,解放军总医院专家医疗队及时将无线便携式远程医疗会诊系统发送至地震灾区伤员集合点医院,第一时间组织开通面向灾区服务的远程医疗会诊系统,与位于地震灾区的多家医院及地震救援队救护车远程医疗系统联通,提供24h包括急诊和危重症救治、骨科、脑外科、肝胆外科、妇产科等相关专业的远程救援服务,对地震伤员的抢救提出了诊断和救治意见,形成了救灾现场专家与后方专家的良性互动,使灾区专家医疗队的救治能力倍增.解放军总医院在芦山地震中共进行远程医疗会诊110余例,在对灾难现场的受伤人员进行有效的紧急救治中实现了实时高清会诊和现场手术指导,并在业务层面实现了多媒体通信系统与医院医疗信息系统的对接,在功能层面实现了各联盟医院的视频、音频和数据以及医疗业务的互联互通,为我国在灾难救援中实施远程医疗抢救提供了可借鉴的经验.     

云南省昭通市巧家县地震后患者心理状态及心理恢复

目的:研究云南省昭通市巧家县地震后患者心理状态及心理恢复。方法:2014年8月23日到9月11日笔者和同事对巧家县共计258例就诊者进行前瞻性观察性研究,国际疾病伤害及死因分类标准第十版(ICD-10)分析抑郁、恐惧和品行障碍情况。结果:重伤和轻伤各个时间段之间心理状态差距具有统计学意义(χ2=12.522,P=0.000)。轻伤者心理状态较重伤者普遍好,恢复也快。两组入院和出院的品行障碍在组间和组内之间均无统计学差异(P0.05)。两组入院抑郁发作和广泛焦虑均无统计学差异(P0.05)。出院时重伤组与轻伤组相比具有统计学差异(t=3.243,P0.05)。重伤组和轻伤组入院和出院时相比具有统计学差异(t=4.531,P0.05)。结论:巧家县地震后重症和轻症患者心理状态均恢复良好,出院时比入院时心理恢复好。患者能很快恢复正常生活,以美好的心态迎接未来的人生。     

Post-traumatic stress disorder in DSM-5: Estimates of prevalence and criteria comparison versus DSM-IV-TR in a non-clinical sample of earthquake survivors

Background

The latest edition of DSM (DSM-5) introduced important revisions to PTSD symptomatological criteria, such as a four-factor model and the inclusion of new symptoms. To date, only a few studies have investigated the impact that the proposed DSM-5 criteria will have on prevalence rates of PTSD.

Methods

An overall sample of 512 adolescents who survived the L'Aquila 2009 earthquake and were previously investigated for the presence of full and partial PTSD, using DSM-IV-TR criteria, were reassessed according to DSM-5 criteria. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR).

Results

A DSM-5 PTSD diagnosis emerged in 39.8% of subjects, with a significant difference between the two sexes (p<0.001), and an overall 87.1% consistency with DSM-IV-TR. Most of the inconsistent diagnoses that fulfilled DSM-IV-TR criteria but not DSM-5 criteria can be attributed to the subjects not fulfilling the new criterion C (active avoidance). Each DSM-5 symptom was more highly correlated with its corresponding symptom cluster than with other symptom clusters, but two of the new symptoms showed moderate to weak item-cluster correlations. Among DSM-5 PTSD cases: 7 (3.4%) endorsed symptom D3; 151 (74%) D4; 28 (13.7%) both D3 and D4; 75 (36.8%) E2.

Limitations

The use of a self-report instrument; no information on comorbidity; homogeneity of study sample; lack of assessment on functional impairment; the rates of DSM-IV-TR qualified PTSD in the sample was only 37.5%.

Conclusions

This study provides an inside look at the empirical performance of the DSM-5 PTSD criteria in a population exposed to a natural disaster, which suggests the need for replication in larger epidemiological samples.     

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan

We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.     

Temporal features of elevated hair cortisol among earthquake survivors

This study aimed to determine the effect on hair cortisol level of a chronic stress response from the Wenchuan earthquake, and to explore the temporal features of elevated hair cortisol. We recruited two cohorts of earthquake survivors: cohort A consisted of 12 male adults and 8 females and cohort B of 20 male adolescents, with 23 and 29 participants as controls, respectively. Their hair samples closest to the scalp were assayed with mass spectrometry to determine cortisol content. Results revealed that hair cortisol content in survivors of cohort A was significantly higher than in the control. For survivors of cohort B, hair cortisol levels increased 6 and 22 weeks after the earthquake and decreased 43 weeks after the outburst. In conclusion, the chronic stress response elicited by the earthquake resulted in elevated hair cortisol. Timing since the earthquake outburst played an important role in the long‐term response of the HPA axis to a major acute stressor.     

