道路交通伤研究进展

目前全球每年因车祸死亡的人数已超过100万,伤1500万。道路交通伤的发生有不断增多趋势,且死伤者以青少年居多,多发伤居多。事故原因主要为人的因素,24岁以下年轻人与70岁以上老年人多发,有一定的事故倾向。粘性标准可作为最有效的伤情指数。综合治理,加强交通安全的研究、管理与教育,健全医疗服务系统,加强创伤急救,缩短急救反应时间是减少交通事故、降低死亡率的必要措施。     

Pattern of injury in Shiraz

Objective： Injury is a major neglected health problem in developing countries. The first step in dealing with injury problem is to identify the injury patterns and characteristics. Therefore, we aimed to demonstrate the current status of trauma admissions to hospitals in Shiraz, as a major city of Iran.
Methods： A hospital-based study was conducted in 2002. All injured patients admitted during 6 months in emergency departments of two general hospitals of Shiraz, Nemazi and Chamran were included.
Results： A total of 1 765 injured patients were registered during the study period, with mean age of 33 years. Manual workers were the most vulnerable group among occupational categories. Inner-city roads were the most common place of injury and traffic accident was the major cause of injury. Overally, falling injury was the second common cause of injury in males and the first cause in females （ especially at the age of over 60）.
Conclusion： As other studies conducted in our society, traffic accidents are the major cause of morbidity and mortality and this can emphasize on the obligation to take legislative action in the field of driving and road safety, directing resources and educating the public and raising the awareness of the community in prevention of this iceberg-like problem.     

837例住院交通伤所致骨折分析

目的 探讨道路交通伤所致骨折的流行病学特点。方法 回顾分析我院1997年1月～2001年12月救治837例道路交通伤所致骨折的病例。结果 道路交通伤所致骨折837例，死亡8例；中青年男性占受伤患的58．7％；机动车是造成人员伤亡的主要原因，占84．6％；骨折部位以下肢最为常见，占41．5％；每年1～2月和7～10月有两个高峰时间分布；治疗方法以手术治疗为主。结论 车祸常累及中青年男性，致伤原因多与机动车有关，下肢骨折最常见。     

Comparative study on characters and outcomes of patients injured from traffic accidents in different rank hospitals

Objective:To compare the characters and outcomes of patients injured from traffic accidents in different rank hospitals.Methods:From 8 hospitals of ranks I-Ⅲ,1915 cases were sampled and divided into 4 groups.Injuries of all patients were accessed by the method of RTS,AIS-ISS-AP and ASCOT.Results:(1)The higher rank of hospitals,the severer the patients‘ condition were.Mean ISSs in hospital ranks Ⅱ and Ⅲ were greater than 16,which were recommended as a standard of severe trauma.(2)Transportation of severe patients to high level hospitals prolonged the pre-hodpital duration by 5-9h.(3)Factors contributing to death were the trauma severity,complications,hospital ranks that reflect the quality of the medical care.Conclusions:(1)This sample of 1915 cases matches the condition of most Chinese hospitals in characteristics of traffic trauma patients.(2)Most Chinese hospitals can be divided into 3 degree of trauma center by a criteria of ISS and the unexpected death.(3) Incidence of multiple injuries shows no significant difference in each rank of hospitals.(4)The relationship between the hospital rank and the quality of trauma care is significant.We suggest that a RTS=11 or ISS=9 be triaged to trauma center,and a 10% Ps(survival probability) less than the average Ps of a hospital be triage to higher level hospitals.     

Road traffic deaths in Kashan region, Iran: An eight-year study (2006e2013)

Purpose

The aim of this study was to analyze the trend of road traffic fatalities in Kashan Region, Iran, in a period of eight years.

