Use of immunomodulator derinat in the treatment of patients with surgical sepsis in traumatic shock

The reparative effects of Derinat were studied in 15 patients with traumatic shock whose state was complicated by the development of sepsis. The immunomodulating effect of the drug lies in increasing the number of lymphocytes, reducing the total number of granulocytes and in elevation of the number of functionally valuable cells in them. Using Derinat was shown to facilitate the restoration of the initially reduced number of blood erythrocytes. The maximum effect of the drug was observed within 3-4 days. Readministrations of Derinat should be made twice a week.     

The surgical treatment of traumatic diaphragmatic hernias

The article discusses experience in treating traumatic diaphragmatic hernias in 68 patients, 63 of them underwent operation. Closed injuries to the diaphragm suffered in falling from a height and in car accidents and knife thoracoabdominal injuries were the main causes of this type of hernia. The principal role in their diagnosis belongs to X-ray examination with obligatory contrast study of the organs of the gastrointestinal tract. Among 41 patients who were operated on for non-strangulated hernia of this localization one died. In a group of 21 patients with a strangulated diaphragmatic hernia 11 died after surgery. Necrosis of the gastric and colonic wall, incompetence of the anastomosis sutures, peritonitis, and pleuritis were causes of death.     

外伤性胃穿孔30例诊断和外科治疗

目的 探讨外伤性胃穿孔的临床特点与诊治。方法 回顾性分析30例外伤性胃穿孔患者的临床资料,全部均行手术治疗,其中胃穿孔修补术28例,胃部分切除胃空肠吻合术2例。结果 治愈27例,死亡3例,病死率10％。结论 开放性损伤是外伤性胃穿孔常见的致伤原因,合并伤常见。手术是外伤性胃穿孔的主要治疗手段,以缝合修补为主。术中应注意胃贯穿性与后壁穿孔及其他脏器的合并伤的处理。     

创伤性枢椎滑脱的手术治疗

目的探讨创伤性枢椎滑脱的稳定性判断标准、手术适应证、内固定方式选择等.方法对25例来自不同医院具有影像学资料的住院病例临床分析.稳定性判断根据Fransic标准和Coric标准.分类标准参照Levine-Edwards方案.手术方法以前路C2-3椎间植骨融合内固定为主.结果不稳定16例,稳定9例.Ⅰ型4例,Ⅱ型19例(占76%),Ⅱa2例,无Ⅲ型.14例CT检查中,对称性骨折4例;不对称性骨折10例,占71%.保守治疗12例,其中不稳定型8例,稳定型4例.手术治疗13例,Ⅰ型2例,Ⅱ型9例,Ⅱa型2例,其中不稳定型8例,稳定型5例.骨折均在3个月内愈合.结论TSA各家稳定性评判标准未必可靠,仍应结合动力X线片和牵引动态X线片观察结果.大多数病例只需保守治疗,手术指征应严格掌握.对Ⅱ型经保守治疗无效病例应手术.手术前、后入路各有其适应症.     

The treatment of traumatic shock: recent advances and unresolved questions

Uncontrolled bleeding remains a leading cause of potentially preventable death after trauma. Timely, adequate resuscitation in traumatic shock is an essential, lifesaving aspect of polytrauma care. Whilst basic principles in the treatment of traumatic shock remain the same—achieving hemorrhage control and replacing lost volume, the way this is achieved has changed significantly in the last five years. The abandonment of blood pressure driven uncontrolled fluid resuscitation, the introduction of the concept of hemostatic resuscitation, and the increasing use of massive transfusion protocols have all contributed to an improvement in timely access to various blood products. The increase in knowledge regarding the pathophysiology of trauma, the availability of adjuncts, and the array of resuscitation monitoring options available have all contributed to a potentially improved approach to resuscitation. The purpose of this report is to review the most important advances in traumatic shock therapy in the last five years.     

Successful treatment of complex traumatic and surgical wounds with a foetal bovine dermal matrix

A foetal bovine dermal repair scaffold (PriMatrix, TEI Biosciences) was used to treat complex surgical or traumatic wounds where the clinical need was to avoid skin flaps and to build new tissue in the wound that could be reepithelialised from the wound margins or closed with a subsequent application of a split‐thickness skin graft (STSG). Forty‐three consecutive cases were reviewed having an average size of 79·3 cm², 50% of which had exposed tendon and/or bone. In a subset of wounds (44·7%), the implantation of the foetal dermal collagen scaffold was also augmented with negative pressure wound therapy (NPWT). Complete wound healing was documented in over 80% of the wounds treated, whether the wound was treated with the foetal bovine dermal scaffold alone (95·2%) or when supplemented with NPWT (82·4%). The scaffold successfully incorporated into wounds with exposed tendon and/or bone to build vascularised, dermal‐like tissue. The new tissue in the wound supported STSGs however, in the majority of the cases (88·3%); wound closure was achieved through reepithelialisation of the incorporated dermal scaffold by endogenous wound keratinocytes. The foetal bovine dermal repair scaffold was found to offer an effective alternative treatment strategy for definitive closure of challenging traumatic or surgical wounds on patients who were not suitable candidates for tissue flaps.     