Earthquake generated proximal tibial nerve compression treated by surgery

Purpose

This article reports on nine cases of proximal tibial nerve compression by the soleal tendinous arch caused by unsuitable treatment of acute compartment syndrome (ACS). Also, we report the clinical results of neurolysis and analyse the cause of this special type of neurological compression.

Methods

There were nine extremities in nine patients included in the study. All patients were among the victims of the Wenchuan earthquake in 2008. All patients had a previous lower extremity ACS. Pain level, numbness in the sole, muscle strength of the flexor hallucis longus and Tinel’s sign were evaluated pre- and post-operatively. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal tendinous arch.

Results

At a mean follow-up of 22 months, eight patients (87 %) with weakness of the flexor hallucis longus showed improvement in flexor strength and seven patients (78 %) exhibited improved sensory function in the sole. All patients experienced pain relief. Subjective pain was reduced from an average score of 2.7 to 0.7 based on a visual analogue scale. Physical examination for Tinel’s sign revealed all patients experienced relief of radiating pain, but two patients still retained a positive Tinel’s sign (mild) over the soleal tendinous arch. In summary, four patients were highly satisfied, four were satisfied and one was neither satisfied nor dissatisfied with functional recovery after neurolysis.

Conclusions

Unsuitable treatment of lower extremity ACS can lead to tibial nerve compression beneath the soleal tendinous arch. Neurolysis may improve pain and sensory and motor function.     

芦山地震中胫腓骨远端开放性骨折的治疗

目的 总结地震灾害所致胫腓骨远端开放性骨折的特点,并探讨其治疗. 方法 2013年4月21日至27日共收治12例地震伤所致胫腓骨远端开放性骨折伤员,男5例,女7例;年龄33～85岁(平均54.8岁).开放性骨折按Gustilo分型:Ⅱ型5例,ⅢA型4例,ⅢB型3例.2例患者合并同侧膝关节闭合性骨折,3例患者合并内、外踝骨折.1 1例患者在急诊行清创、HoffmannⅡ型组合式单边外固定支架固定,l例患者伤后5d行外固定支架固定.对于一期手术后下肢力线偏离、关节对应关系不佳及伴有踝关节脱位的患者,进行二期外固定支架调整. 结果 11例行急诊清创外固定支架固定术的患者中,4例下肢力线恢复满意,7例下肢力线恢复不满意.4例患者因软组织损伤较轻,拟近期更换内固定时直接调整下肢力线;另3例患者软组织损伤严重,且伴有内外踝骨折、踝关节脱位,行二期外固定支架调整术.此3例患者术后骨折均获得良好复位,下肢力线恢复满意,关节对应关系良好. 结论 组合式外固定支架可以快速、有效处理地震灾害中的胫腓骨远端开放性骨折.对于地震伤员,应尽可能一次将骨折复位及下肢力线固定好.对于复位不良者,应及时进行调整,以免因转运而影响治疗和最终功能.     

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.     

Earthquakes and Rehabilitation Needs: Experiences From Bam,Iran

Abstract

Background: In December 2003, a devastating earthquake destroyed Bam and surrounding areas in Iran, leaving many people with residual deficits and disabilities, of which approximately 240 patients had spinal cord injury (SCI).

Methods: As an independent volunteer working in outpatient clinics, I visited the patients as part of a mobile team and set up a short educational course in spinal cord medicine.

Results: I visited 34 patients with SCI in the first 3 months. Eight months after the disaster, I visited 54 patients with SCI, 29 female (53.7%) and 25 male (46.3%). Postdisaster problems were identified, including need for accurate data collection, identification of patients' conditions, attention paid to psychosocial issues, ethical dilemmas, and research needs.

Conclusion: Disaster preparedness for earthquakes should include first aid and injury prevention, coordination of relief efforts, basic education and medical care, and short-and long-term rehabilitation needs. The major focus of rehabilitation medicine specialists' should be education of the general and professional population toward integrating the concept of rehabilitation.