创伤救治面临的核心问题与能力提升的驱动力

综合性医院的创伤中心建设正处于起步阶段,创伤救治面临的核心问题包括团队能力建设与管理、关键时刻关键技术有效实施以及技术与体系的高效整合.解决上述核心问题、提升创伤救治能力需要驱动力,包括创伤救治理念更新和创伤救治流程管理创新、规范遵循创伤救治指南和专家共识以及创伤救治关键技术的普及应用.尽可及资源,予最佳治疗,是未来各...     

多科协作创伤救治模式探索

目的 探讨在创伤救治中的多科协作模式.方法 回顾总结我院创伤救治中心成立以来多科协作模式的运行方式和救治流程,创伤患者救治的时间节点与创伤中心成立前作比较.结果 对照组收治955例,抢救成功823例,占86.18%;本组2 670例,抢救成功2 618例,成功率98.05%.两组比较统计学有显著差异(P<0.01).结论 多科协作模式是提高创伤救治成功率的有效途径.创伤中心的设立、成套的创伤救治体系建立、高素质专业人员培养及由创伤中心医师组织多科协作的实施,开展急诊手术尽早修复损伤器官、消除致死致残因素、重视重症监护与治疗是提高救治成功率的关键.     

将3D打印技术应用到颅颌面战创伤救治中

颅颌面部战创伤是战伤减员的重要组成部分,加强对颅颌面部战创伤救治的教学是提高我军战场急救水平的迫切需求.随着3D打印技术的发展,3D打印技术已经广泛应用到口腔种植、口腔修复、口腔颌面外科等临床及教学多个领域中.将低成本的3D打印模型引入到颅面部战创伤救治的教学,可以提高颅面部战创伤相关的解剖结构及救治方法的教学效果.颅颌面部战创伤模型的3D打印主要是在标准或损伤后颅颌面部立体光刻(stereolithography,STL)文件上创建模拟出战创伤的损伤形态,利用计算机辅助设计和制造(CAD/CAM)及3D打印技术制作出损伤模型,再将其用于颅面部战创伤救治的教学中.     

院前创伤救治体系发展与"移动急诊科"方案

随着社会的发展,高能创伤发病率呈日益增长的趋势.据世界卫生组织统计,每年大约有580万人死于各种原因导致的创伤.创伤属于"时间敏感性"疾病,研究表明院前早期标准化救治可降低创伤相关病死率.本研究回顾西方发达国家和我国院前创伤救治体系,分别论述德国、美国及我国现行创伤救治优势和不足,结合美军战伤救治理念,笔者建议将创伤中心前置至事故现场构建院前移动创伤中心——"移动急诊科",形成我国标准化院前创伤救治体系,最大限度提高生命救护的成功率,促进我国院前创伤救治能力的进一步提升.     

创伤死亡曲线研究现状

创伤死亡曲线是大样本创伤死亡病例研究中总结出的,用图表方式展示的创伤死亡人数(比例)及创伤死亡者致伤机制、致伤部位等的时间分布规律.其研究成果对指导临床创伤救治具有重要意义,对创伤救治资源合理分配具有重要的指导意义.     

腹腔镜在腹部创伤中的应用

腹部创伤的诊治手段正在不断地更新发展,微创技术的运用为腹部创伤的诊治带来了革命性的变化.随着微创外科技术的不断进步,诊断性和治疗性腹腔镜在腹部创伤救治中的作用日益重要.本文从腹腔镜在腹部创伤救治中应用现状、应用价值、适应证、禁忌证、相关并发症及诊治腹部创伤面临的挑战等方面进行探讨,指出严格筛选腹部创伤患者使用腹腔镜技术...     

网络版创伤数据库系统V3.0的研究

目的 研制适用于医院创伤救治信息积累和分析的创伤数据库及其网络软件系统.方法 针对创伤救治过程与创伤救治基本信息,基于windows操作系统和SQL SERVER 2000数据库平台,采用vb.net和asp.net软件编程语言,以B/S访问模式进行开发.结果 建立了适应于医院管理和创伤救治流程的创伤数据库结构与内容,形成了规范的数据库字段313个;编制出网络版创伤数据库系统V3.0软件.建立了创伤救治信息流,实现了创伤ICD诊断与简明损伤定级(AIS)的关联选择、创伤评分与救治质量的评估、对数据库任意字段内容进行查询并形成包括三重交叉表在内的高级报表等功能.该系统在多家医院和"5·12"地震伤员资料调查中得到很好应用.结论 研制出适用于医院创伤救治信息登记的创伤数据库内容和网络版软件系统,使医师能规范地录入收集创伤发生、救治、结局与质量评估等的信息,并能很方便地进行资料的查询和分析.     

