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Usher EJ 《Air medical journal》2001,20(5):40-42
In the past, blast injuries were associated strictly with war and catastrophic industrial accidents. Unfortunately, these injuries are on the front lines of each ED and EMS system in the form of pipe bombs and terrorist plots. Domestically and internationally, the incidence of blast injuries is sporadic and infrequent. The injuries often are the result of fireworks--10,000-12,000 ED visits annually for this reason.(1) 相似文献
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Sternoclavicular joint subluxation/dislocation injuries in the athlete are uncommon. They can be organised by degree (subluxation, dislocation), timing (acute, chronic, recurrent, congenital), direction (anterior, posterior), and cause (traumatic, atraumatic). The unusual case reported is an adolescent butterfly swimmer with recurrent bilateral sternoclavicular subluxation associated with pain and discomfort. The condition was treated and resolved with conservative management. The diagnosis, investigations, and treatment options are discussed. 相似文献
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Long-term outcome of knee and ankle injuries in elite football 总被引:4,自引:0,他引:4
E. Larsen P. K. Jensen P. R. Jensen 《Scandinavian journal of medicine & science in sports》1999,9(5):285-289
To estimate the risk and evaluate the long-term outcome of knee and ankle injuries in former national team elite football, 69 players were randomly selected, followed by clinical and stress radiographic examinations. Thirty-nine players (49 knees) had had knee injuries and 29 ankle injuries (35 ankles). The median time from injury until study examination was 25 years. The knee injuries were tears of the medial collateral ligament (MCL) in 24 cases combined with rupture of the anterior cruciate ligament (ACL) and meniscus lesions in three. Meniscus lesions had occurred in 17 cases including three combined with ACL and MCL and another two with ACL ruptures. Isolated rupture of the ACL had occurred in four cases. The ankle lesions were in 26 of 35 cases ruptures of the lateral ligaments. In all, 12 players had completely stopped football and three had changed occupation. Signs of arthritis were present in 63% of the injured knees and in 33% of the injured ankles. The incidence of arthritis in the group of 17 uninjured players was 26% in the knee and 18% the ankle. In elite football players knee and ankle injuries seem to have a serious long-term outcome, but also uninjured players have a higher risk of developing arthritis than the normal population. 相似文献
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ObjectivesPrevalence, clinical characteristics and severity of gradual onset injuries (GOIs) in cyclists are poorly documented. We determine the prevalence, anatomical regions/sites affected and severity of GOIs among entrants in a community-based mass participation event.DesignCross-sectional study;SettingCape Town Cycle Tour;ParticipantsRace entrants.Main outcome measuresOf 35,914 entrants, 27,349 completed pre-race medical questionnaires. We studied 21,824 consenting cyclists (60.8% of entrants). Crude lifetime prevalence, retrospective annual incidence, anatomical region/sites, specific GOI, tissue type and GOI severity is reported.ResultsThe lifetime prevalence of GOIs was 2.8%, with an annual incidence of 2.5%. More common anatomical regions affected by GOIs were lower limb (43.4%), upper limb (19.8%), and lower back (11.5%). The knee (26.3%), shoulder (13%), and lower back (11.5%) regions were mostly affected. The most common GOI was anterior knee pain (14.2%). Of the GOIs, 55% were in soft tissue. 50% of cyclists reported symptom duration >12 months, and 37.3% of GOIs were severe enough to reduce/prevent cycling.Conclusion2.5% recreational cyclists report a GOI annually. >50% of GOIs affect the knee, lower back and shoulder. GOIs negatively affect cycling. Risk factors related to GOIs in cyclists need to be determined to develop and implement prevention programs. 相似文献