Injury patterns of seniors in traffic accidents: A technical and medical analysis

AIM: To investigate the actual injury situation of seniors in traffic accidents and to evaluate the different injury patterns.METHODS: Injury data, environmental circumstances and crash circumstances of accidents were collected shortly after the accident event at the scene. With these data, a technical and medical analysis was performed, including Injury Severity Score, Abbreviated Injury Scale and Maximum Abbreviated Injury Scale. The method of data collection is named the German In-Depth Accident Study and can be seen as representative.RESULTS: A total of 4430 injured seniors in traffic accidents were evaluated. The incidence of sustaining severe injuries to extremities, head and maxillofacial region was significantly higher in the group of elderly people compared to a younger age (P < 0.05). The number of accident-related injuries was higher in the group of seniors compared to other groups.CONCLUSION: Seniors are more likely to be involved in traffic injuries and to sustain serious to severe injuries compared to other groups.     

车祸伤小肠破裂40例诊治分析

目的提高因车祸致小肠破裂的诊治水平.方法对我院1994年1月-2004年12月诊治的因车祸引起小肠破裂的40例患者进行回顾性分析.结果所有患者均有不同程度的腹痛和腹膜刺激征,腹穿阳性率为75%,X线检查提示膈下游离气体阳性率62.5%,CT检查提示腹腔积液阳性率75%.患者治愈39例,死亡1例.结论①早期诊断车祸致小肠破裂的关键是必须结合病史、阳性体征、临床表现及辅助检查进行综合分析.②早期手术治疗是提高车祸致小肠破裂治愈率的关键.③手术探查必须全面、仔细,按顺序进行,避免漏诊.     

The role of social advocacy in reducing road traffic accidents in India

Road traffic accidents (RTA) account for a significant proportion of mortality and morbidity worldwide, especially the developing countries. ‘Hidden pandemics’ such as deaths due to RTA often receive minimal attention globally. If not addressed adequately, the forecast looks bleak, especially for the developing countries in the coming decades. Healthcare professionals have an important role in advocating measures to reduce injuries following RTA and, along with like-minded social individuals, can act as a powerful lobby to implement change. Following a ‘Public Interest Litigation or PIL’ by the Indian Orthopaedic Association (IOA) in 2012 – which challenged the Government to accept responsibility for this glaring problem and form an apex body to enforce road safety – the Supreme Court of India identified the existing road-safety laws to be inadequate. It created an ‘Empowered Committee’ which oversaw various new road safety measures implemented by respective state governments. A public movement called ‘UYIR’ (meaning ‘life’ in Tamil) was launched at Coimbatore to reduce RTA. Early results following the implementation of this program showed promising results with a reduction in major accidents. It emphasized that well-planned programs involving the general public could be the way forward in reducing accidents across the country. Hence, Social Advocacy is crucial when an individual or group supports and influences political, economic, and social decisions. Such advocacy aims to gain support in an adverse environment to create the necessary change for the better.     

Injury Characteristics and Predisposing Effects of Various Outdoor Traumatic Situations in Children and Adolescents

BackgroudMany studies have reported injury characteristics of individual traumatic situations. However, a comparative analysis of specific risks is meaningful to better understand injury characteristics and help establish injury-prevention measures. This study was conducted to investigate and compare injury characteristics in children and adolescents by various outdoor traumatic situations.MethodsOutdoor traumatic situations were determined and classified into physical activity-related injury (n = 3,983) and pedestrian (n = 784) and passenger (n = 1,757) injuries in traffic accidents. Home injury (n = 16,121) was used as the control group. Then, the characteristics of each outdoor trauma were compared with 1:1 matched indoor trauma (among home injuries); each outdoor traumatic situation''s predisposing risk for the injured body part, injury type, and injury severity were analyzed; and changes by age of frequency ranking among physical activity-related injuries were investigated.ResultsOutdoor trauma showed higher risks for limb injuries (injured body part), fracture and muscle/tendon injuries (injury type), and severe injuries (severity) than indoor trauma. Various outdoor traumatic situations presented different predisposing effects on injury characteristics. Among physical activity-related injuries, bicycle injury was commonest across all ages, and playing activities were common causes for injury for individuals of age < 9 years, whereas sports activities overwhelmed the common causes thereafter.ConclusionsThe findings would help to better understand the specific injury risk of various outdoor traumatic situations and may potentially facilitate the establishment of more effective injury-prevention measures.     