5G技术在创伤急救中的应用及探索

随着数字科技的快速发展,以往的创伤医疗救治模式已不能适应未来医学现代化的发展要求。大数据共享背景下的5G技术助力创伤急救成为人们关注的重点,并已在一些救治过程中尝试应用。探索出更多5G技术应用于创伤识别、救治及预防的新场景,有望实现区域急救资源合理调配、生命体征信息实时传输及创伤救治各个环节的有效衔接,提高创伤患者的救治效果。     

外军创伤系统建设对我军的启示

外军在批量伤员救治的军事实践中建立了创伤系统,用于伤亡态势实时感知、医疗决策和战救质量改进等,并尝试在军民融合工作机制下实现创伤的预防,院前、院内救治,康复及教育等功能.我国在严重创伤批量伤员救治具有举国体制优势,而民用创伤系统还处于发展阶段,建立一个可用于军事行动的创伤系统并实现军民融合式应用还任重道远.本文结合笔者研究和救援实践体会,借鉴外军创伤系统的经验,总结了外军创伤救治系统的经验和不足,提出相关启示参考.     

26例地震灾区老年骨创伤患者的诊治

目的 总结地震灾害中老年骨创伤患者的救治经验.方法 回顾分析我科采用骨科损害控制技术、心理干预及多学科联合治疗等综合方法进行救治的汶川地震后老年骨创伤患者的临床资料.结果 我科收治的26例地震灾区老年骨创伤患者均得到时及时有效的救治,及早恢复了患者下床活动及在床上无痛性活动的能力;无死亡病例及严重并发症的出现.结论 地震灾区老年骨创伤患者尽早进行心理干预、遵循骨科损害控制技术的原则、采用多学科联合治疗方法进行救治,是减少死亡率和伤残率、提高救治效果的有效措施.     

Treatment of patients with purulent diseases of the hand, the typical mistakes and complications

In a review of the literature addresses the causes, characteristics of the purulent process of the hand, the questions of treatment of purulent diseases of the hand, methods of anesthesia and rehabilitation of the patients with this pathology. The typical mistakes in the delivery of health care of this category of patients.     

Preventing Overuse Cycling Injuries

In brief: Concurrent with the renaissance in bicycling has come an increase in associated injuries. The most common problem the author sees in his practice is knee pain—usually chondromalacia patellae, patellar tendinitis, or bursitis. The patellofemoral joint is under particular stress in bicycling, and many new recreational riders make two errors: setting the saddle too low and the gears too high. These mistakes cause excessive pressure on the patellofemoral joint. Obtaining the best-fitting bicycle and saddle, adjusting the saddle properly, and using lower gears will help prevent such problems.     

Pearls and pitfalls in breast MRI

At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.     

Pitfalls in sonography of the Gamekeeper's thumb

The gamekeeper's or skier's thumb is a very common injury. Nondisplaced tears of the ulnar collateral ligament of the thumb (UCL) may be treated conservatively. For that reason an accurate diagnosis is mandatory for choosing the correct therapy. Ultrasound is able to depict the position of the torn UCL correctly in approximately 90 % of cases. Sonographic pitfalls can be caused by a dislocation of the palmar joint capsule to the ulnar joint space, by a scalloping of the adductor aponeurosis due to the displaced UCL, and by scar tissue or technical mistakes. It is important to know about those pitfalls because conservative treatment of displaced UCL tears leads to instability. Therefore, the use of MRI is recommended whenever a nondisplaced UCL tear is suspected by US and a conservative therapy is suggested. Splitting the diagnostic pathway between US and MRI and preferring conservative therapy in nondisplaced UCL tears should help to save money in this field. Received 25 September 1995; Revision received 4 March 1996; Accepted 5 March 1996     

