道路交通伤的早期救治

道路交通伤是人类安全的重大威胁,是15～19岁青少年的第一死因.在不同受伤人群、车型和事故类型,具有不同的损伤特点和规律性.了解这些临床特点,有助于提高早期诊断治疗水平.道路交通伤时多发伤发生率高,诊断治疗牵涉到多学科、多专业,高效率的院前急救和专业化的创伤科有利于提高抢救生存率.     

装甲车乘员爆炸伤研究进展

通过对以往战伤资料研究发现,早期装甲兵战伤中烧伤发生率高,四肢骨折、创伤性截肢比例增加,复合伤更多,死亡率更高,与步兵战伤不同。随着新技术、新材料的应用,装甲车正面防护能力不断增强,当受到反装甲武器袭击时有相当一部分未被击穿。由于装甲车被击穿与否,导致乘员损伤的因素及机制不同,装甲兵战伤特点也随之改变,如四肢伤、多发伤、潜在脊髓损伤,伤情较轻,死亡率低;另外,创伤性颅脑损伤发生率高也可能与此有关。笔者就装甲车乘员爆炸伤研究进展进行综述。     

Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective

Recent data suggest that the risk of paediatric sport injury is high and constitutes a significant public health burden. A concern regarding long-term consequences of youth sports injury is the risk of developing osteoarthritis (OA) at a young age. Based on the available evidence, a link between youth sports injuries, particularly acute injury of the knee and ankle, and OA, is likely. Early OA development and intense participation in high-impact, high-stress elite sports at an early age also may be associated, but follow-up of elite athletes into the early adult years is needed to examine this relationship. Given that some antecedents of early adult-onset OA may be traced to child and adolescent sports injury and related surgery, and perhaps intense training regimens, it follows that efforts to prevent sports-related joint injury should begin during the childhood years. Based on the results of recent research evidence, programmes addressing prevention of youth sports injuries may provide the rewarding results of OA prevention.     

Impact and overuse injuries in runners

Forces that are repeatedly applied to the body could lead to positive remodeling of a structure if the forces fall below the tensile limit of the structure and if sufficient time is provided between force applications. On the other hand, an overuse injury could result if there is inadequate rest time between applied forces. Running is one of the most widespread activities during which overuse injuries of the lower extremity occur. The purpose of this article is to review the current state of knowledge related to overuse running injuries, with a particular emphasis on the effect of impact forces. Recent research has suggested that runners who exhibit relatively large and rapid impact forces while running are at an increased risk of developing an overuse injury of the lower extremity. Modifications in training programs could help an injured runner return to running with decreased rehabilitation time, but it would be preferable to be able to advise a runner regarding injury potential before undertaking a running program. One of the goals of future research should be to focus on the prevention or early intervention of running injuries. This goal could be accomplished if some easily administered tests could be found which would predict the level of risk that a runner may encounter at various levels of training intensity, duration, and frequency. The development of such a screening process may assist medical practitioners in identifying runners who are at a high risk of overuse injury.     

常温下全肝血流阻断处理严重肝外伤

目的 探讨常温下全肝血流阻断切肝术治疗严重肝外伤合并肝静脉和（或）下腔静脉损伤,以期提高严重肝损伤病人的抢救成功率,减少术后并发症。方法 采用常温下全肝血流 术切除肝叶,修复肝静脉和（或）下腔静脉处理８例严重肝外伤患者。结果 ８例合并肝静脉和（或）下腔静脉损伤的严重肝外伤病人,均采用全肝血流阻断处理,除１例合并其他损伤死亡外,其余均治愈。结论 常温下全肝血流阻断在处理合并肝静脉和（或）下腔静脉损伤     

Cardiac Effects of Running in Untrained College Men

In brief: Children are at high risk of growth plate injury, contrary to previous research data. Of 134 consecutive growth plate injuries seen at the University of Arizona Hospital in Tucson over a six-year period, 22% occurred in team sports and 20% in activities such as using playground equipment, horseback riding, roller and ice skating, skateboarding, and bicycling. The authors review clinically useful anatomical and biomechanical aspects of the growth plate and its injuries, reflecting their own research as well as other studies. They also discuss prevention and diagnosis of this common source of childhood injury.     