四肢脊柱交通伤的救治

四肢和脊柱是交通伤中最常见的致伤部位之一。交通伤的院前救治是我国交通伤救治中最薄弱的环节,为此,应该逐步增设院前急救网点,建立院前-院内一体化创伤救治服务体系,加强院前急救员的培养训练工作。在四肢脊柱交通伤的救治中,首先应抢救危及生命的严重创伤,但同时也要兼顾骨折的及时处理。详细了解致伤机制和全面查体是防止交通伤漏诊的重要方法。在四肢交通伤骨折的救治中,特别是对多发伤伤员的急救,外固定器技术具有明显的优越性。带锁髓内钉技术治疗四肢长管状骨骨折也可取得满意疗效。骨盆骨折的早期可采用外固定器稳定骨折,同时采用髂内动脉栓塞等技术积极处理骨盆骨折所导致的大出血。在脊柱交通伤的治疗中,应考虑到脊柱的稳定性和迟发性截瘫等因素,适当确定手术适应证。椎管环形减压术可充分地解除对脊髓的压迫。颈椎骨折常可采用颈椎前路钢板螺钉固定颈椎融合手术。胸腰椎骨折脱位可实施经椎弓根后路短节段内固定手术治疗。     

四肢脊柱车祸伤356例救治体会

目的 探讨分析四肢脊柱车祸伤的临床特点,提出相应的救治措施。方法 对365例四肢脊柱车祸伤的发生因素、临床表现、救治经过及后果进行分析研究,找出其临床特点及其有效的救治方法。结果 四肢脊柱车祸伤的临床特点有:①创伤重且复杂;②复合伤多且危险;③多发伤及开放伤多;④软组织辗压,挫灭严重;⑤汽车肇事伤最多,最重。结论 针对车祸伤的特点,采取相应的预防及救治措施,将能减少车祸伤的发生,也能减少并发症的出现,对减少残废,降低死亡率亦有很大的指导意义。     

Evaluation of differences in injury patterns according to seat position in trauma victims survived traffic accidents

Purpose: Investigation of injury patterns epidemiology among car occupants may help to develop different therapeutic approach according to the seat position. The aim of the study was to evaluate and compare differences in the incidence of serious injuries, between occupants in different locations in private cars. Methods: A retrospective study including trauma patients who were involved in motor vehicle accidents and admitted alive to 20 hospitals (6 level Ⅰ trauma centers and 14 level Ⅱ trauma centers). We examined the incidence of injures with abbreviated injury score 3 and more, and compared their occurrence between seat locations. Results: The study included 28,653 trauma patients, drivers account for 60.8% (17,417). Front passenger mortality was 0.47% higher than in drivers. Rear seat passengers were at greater risk (10.26%) for traumatic brain injuries than front seat passengers (7.48%) and drivers (7.01%). Drivers are less likely to suffer from serious abdominal injuries (3.84%) compared to the passengers (front passengers - 5.91%, rear passengers - 5.46%). Conclusion: Out of victims who arrived alive to the hospital, highest mortality was found in front seat passengers. The rate of serious chest injuries was higher as well. Rear seat passengers are at greater risk for serious traumatic brain injuries. All passengers have a greater incidence of abdominal injuries. These findings need to be addressed in order to develop “customized” therapeutic policy in trauma victims.     