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目的 观察单核吞噬细胞在创伤性非断离轴索损伤(NDAI)继发断离的作用,探讨NDAI继发断离的机制。方法 液压冲击脑损伤SD大鼠55只,采用全鼠脑连续矢状冰冻切片去磷酸化神经丝蛋白轻链(NF68)和单核吞噬细胞标记抗原(ED1)组化双标及NF68组化电镜染色,光镜电镜观察,计数肿胀轴索及轴索球。结果 伴有血管损伤的冲击区皮质及部分胼胝体主要是断离性轴索损伤,轴索碎片呈NF68杂染,早期即有ED1阳性细胞浸润;远离冲击区的基底节区、脑干、小脑无血管损伤,主要是NDAI,伤后3~12h出现NF68阳性反应的肿胀轴索和轴索球,7~14d毛细血管周边出现ED1阳性细胞,21~28d除肿胀轴索和轴索球外,部分神经元NF68阳性反应,ED阳性细胞广泛浸润。结论 延迟的NDAI继发断离与中枢吞噬细胞免疫反应密切相关。 相似文献
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目的 利用磁共振波谱技术探讨颅脑爆震伤后不同时间段脑局部代谢变化.方法 新西兰大白兔45只采用随机数字表法分为对照组(10只)和创伤组(35只),采用600 mgTNT当量纸雷管在创伤组兔脑上方约6.5 cm垂直距离爆炸,于伤后1,6,12,24 h、3,7,14 d用磁共振波谱技术观测动物存活情况,并检测脑损伤区病理及磁共振波谱表现,观察乙酰天门冬氨酸(N-acetylaspartate,NAA)/肌酸(creatine,Cr)、胆碱(choline,Cho)/Cr在爆震伤后随时间发展的演变过程.结果 创伤组兔存活时间在7 d以上,病理及常规MRI示脑挫伤病灶;NAA/Cr均值在损伤后1 h明显下降,持续至伤后24 h,24 h后义上升,7 d后再次下降.Cho/Cr均值在损伤1 h后即明显升高,12 h后下降,3 d后义逐渐升高.结论 磁共振波谱技术可反映兔颅脑爆炸伤不同时间段局部组织的代谢变化,为了解爆雀伤后局部组织变化情况及判断组织损伤类型提供理论依据.Abstract: Objective To evaluate the regional cerebral metabolic changes in different episodes by magnetic resonance spectroscopy (MRS) after explosive brain injury in rabbits. Methods Fortyfive New Zealand white rabbits were randomly divided into eight groups, ie, normal control group( 10 rabbits) and trauma group (35 rabbits). The explosive injury in trauma group was induced by explosion of 600 mg TNT equivalent of paper detonators at 6.5 cm above the rabbit brain. The rabbits in trauma group was divided into 1,6, 12, 24 hours, 3, 7, 14 days subgroups (6 rabbits per group). The survival rate was observed at different time points after explosive injury. The MRS was used to detect the regional cerebral metabolic changes including N-acetylaspartate (NAA)/creatine (Cr) ratio and choline(Cho)/Cr ratio as well as evolution of blast injuries over time. Results The rabbits survived for overseven days in the trauma groups, with typical brain contusion manifested by pathological and conventional MRI. Compared with the normal control group, the NAA/Cr ratio was markedly decreased at one hour after injury, slightly rose again at 24 hours and fell again after seven days. The Cho/Cr ratio was markedly increased at one hour after injury, slightly fell again at 12 hours and rose again at three days after injury.Conclusions MRS can manifest the regional cerebral metabolic changes of rabbits with explosive injury at different time points and hence provide a theoretical basis for understanding the local tissue changes and determining the type of tissue damage after blast injury. 相似文献
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92例胸腹联合伤临床分析 总被引:42,自引:1,他引:42
目的 探讨胸腹联合伤的诊断及治疗特点。方法 总结经手术证实的胸腹联合伤92例,其中开放性损伤41例(44.57%),以锐器刺伤为主;闭合性损伤51例(55.43%),以交通伤多见。分析不同原因的损伤类别及不同临床症状与手术方式。结果 92例中,术前明确有膈肌破裂42例(45.65%);88例在第一次手术中发现膈肌破裂,并予以修补(95.65%),4例未探查膈肌而漏诊(4.35%);死亡13例(14.13%)。结论 胸腹联合伤是一种特殊类型的损伤,伤情复杂、严重,死亡率高。诊断应根据受伤机制和出血量判断,特别注意避免漏诊膈肌损伤。治疗原则为先处理胸部损伤,后处理腹内脏器损伤。 相似文献
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Calpain抑制剂Ⅰ对大鼠脑非断离性轴索损伤继发断离的影响 总被引:2,自引:1,他引:1
目的 研究Calpain抑制剂Ⅰ对非断离性轴索损伤 (NDAI)继发断离的影响 ,探讨NDAI的治疗途径。 方法 将 16只雄性SD大鼠随机分为Calpain抑制剂Ⅰ组和对照组各 8只 ,液压冲击致大鼠脑弥漫性损伤 ,比较两组伤后 2 4 ,72h胼胝体区、间脑中脑区、桥脑延脑区和小脑区肿胀轴索及轴索球最大密度变化。 结果 大鼠致伤后 ,NF6 8免疫组化显示肿胀的轴索及轴索球。伤后 2 4h ,Calpain抑制剂Ⅰ组桥脑延脑区、小脑区肿胀轴索及轴索球最大密度明显减少 (P <0 .0 1) ;伤后 72h ,Calpain抑制剂Ⅰ组小脑肿胀轴索及轴索球减少 (P <0 .0 5 ) ,而胼胝体区、间脑中脑区、桥脑延脑区变化不明显 (P >0 .0 5 )。 结论 Calpain抑制剂Ⅰ可减轻NDAI的继发断离 ,主要是减少损伤较轻的NDAI的继发断离。 相似文献