Imaging of renal trauma: a comprehensive review.

Computed tomography (CT) is the modality of choice in the evaluation of blunt renal injury. Intravenous urography is used primarily for gross assessment of renal function in hemodynamically unstable patients. Selective renal arteriography or venography can provide detailed information regarding vascular injury. Retrograde pyelography is valuable in assessing ureteral and renal pelvic integrity in suspected ureteropelvic junction injury. Ultrasonography is useful in detecting hemoperitoneum in patients with suspected intraperitoneal injury but has limited value in evaluating those with suspected extraperitoneal injury. Occasionally, radionuclide renal scintigraphy or magnetic resonance imaging may prove helpful. Renal injuries can be classified into four large categories based on imaging findings. Category I renal injuries include minor cortical contusion, subcapsular hematoma, minor laceration with limited perinephric hematoma, and small cortical infarct. Category II lesions include major renal lacerations extending to the medulla with or without involvement of the collecting system and segmental renal infarct. Category III lesions are catastrophic renal injuries and include multiple renal lacerations and vascular injury involving the renal pedicle. Category IV injuries are ureteropelvic junction injuries. CT is particularly useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help assess the extent of penetrating injuries in selected patients with limited posterior stab wounds. Integration of the imaging findings in renal injury with clinical information is critical in developing a treatment plan.     

Incidence, severity, aetiology and prevention of sports injuries. A review of concepts.

Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the 'sequence of prevention'. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step. In this review some aspects of the first and second step of the sequence of prevention are discussed. The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of 'sports injury' and 'sports participation'. The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample. Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the 'sequence of prevention' the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model.(ABSTRACT TRUNCATED AT 400 WORDS)     

108例严重肝脏损伤诊治分析

目的总结严重肝脏损伤诊治经验,提高救治水平。方法对2005年1月-2013年12月收治的108例严重肝脏损伤的患者资料进行回顾性分析,男性72例,女性36例;年龄15-75岁,平均（37.0±0.7）岁。道路交通伤55例,坠落伤28例,锐器伤15例,塌压伤5例,摔伤3例,击打伤2例。结果早期诊断正确率94.4%（102/108）,救治成功率89.8%（97/108）,肝脏损伤非手术治疗AE止血有效率为88.9%（8/9）;并发术后出血5例、膈下感染4例、胆瘘11例、胆汁瘤6例,腹腔间隙综合征（ACS）5例,存在并发症的患者2例死亡,余经手术治愈或自愈。总死亡率10.2%（11/108）,死因为失血性休克4例,脑伤3例,胸伤2例,腹腔间隙综合征2例。结论及时正确的伤情评估、合理掌握非手术和手术的指征、正确的选择手术方式、合理运用损害控制策略和肝周填塞对提高救治水平有重要意义。     

Warm-up and muscular injury prevention. An update

Musculotendinous injuries are responsible for a significant proportion of injuries incurred by athletes. Many of these injuries are preventable. Importantly, musculotendinous injuries have a high incidence of recurrence. Thus, muscle injury prevention is advocated by coaches and trainers. Yet, most of the recommendations for muscle injury prevention are attempted by athletes and taught by coaches without supporting scientific evidence. This paper reviews the mechanics of muscular injury, associated and predisposing factors, and methods of prevention with a review of the supporting research and rationale for these methods with an emphasis on warm-up, stretching and strengthening. Muscles that are capable of producing a greater force, a faster contraction speed and subjected to a greater stretch are more likely to become injured. Many factors have been associated with muscular injury. From current research, some conclusions and recommendations for muscle injury prevention can be made. Overall and muscular conditioning and nutrition are important. Proper training and balanced strengthening are key factors in prevention of musculotendinous injuries as well. Warm-up and stretching are essential to preventing muscle injuries by increasing the elasticity of muscles and smoothing muscular contractions. Improper or excessive stretching and warming up can, however, predispose to muscle injury. Much research is still needed in this important aspect of sports medicine.     

Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis

Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.     

Preventing injuries to competitive and recreational adult golfers: What is the evidence?

Although injuries to golfers are not common, both survey studies and hospital emergency department records have provided objective evidence that golfers are sometimes at risk of injury. While many golf injury studies describe the associated mechanisms and types of injuries, less attention has been given to research relating to the various injury prevention measures for this sport. This paper provides a critical review of the range of countermeasures to prevent golf injuries and highlights areas to be considered for future research, development, and implementation. In particular, it focuses on the strength of the evidence for the effectiveness of these measures. This review concludes that there needs to be more formal evaluation of the suggested countermeasures to prevent golf injuries. Particular attention should be given to evaluations of the golf swing and its relationship to particular injuries such as low-back, wrist, and shoulder problems. These countermeasures and associated strategies are recommended to reduce the incidence of injury in this popular and accessible sport.     

肝外伤伴肝后静脉损伤的处理

目的 探讨肝外伤伴肝后静脉损伤的处理方法，以提高肝外伤伴肝后静脉损伤的外科治疗水平。方法 采用分步全肝血流阻断下显露修补、直接压迫下显露修补、缝扎肝静脉、缝合修补肝组织、纱布填塞等5种方法处理肝外伤伴肝后静脉损伤23例。结果 治愈18例(78．3％)，死亡5例(21．7％)。结论 术前合理的急救复苏、术中正确的综合手术治疗，是提高肝外伤伴肝后静脉损伤疗效的关键。     

放射性肝损伤的早期影像学评价实验研究

目的:探讨早期放射性肝脏损伤的99mTc-Phytate显像和超顺磁性氧化铁(SPIO)增强MRI表现。方法:12只成年家兔,左侧半肝X线照射后第3、4天,行99mTc-Phytate显像SPECT和SPIO增强MRI检查,并进行病理分析。结果:99mTc-Phytate肝显像,家兔肝脏照射区核素摄取减弱呈放射性稀疏区;SPIO增强早期MRI,家兔肝脏照射区较未照射区呈高信号;特异性铁颗粒染色肝脏照射区吞噬SPIO颗粒的Kupffer细胞数量下降。结论:99mTc-Phytate肝显像与SPIO增强MRI均可敏感地检出肝脏照射后早期出现的网状内皮系统损伤,SPIO增强MRI对早期诊断有很好的应用潜力。     

Head injuries in the female football player: incidence, mechanisms, risk factors and management

Although all injuries in sports are a concern for participants, head injuries are particularly troublesome because of the potential for long-term cognitive deficits. To prevent any specific injury, it is important to understand the basic frequency and incidence of injury and then the mechanism of injury. Once these are established, prevention programmes can be tested to see if the rate of injury changes. A primary problem with head injuries is recognising that the injury has occurred. Many athletes are not aware of the seriousness of concussive injury, thus this type of injury is probably under-reported. Once the diagnosis of a concussion is made, the next difficult decision is when to return a player to the game. These two management issues dominate the continuing development of understanding of concussive head injury. This paper explores the known gender differences between head injuries and highlights the areas that need to be considered in future research.     

地震伤严重伤员的早期救治

目的 探讨地震伤严重伤员的早期救治方法.方法 对286例严重地震伤员实施早期救治,单部位伤189例(66.1%),AIS评分平均3.8分;多发伤97例(33.9%),ISS评分平均27.7分.紧急手术65例:其中肝破裂修补12例,脾破裂行脾切除13例,肠系膜血管损伤修补3例,腹部多脏器损伤修补6例,膈肌破裂修补4例,颅内血肿清除术12例,大量血气胸行开胸手术9例(肺破裂修补4例,肺及支气管部分切除5例),心脏压塞行心包切开1例,连枷胸行肋骨内固定5例.早期手术72例:清创加骨折外固定支架固定57例,截肢术15例.结果 59例治愈出院,196例经初期治疗后转院,28例接受后期康复治疗,死亡3例.结论 分级救治可保证严重伤员得到及时有效救治;危重伤员及伴有严重心肺等基础疾病的伤员应实施损害控制;做好反复检诊是防止延误诊治的有效方法;加强多专业合作对提高危重病人救治成功率具有非常重要的作用.     