交通事故导致的股骨髁间骨折的治疗和并发膝关节强直的处理

目的 总结交通事故致股骨髁间骨折的治疗及治疗后并发膝关节强直的原因和处理。方法 对６８例该种类型的骨折进行统计分析。结果 ４２例骨折的膝关节面基本达解剖复位,４０例骨折愈合后出现不同程度的膝关节强直。结论 并发膝关节强直的病例宜尽早行膝关节粘连松解＋关节持续被动运动治疗,应强调关节的主动运动对关节功能恢复所起的作用。     

交通伤四肢复合组织缺损的组织瓣移植修复

目的 探讨游离组织瓣移植联合应用外固定器固定骨、关节用于修复交通伤四肢组织缺损伤的临床效果. 方法对上肢和下肢交通伤造成骨、关节合并软组织、皮肤缺损等病例共36例,应用游离组织瓣移植,包括骨皮瓣、肌皮瓣、皮瓣移植,同时采用A-O管状外固定器、单侧多功能外固定器及单侧踝关节外固定器行骨关节外固定,加速骨质愈合. 结果56例移植皮瓣全部成活,骨关节缺损愈合良好,术后上肢3-6个月、下肢6-8个月拆除外固定器,肢体功能恢复满意,无畸形及骨不连接. 结论应用组织瓣移植同时以外固定器固定骨关节对交通伤肢体组织的复合性缺损进行修复和重建,具有骨关节固定简单可靠,肢体及移植组织损伤小,便于观察血运.对肢体交通伤功能得以早期训练以及护理便利起积极作用.     

交通伤致四肢脊柱骨折的治疗

道路交通伤中四肢脊柱骨折的发生率较高,可由多种致伤机制所致,其中以碰撞最为常见。道路交通伤中的骨折病例呈“离心”分布,多发性骨折、同侧肢体损伤和传导暴力损伤多见。交通伤的急救,首先应处理危及生命的严重合并伤与并发症,在全身情况稳定的情况下,积极处理开放性损伤与骨折。交通伤所致的骨折患者,特别是全身情况差及老年患者,采用外固定器、特别是单侧外固定器治疗是较理想的选择;应用带锁髓内钉治疗长管状骨骨折也取得了较满意的疗效。交通伤所致的骨盆骨折,早期可采用外固定器治疗,同时积极处理骨盆骨折所引起的大出血,对C型骨盆骨折待生命体征稳定后应尽早改用内固定。交通伤所致的脊柱脊髓损伤,钛合金是首选的置入材料,通常颈椎骨折宜采用颈前路钢板螺钉固定融合术,胸腰椎骨折脱位多主张经椎弓根螺钉后路固定术。     

The impact of non weight bearing: A prospective cohort study

BackgroundPatients with lower limb injuries are commonly advised to non weight bear (NWB) on their injured limb as part of treatment. Occasionally, patients complain that offloading one limb, associated with the use of crutches or other mobility aids, may lead to pain on one of the other supporting limbs. This has led to compensation claims (1) but has never been the subject of formal research.MethodsA prospective cohort trial was undertaken to address this question. Patients were recruited from two Metropolitan Hospital Orthopaedic Fracture Clinics and Orthopaedic Wards. A survey was administered at two time points; the first at the point of definitive orthopaedic treatment and commencement of the NWB phase. The second after the NWB phase was completed. The surveys included a pain Visual Analogue Scale (VAS), Short Form (SF)12, a pain body chart and a health questionnaire.ResultsA total of 55 patients were enrolled in the study. Seven patients developed new joint pain after a period NWB. These patients scored significantly lower on the follow up SF12 when compared to those who did not develop new pain (p = 0.045). Follow up phone calls at least 6 months following completion of the second survey revealed that all initial and new pain areas in these participants had resolved. The main limitation of this study was the limited numbers.ConclusionThis study supports the idea that crutches, prescribed in the short term to allow a limb to be NWB, achieve this aim with minimal impact. Their use may be associated with new other joint pain however it can be anticipated this will resolve after cessation of crutch use.     