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目的 研究高能战斗部 (HEF)致胸部伤特点和规律 ,为胸部爆炸伤的救治提供原则和依据。 方法 用电启动的方式引爆HEF ,将 45只绵羊布放于距爆心 30~ 2 40m处 ,致伤时测量冲击波超压和破片速度 ,致伤后进行病理解剖观察。 结果 胸部破片伤的发生率为 6 7% (30 /45 ) ,伤后即刻死亡率为 73% ;损伤类型以盲管伤和贯通伤为主 ,分别为 5 7%和 31% ;在 30只有胸部破片伤的动物中 ,肺冲击伤、肋骨骨折、大量胸腔积血 (>10 0 0ml)及胸腹联合伤的发生率分别为80 %、33%、2 7%和 33% ,心脏被直接击中的概率为 33 %。 结论 破片击中胸部的概率高 ,胸壁穿透伤多 ,伤情严重 ,伤后多迅速死亡。胸部严重毁损、心脏破片伤、多脏器受损以及快速失血是其主要死亡原因。 相似文献
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Michael J. Tuite M.D. Donald R. Yandow M.D. Arthur A. De Smet M.D. John F. Orwin M.D. Fernando A. Quintana B.S. 《Skeletal radiology》1995,24(7):495-498
Purpose. To determine the effect of decreasing the field of view (FOV) on the accuracy of MR for diagnosing rotator cuff tears.
Material and methods. One hundred shoulder MR scans with surgical correlation were evaluated for the presence or absence of a cuff tear. The sensitivity and specificity of MR relative to the surgical results were determined for the 59 patients scanned with a 24-cm FOV, and the 41 patients scanned with an 18-cm FOV. All other imaging parameters including acquisition time were identical. The sensitivity and specificity of the two groups were compared using a t-test.
Results. The specificity of MR for diagnosing a rotator cuff tear improved from 0.65 for the 24-cm FOV group to 0.89 for the 18-cm FOV group (P = 0.04). The sensitivity changed from 0.91 to 0.96 (P = 0.25).
Conclusion. Reducing the FOV from 24 cm to 18 cm results in a statistically significant improvement in specificity of MR for diagnosing rotator cuff tears. 相似文献
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放射性脑损伤是脑与头颈部恶性肿瘤放射治疗后常见的并发症。近年来随着脑与头颈部肿瘤放射治疗技术的日渐推广,该病发病率逐年升高,严重影响了患者的生活质量和生存期,因而对放射性脑损伤的研究显得较为迫切。本文综述了其发病机制及治疗措施,为减少放射性脑损伤的发生及采取科学合理的治疗措施提供参考。 相似文献
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目的 评价采用骨锚治疗腕舟骨月骨间韧带损伤的临床效果。方法 对2003年9月-2005年12月9例舟骨月骨间韧带损伤患者,采用Mitek骨锚修复舟骨月骨间韧带。术后平均10个月获得随访,随访检查包括疼痛程度、腕关节活动度、握力及X线检查。腕关节总体功能评价采用Krimmer腕关节评分表。患者自我功能评价采用上肢功能评定表(DASH)问卷调查表。结果 腕关节疼痛值为21±5.2,术前为43±11;腕关节屈伸活动度为(97±16)°,术前为(60±10)°;尺桡偏为(55±12)°,术前为(32±9)°;随访平均握力为(36±7)kg,术前为(28±6)kg。X线检查结果舟月角为(53±9)°,术前为(80±13)°;舟月骨间隙为(2.8±0.7)mm,术前为(5.1±0.8)mm。Krimmer腕关节评分为(82±12)分,优良率为89%。上肢功能评定表(DASH)值为(23±12)分,术前为(42±14)分。结论 骨锚修复舟骨月骨间韧带能恢复舟月骨稳定性,术后腕关节功能明显改善。 相似文献
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Purpose
To investigate the accuracy of MRI in assessment of sports related knee injuries.Materials and methods
From August 2012 to March 2013 thirty patients referred for sports related knee pain have been included in this study. Patients were subjected to a dedicated MR knee study and correlated knee arthroscopy and surgery.Results
The study included thirty patients complaining of sports related knee pain, only 5 patients (16.6%) were with normal MRI findings and 25 patients (83.4%) were with abnormal MRI findings. Among the 25 patients who had injuries of their knees, 15 patients (60%) had ACL injuries, 2 patients (8%) had PCL injuries, 10 patients (40%) had meniscal injuries, 8 patients (32%) had collateral ligament injuries, 5 patients (20%) had bone injuries and 2 patients (8%) had muscular injuries. Only 7 patients (28%) were represented with isolated injury and 18 patients (72%) were represented with combined injuries. In correlation with arthroscopies and surgeries, morphological analysis was true-positive in 23 (92%) patients of the 25 injured patients, and true-negative in 3 (60%) patients of the 5 normal patients. Morphological analysis revealed overall 92% sensitivity and 60% specificity. Regarding the 15 patients who had ACL injuries, 13 patients (86.6%) were true-positive and 8 patients (80%) of the 10 patients who had meniscal injuries were true-positive.Conclusion
MRI represents the optimal imaging tool in the evaluation of the sports related knee injuries, which has been shown to be an accurate and non invasive method of diagnosing ligament, meniscal, cartilage and muscular knee injuries. 相似文献16.