Imaging in renal trauma

Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.     

钝性肝脾肾损伤的CT平扫与增强扫描比较

目的:比较CT平扫与增强扫描对肝脾肾钝性损伤的诊断能力。方法:回顾性分析临床疑似钝性肝脾肾损伤,并经手术和临床观察证实的CT平扫和增强扫描的患者84例。结果:平扫确定的损伤:肝12例,脾25例,肾5例;平扫可疑损伤:肝22例,脾15例,肾5例。增强确定的损伤:肝32例,脾40例,肾12例(全肾梗塞1例,局限性梗塞3例);对比剂外溢(活动性出血)3例;无可疑损伤。平扫无异常而增强确定有损伤:肝10例,脾5例,肾2例。增强显示的损伤灶比平扫范围明显大、病灶多、界限清楚。结论:CT增强扫描显示肝脾肾损伤明显优于平扫,延时扫描有助于发现活动性出血,应常规增强扫描。     

大批量地震伤员的早期救治

目的 探讨大批量地震伤员的早期救治方法.方法 对1 123例地震伤员实施早期救治.受伤部位:四肢伤925例,脊柱伤65例,头部伤46例,胸部伤53例,腹部伤72例.单部位伤809例,多发伤314例.紧急手术67例,其中肝破裂修补13例,脾破裂行脾切除14例,肠系膜血管损伤修补3例,腹部多脏器损伤修补6例,胸腹联合伤行胸腹脏器损伤修补及膈肌破裂修补4例,颅内血肿清除术12例,肺破裂修补4例,肺及支气管部分切除5例,心脏压塞行心包切开1例,连枷胸行肋骨内固定5例.早期手术166例,其中早期单纯清创105例,清创加骨折外固定支架固定36例,截肢25例.结果 406例治愈出院,673例经初期治疗后转院治疗,死亡3例.结论 分级救治方法适用于大批量地震伤员的早期救治.危重伤员及伴有严重心肺等基础疾病的地震伤员早期应采用损害控制技术.反复检诊是防止延误诊治的有效方法.     

The influence of methodological issues on the results and conclusions from epidemiological studies of sports injuries: illustrative examples

Data obtained from epidemiological studies of sports injuries are an essential requirement for developing injury prevention, treatment and rehabilitation strategies. Although many authors have discussed the strengths and weaknesses of research methods employed in epidemiology, the potential effects that variations in research design and methods of analysis can have on study conclusions have not been clearly illustrated. This article addresses a number of methodological issues and illustrates their potential effects using examples based on injury data obtained from a single, large epidemiological study in professional rugby union. The examples demonstrate that conflicting conclusions can be reached depending on how the data are collected and analysed. The pivotal roles played by injury definition (loss-of-time, missed matches, diagnostic assessment and surgery), recurrent injury definition (clinical judgement and same injury/same location/same season), method of reporting injuries (number, proportions and incidence) and method of calculating incidence (injuries per 1000 player-hours, per 1000 athlete-exposures and per 1000 matches) are highlighted and illustrated. Other examples show that if training and match injuries are combined, the incidence of injury is more likely to reflect the incidence of training injuries but the distributions of injuries are more likely to reflect the distributions of match injuries. An example is presented that demonstrates that the identification of injuries causing the greatest concern within a sport depends on whether the assessment is based on injury incidence, severity or risk. Finally, examples are presented to show that the relationships identified between sports injuries and risk factors may be dependent on whether case-control or cohort study designs are used.Although there are no simple solutions available to resolve the issues raised, the discussion demonstrates the importance, at least within a sport, of reaching consensus agreements on acceptable study designs and methods of data analysis in sports epidemiology.