2005-2009年温州市甬台温高速公路（温州段）交通伤特点分析

目的通过调查分析甬台温高速公路（温州段）交通伤的特点,为进一步提高交通伤害救治水平提供依据。方法收集发生于宁波-台州-温州（简称甬台温）高速公路（温州段）交通事故的原始数据,用描述流行病学方法分析交通伤特点;采用SPSS18．0软件对调查指标进行分析。结果2005年1月1日至2009年12月31日（5年间普通程序处理的事故）甬台温高速公路发生交通事故308起,累计伤亡603人。其中死亡157人。交通事故以尾随相撞最为多发,占总事故的39．29％,主要原因为司机疲劳驾车及超速行驶。结论高速公路交通事故有时间、年龄分布不均衡性;男性青壮年为发生概率的高危人群,但高龄受累人群的死亡率更高。通过对温州段高速公路交通伤特点分析,可针对性地进行高速公路行车安全培训,借此创建安全的高速公路交通环境。     

Clinical analysis of 28 children suffering from intracranial hematoma and multiple injuries following traffic accidents

Objective: To evaluate the result of diagnosis and treatment of intracranial hematoma and multiple injuries caused by road traffic accidents. Methods: Twenty-eight patients, aged from 1 to 14 years, receiving craniotomy and other surgical treatments were retrospectively reviewed. Results: Among the 28 cases, 23 cured with the recovery rate of 82.3%, 2 had a sequel of moderate disability, and 3 died from severe brain injury, hemorrhagic shock, and other visceral complications. The clinical sympotoms and signs were severe and perplexing. The major characters included: severe head injury, usually combined by multiple injuries, and easy of access to missed diagnosis and misdiagnosis. Conclusions: The occurrence of infection is high after traffic accidents as a result of depression of humoral and cellular immunity, long-term bed rest, and fractures of limbs. Hence, on the basis of maintaining vital signs, the management of primary wound is essential to reduce infection and underlying death. In addition to the management of brain injury, concurrent injuries should also be highlighted so as to reach a good result for their patients.     

An in-depth technical and medical investigation of facial injuries caused by car accidents

BackgroundMany studies have investigated the issue of facial injuries caused by car accidents, but only a few have addressed the technical and clinical aspects of such accidents and injuries in depth. The aim of this study was to identify risk factors and protective elements for facial injuries in car accidents.MethodsWe analysed the technical and clinical data of patients with facial injuries caused by car accidents over a 16-year period (2000–2016) and investigated the following factors: sitting position, sex, age, accident time, use of a seatbelt, deployment of the front airbag, direction of impact, speed at the time of collision, and occurrence and location of facial injuries.ResultsOf the 1291 patients involved in car accidents who were included in our study, 291 (22.5%) had suffered facial injuries. We found a significant association between occurrence of facial injuries and sex, speed at the time of collision, impact from the back, seatbelt usage, and deployment of the front airbag. In accidents occurring at speeds over 40 km/h, automobile security measures had no significant influence on the occurrence of facial injuries in drivers and front-seat passengers. In accidents occurring at speeds between 0 and 20 km/h, seatbelt usage (without airbag deployment) solely showed a significant protective influence against the occurrence of facial injuries (odd ratio [OR], 0.130; confidence interval [CI], 0.038–0.451). In contrast, patients who were in accidents at speeds between 21 and 40 km/h suffered significantly fewer facial injuries when wearing a seatbelt with the front airbag being deployed (OR, 0.245; CI, 0.091–0.665) or undeployed (OR, 0.216; CI, 0.084–0.561).ConclusionMale sex and a high speed at the time of collision are significant risk factors for the occurrence of facial injuries. The security measurements evaluated in this study only exerted a protective influence at low speeds (below 40 km/h). This indicates a possible weakness of these security systems with regard to preventing facial injuries. Engineers could benefit from these findings and improve the efficiency of existing security measures and eventually help decrease the incidence of facial injuries.