胰腺钝性损伤急诊CT诊断与外科治疗

【摘要】〓目的〓探讨胰腺损伤的诊断及外科治疗。方法〓回顾分析经临床诊疗和手术证实为钝性胰腺损伤(13例)患者CT表现和治疗结果。结果〓13例患者中,胰腺挫伤4例,挫裂伤9例,其中胰腺横断伤1例;均伴有胰周被膜、肾前筋膜增厚,胰腺周围脂肪间隙模糊及积液;2例伴假囊肿形成。合并伤包括脾挫裂伤5例,肝挫裂伤6例,肾挫裂伤3例。12例痊愈,1例死亡,3例术后6月假性囊肿形成。结论〓腹部CT检查对胰腺损伤的早期诊断及治疗具有非常重要的价值。     

创伤性三尖瓣损伤的诊断和手术治疗

创伤后三尖瓣瓣膜损伤临床上较为少见.本院自1993年5月至2003年1月,共收治该类患者5例,均得到明确诊断和手术治疗,效果良好.现报告如下.     

外伤性颈髓中央综合征的手术治疗

目的回顾性分析手术治疗外伤性颈髓中央综合征的效果，探讨合理评估疗效的方法。方法2001年3月至2005年5月，手术治疗外伤性颈髓中央综合征32例，年龄22-65岁，平均48岁。合并颈椎间盘突出5例，颈椎骨折10例，颈椎明显退变20例。根据颈髓压迫来源，行前路减压、固定及融合术21例，前后路联合减压术8例，单纯后路减压术3例。比较手术前后美国脊髓损伤委员会（American Spinal Injury Association，ASIA）运动功能评分（ASIA motor score，AMS）和恢复率，评估SF-36各项指标及患者满意度。结果32例术后随访11-53个月，平均33个月。1例因内固定物松动于术后4个月将其取出。与入院时相比，术后6个月和末次随访时AMS明显提高，运动功能恢复率分别为53．7％和70.3％。患者年龄、伤后手术时间及伤前是否存在明显颈椎退变对最后的AMS无明显影响；颈椎明显退变组AMS的恢复主要在术后6个月内，而颈椎无明显退变组手术6个月以后仍有AMS的恢复。末次随访时，伤后踝阵挛阳性组的AMS和恢复率高于踝阵挛阴性组。本组术后平均AMS明显提高，但SF-36各项指标及患者自评疗效的满意率并不高，约1／3患者对总体疗效不满意，其中手功能障碍及下肢肌肉痉挛为主要原因。结论手术治疗伴颈髓受压或颈椎不稳的颈髓中央综合征可明显提高AMS，但AMS不能全面反映患者整体功能，结合SF-36等标准可更全面地评估手术远期疗效。     

外伤性面瘫的早期手术治疗

目的回顾总结锐器切割伤导致面瘫的早期治疗效果。方法自2000年1月至2006年8月,治疗锐性面神经损伤患者5例。其中行Ⅰ期急诊手术者4例,根据面神经解剖表面标志,解剖并游离神经两端,在显微镜下端端吻合离断的面神经;行Ⅱ期手术者1例,在外伤后3个月内进行。结果术后随访患者5～8个月,5例患者均获得了比较满意的面肌功能恢复。结论早期采用面神经端端吻合术是治疗锐利性面神经损伤的关键。     

复杂性外伤肝破裂的外科处理：附38例报告

目的 探讨复杂性外伤肝破裂的处理经验与治疗方法.方法 对38例复杂性外伤肝破裂患者的临床资料进行回顾性分析.结果 38例中,开放性损伤3例,闭合性损伤35例,有合并伤12例;肝外伤属Ⅲ级者13例.Ⅳ级15例,V级9例,Ⅵ级1例;入院时均有休克及腹膜炎表现.本组38例均行手术治疗.行单纯修补缝合6例,大网膜填塞加缝合9例,左肝外叶切除2例,不规则肝段切除2例,明胶海绵填塞加缝合9例,纱布填塞10例.17例发生近期并发症.34例治愈,死亡4例.其中死于大血管破裂失血性休克1例,死于颅脑外伤、肝创面再出血及多器官功能衰竭1例.结论 手术是治疗复杂性外伤肝破裂的有效方法,应根据患者的局部和全身情况选择手术方式;肝周填塞对降低复杂性外伤肝破裂的病死率有重要意义.