Noninvasive radiology of vascular complications in renal transplantation

The gamekeeper's or skier's thumb is a very common injury. Nondisplaced tears of the ulnar collateral ligament of the thumb (UCL) may be treated conservatively. For that reason an accurate diagnosis is mandatory for choosing the correct therapy. Ultrasound is able to depict the position of the torn UCL correctly in approximately 90 % of cases. Sonographic pitfalls can be caused by a dislocation of the palmar joint capsule to the ulnar joint space, by a scalloping of the adductor aponeurosis due to the displaced UCL, and by scar tissue or technical mistakes. It is important to know about those pitfalls because conservative treatment of displaced UCL tears leads to instability. Therefore, the use of MRI is recommended whenever a nondisplaced UCL tear is suspected by US and a conservative therapy is suggested. Splitting the diagnostic pathway between US and MRI and preferring conservative therapy in nondisplaced UCL tears should help to save money in this field. Received 14 December 1995; Revision received 27 December 1995; Accepted 25 January 1996     

Mistakes in the diagnosis and treatment of the complete dislocation and fractures of the acromial end of the clavicle

The analysis of the mistakes in the operative treatment of the sick with such a trauma was conducted. Two typical examples were given. The mistakes were stipulated non-diagnosis of the simultaneous break of the coracoclavicular ligament and not taking measures for its recovery. The radiodiagnosis based on N. Z. Shmidt's method is considered to be inevitable for this category of the sick. After the confirmation of the diagnosis the operation of choice can be the operation of Yotkins-Leochuk for the sick with the complete dislocation of the acromial end of the clavicle, and the operation of Yotkins for the sick with fractures of the acromial end of the clavicle with the break of the coracoclavicular ligament. By means of these methods 43 sick men with the dislocation and 7 sick men with fractures of the acromial end of the clavicle have been operated since 1973. No cases had complications, relapses or unsatisfactory results.     

An investor perspective on forming and funding your medical device start-up

Novel and transformative medical technologies of all forms have the potential to make a significant positive impact on the lives of patients and on the health care system, and one common pathway for guiding such innovations from concept through commercialization is via the formation of a company. For entrepreneurs looking to build a medical technology company, several common challenges await, including questions around how and where to raise funding. Here, we review key considerations for the formation of medical technology companies as viewed through the lens of an investor. We survey common sources of capital for early-stage companies, including grants, angel investors, and venture capital, and offer insights into how to differentiate among them to select the best partners for your start-up׳s needs. Finally, we discuss the critical components of pitching your ideas to potential investors, and offer guidance on best practices and common mistakes. We hope this primer on fundamental concepts and the various health care funding alternatives will prepare entrepreneurs to achieve their mission to improve patients׳ lives through commercialization of their medical innovations.     

Clinical Risk Management in radiology. Part I: general background and types of error and their prevention

The present contribution, presented as an Editorial, addresses the issue of patient safety in Radiology: this topic, of great current National and Regional interest, has stimulated a strong focus on accidents and mistakes in medicine, together with the diffusion of procedures for Risk Management in all health facilities. The possible sources of incidents in the radiological process are exposed, due to human errors and to system errors connected both to the organization and to the dissemination of Information Technology in the Radiological world. It also describes the most common methods and tools for risk analysis in health systems, together with some application examples presented in Part II.     

创伤性膈疝32例分析

目的 总结创伤性膈疝(TDH)的临床特征和诊治方法,以减少工作中的失误.方法 回顾性分析1990年1月～2011年1月我院32例TDH的分期、损伤类型和部位、疝入器官、诊断和治疗方法等.结果 32例中,男性24例,女性8例;年龄16～89岁.钝性伤23例(71.9%),穿透伤6例 (18.8%),医源性损伤3例(9.4...     

Avoiding pitfalls in anatomic ACL reconstruction

As interest in double-bundle anterior cruciate ligament (ACL) reconstruction grows, we continue to refine our technique to perform the most anatomic reconstruction possible. Our experience has brought to our attention the potential mistakes that should be avoided when performing an anatomic double-bundle ACL reconstruction. These mistakes include (1) failure to visualize the femoral insertion completely, (2) use of the clock face to reference femoral tunnel positioning, (3) nonanatomic tunnel placement leading to graft impingement, (4) mismatching tibial and femoral tunnels, and (5) failure to restore the native tension pattern of the ACL. It is also important to recognize that a double-bundle ACL reconstruction is not necessarily equivalent to an anatomic double-bundle reconstruction. This article reviews potential mistakes in DB ACL reconstruction and describes our way of avoiding them.