狗中度冲击伤复合高速破片致伤的损伤特点研究

本研究初步探讨了狗中度冲击伤复合单侧后肢高速破片伤的致伤特点。结果表明,冲击伤,破片伤及两者复合伤后PaO_2均有降低,而PAP则有所升高,以复合伤后变化的幅度最大。且复合伤后24h肺体指数与肺含水率明显高于冲击伤后及破片伤后。形态学的改变显示:复合伤动物多数发生重度肺损伤,冲击伤动物多数为中度肺损伤,而破片伤动物仅少数出现轻度肺损伤。结果提示:狗肢体高速破片致伤对中度冲击伤的肺损伤具有加重作用。     

高海拔地区颅脑火器伤的评估与护理对策

目的探讨高海拔地区颅脑火器伤的评估与护理，为临床工作提供依据。方法对18例颅脑火器伤患者进行回顾性分析，根据患者的伤情和手术，给予相应的评估和护理对策。结果通过对患者意识、瞳孔、肢动、颅内压、生命体征、尿量及颜色、胃液pH、血气分析及创面的动态评估，能及时发现患者的病情变化和继发性损害。结论适宜的血压维持和颅压控制，有效的呼吸道管理，各种感染的预防控制及早期的营养、心理支持和功能康复等综合护理，能降低患者伤残率，提高生活质量。     

Surgical and Prosthodontic Treatment of a Patient with Significant Trauma to the Middle and Lower Face Secondary to a Gunshot Wound: A Clinical Report

Large defects of dentofacial structures may result from trauma, disease (including neoplasms), and congenital anomalies. The location and size of the defects are related to difficulties that patients report relative to speech, mastication, swallowing, facial esthetics, and self-image. This article reports on the evaluation and treatment of a patient who suffered significant trauma to the lower and mid-face secondary to a gunshot injury. It describes the initial presentation, life-saving procedures, and subsequent bone grafts, implant placement, and prosthetic treatments required to rehabilitate the patient to a condition that closely approximated his preoperative condition. This clinical report confirms that no matter the degree of complexity involved in treating the results of significant facial trauma, successful treatment is dependent on thorough physical and radiographic examinations, development of the appropriate diagnoses, and treatment based on sound prosthodontic and surgical principles.     

PENETRATING TRAUMA IN AUCKLAND: 12 YEARS ON

Background : The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined. Methods : Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year. Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts. Results : In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma. Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died. The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients there was no demonstrable change in the numbers of patients or their length of stay. Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU. Mortality of the ‘trauma team’ group was 4/32 in 1995 compared with 7/33 in 1983. Conclusions : Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983. There is a non-significant decrease in length of stay and mortality in the 1995 cohort.     

Missile severances of the radial nerve. Results of 131 repairs

Summary Background. Reports on missile-caused radial nerve injuries are relatively rare in current literature. We present the outcome after repair of such injuries as well as the factors influencing the result of treatment.Methods. Prospective study included 131 complete missile-caused radial nerve severances repaired with nerve graft or direct suture. Final outcome was defined 4 years postoperatively at least, on the basis of motor recovery (M), EMNG recovery (E) and patients judgement on the quality of outcome (P). Recovery was estimated with 0–5 points and final outcome was defined according to the total sum (0–15 points) as: poor, insufficient, good or excellent. Both the good and the excellent outcomes were considered as successful, and both the poor and the insufficient outcome as unsuccessful.Results. Excellent outcome was noted in 38.2% and good outcome in 47.3% of all patients. Average point score was 9.9±3.3 points for the whole series (domain of good outcome) and 6.6±3.0, 10.1±3.2 and 10.9±2.2 points for high, intermediate and low repairs, respectively (p<0.01). Useful motor recovery (M3), good EMNG recovery (E3) and affirmative patients judgement on the outcome (P3) had similar frequencies for intermediate (83.2–89.7%) and low repairs (85.7–92.8%), but for high repairs, good EMNG recovery was more frequent (70%) than were useful motor recovery and affirmative patients judgement (40%). Successful outcome was noted in 89.3% of direct sutures and in 82.7% of nerve grafts (p>0.05). Patients with a successful outcome had a significantly shorter nerve defect (p<0.001), shorter preoperative interval (p<0.001) and younger age (p<0.05) than patients with an unsuccessful outcome. Significant deterioration of results began with defects longer than 8cm, preoperative interval longer than 6 months and age above 40 years.Conclusions. The outcome is significantly worse after high radial nerve repairs than after intermediate and low repairs. The length of nerve defect, duration of preoperative interval and age of the patient also influence the repair outcome. Correlation of motor recovery with EMNG recovery and with patients judgement on the outcome is relatively good, but depends on the level of the repair.     