胸腹联合伤的临床特点和早期救治 总被引:30,自引:4,他引:26
目的探讨胸腹联合伤(combined thoracoabdom inalinjury,CTI)的临床特点和早期救治的经验。方法回顾性分析1985年6月-2005年6月经手术证实的胸腹联合伤49例,年龄16~63岁,平均34岁。其中开放性损伤37例,闭合性损伤12例。49例患者均有不同程度的血胸和(或)气胸,其中23例合并休克。结果经胸手术34例,剖腹手术9例,剖胸+剖腹5例,胸腹联合切口1例。全组损伤严重度评分(ISS)为30.53±10.80。死亡5例,其中3例死于失血性休克,1例死于心脏压塞,1例死于多器官功能衰竭。结论胸腹联合伤死亡率高,最常见的死亡原因是失血性休克;手术入路应视具体伤情而定;及早诊断和及时手术是挽救危重患者生命的关键。 相似文献
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B. Karger A. DuChesne C. Ortmann B. Brinkmann 《International journal of legal medicine》1997,110(5):267-272
A total of 14 cases with self-inflicted injuries intended to simulate a criminal offence are reported. Typical characteristics
of self-infliction such as superficiality, localisation at the anterior aspect, parallel course or avoidance of areas with
high sensitivity to pain are substantiated by most of the cases analysed. However, the majority of cases also comprised atypical
features including large hematomas of the extremities, a gaping cut wound, lip laceration, hematoma of the eyelids, concussion
of the brain, large burn injuries and signs of bonding. Therefore, atypical injuries, which are either found in isolation
or in combination with typical injury patterns, cannot exclude self-infliction. Initially, most “victims” did not intend to
report the matter to the police but the persons whose affection was to be obtained made the report. Psychopathological motivations
are predominant but rational motives such as attempted insurance fraud also occur.
Received: 1 March 1997 / Accepted: 4 April 1997 相似文献
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Blunt trauma patients with myocardial ruptures rarely survive long enough to reach a trauma center; however, for the survivors,
prompt diagnosis and surgery are mandatory and save up to 80 % of patients. Preoperative diagnosis of myocardial ruptures
is assessed by echocardiography or, more rarely, by angiocardiography. We report two cases of blunt trauma patients with an
atrial appendage rupture which could be retrospectively identified on admission CT survey.
Received: 10 February 2000 Revised: 31 May 2000 Accepted: 5 June 2000 相似文献
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重型颅脑损伤合并上颈椎损伤临床分析 总被引:6,自引:1,他引:5
目的 了解重型颅脑损伤合并上颈椎损伤患者的临床特点,以提高对其认识和警惕性。方法 对29例重型颅脑损伤合并上颈椎损伤患者进行临床分析。结果 致伤原因:交通伤26例,高处坠落伤1例,高处陡坡滚落伤1例,矿井塌方致伤1例。治疗结果:生存16例,死亡13例。按格拉斯哥预后评分(GOS)评定:Ⅴ级2例,Ⅳ级7例,Ⅲ级6例,Ⅱ级1例,Ⅰ级13例。结论 重型颅脑损伤合并上颈椎损伤,伤情严重而复杂,颅脑损伤容易受到重视被及时诊断、及时抢救治疗;而上颈椎损伤临床表现容易被掩盖、相对隐蔽,极易漏诊,不能及时处理,死亡率高,严重并发症是死亡的主要原因。 相似文献