纳米银纱布对海水及自来水浸泡的兔后肢枪伤伤道的治疗作用

目的　观察纳米银纱布对海水及自来水浸泡的兔后肢枪伤伤道的治疗作用。方法　兔双后肢致枪伤后伤道分为 2组。组 1:伤道海水浸泡 5h ;组 2 :伤道自来水浸泡 5h。两组实验侧用纳米银纱布 ,对照侧用凡士林纱布换药治疗。各组均于浸泡后 30min和 1、2、3、4、5h取伤道组织活检 ,观察其病理改变。结果　组 1:实验侧较对照侧创周炎出现晚 ,程度轻 ,伤道内干燥 ,分泌物少。平均愈合时间 :实验侧入口 (2 9 4± 6 6 )d ,对照侧入口 (36 3± 6 0 )d (P <0 0 1) ;实验侧出口 (2 0 1± 6 0 )d ,对照侧出口 (2 7 3± 5 7)d (P <0 0 1)。组 2 :实验侧仅 1只兔创周轻度红肿 ,对照侧创周均有红肿 ,分泌物多。平均愈合时间 :实验侧入口 (13 0± 1 5 2 )d ,对照侧入口 (16 0± 3 10 )d(P <0 0 1) ;实验侧出口 (11 0± 2 75 )d ,对照侧出口 (15 6± 2 85 )d(P <0 0 1)。结论　纳米银纱布有抗感染和加速创面愈合的作用     

Distribution and extent of involvement in brachial plexopathies caused by gunshot wounds, motor vehicle crashes, and other etiologies: a 10-year electromyography study

OBJECTIVE: To examine the differences in the extent and distribution of brachial plexopathy involvement caused by gunshot wounds (GSW), motor vehicle crashes (MVCs), and other etiologies, based on electrophysiologic data. DESIGN: Retrospective review of electrophysiologic data from 1993 to 2002. SETTING: A large urban county hospital. PARTICIPANTS: Sequential patients (N=109) with the diagnosis of brachial plexopathy established by electromyography testing. This included 35 patients with GSW, 25 involved in an MVC, and 49 with other etiologies. INTERVENTIONS: Not applicable.Main Outcome Measures The brachial plexus was divided into 9 regions: upper, middle, and lower root; upper, middle, and lower trunks; and lateral, posterior, and medial cords. Regions involved by needle study on electromyography were denoted as positive or negative. The total number of regions involved was also recorded. RESULTS: Injury was most common in the trunks (52%), cords (36%), and roots (12%) (Pearson chi(2), P<.000). Specifically, the "other" category had the greatest number of injuries to the trunks (54%) (Pearson chi(2), P<.000), whereas the trunks (46%) and cords (45%) were more evenly affected in GSW cases (Pearson chi(2), P=.585). In the MVC group, there was a trend toward more trunks (56%) being affected (Pearson chi(2), P=.076). CONCLUSIONS: Differences were noted in the distribution of injury when examining subtypes of traumatic brachial plexopathies.     

高温高湿环境下犬肢体火器伤后血清组织释放酶含量变化的实验研究

将12只犬随机分为高温高湿组和常温常湿组,分别于火器伤后0、2、4、6、8、12、24h抽取外周血检测碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、肌酸激酶(CK)等指标。结果显示,ALP、LDH、CK含量随时间变化呈逐渐增高,其中CK含量变化较ALP、LDH明显;高温高湿组较常温常湿组变化提前且各酶含量升高显著。表明组织释放酶含量与局部组织损伤程度一致;CK含量对组织损伤的反应更敏感;高温高湿环境因素与火器伤因素同时作用后机体变化更为显著,组织损伤更为严重。     

严重心脏火器伤急诊体外循环支持作用的实验研究

目的　实验观察急诊体外循环 (ECC)对严重心脏火器伤的早期救治效果。方法　采用小口径步枪 (子弹 3.2g ,距离 2 5m ,初速 35 0m/s)射击建立的 2 1只严重心脏火器贯穿伤实验犬模型 ,将实验犬分为对照组、ECC组、ECC +手术治疗组。伤后 5～ 7分钟内开始ECC ,ECC组持续 3小时 ;ECC +手术组于ECC支持 0 .5小时后行心脏修补和肺叶切除术。结果　伤后 2分钟胸引量为 (387.71± 6 3.9)ml,对照组均于 7～ 10分钟内死亡 ,尸检发现以右室贯穿伤为主 ,并均伴有肺门部损伤。ECC组行急诊ECC支持 3小时 ,动脉压维持在 8～ 12kPa ;ECC +手术治疗组动物手术后脱离体外循环机 3小时心率、血压、中心静脉压、PaO2 和PaCO2均维持平稳。结论　急诊ECC应用于严重心脏火器伤可以使出血自体回输 ,维持心脏贯穿伤动物生命指标稳定 ,为及时进行手术修补救治争取了时间 ,提高了心脏贯穿伤的救治存活率