The epidemiology of sports injuries in schoolaged children

In the 5-year-period 1988-1992, 6096 children aged 6-17 (54.5% boys and 45.5% girls) were treated at the Emergency Department at Esbjerg Central Hospital after having sustained a sports injury. The data were registred according to the European Home- and Leisure-Accident Surveillance System (EHLASS) protocol. We found a total incidence rate in the municipality of Esbjerg of 73.3 per 1000 per year. Boys were most often injured in soccer, skateboard, handball, gymnastics and basketball, and girls in handball, horseriding, gymnastics, basketball and roller-skating. The types of injuries were contusions 37.1%, fractures 22.0%, sprains 24.8%, wounds 9.5%, strains 5.0% and luxations 1.4%. The hospitalization rate was 3.8%. Compared to other studies the total incidence rate was high.     

膝关节外侧副韧带断裂——附32例手术病例分析

本文报告了我所自1966—1993年间32例手术治疗的膝外侧副韧带断裂病例。对其受伤项目、受伤机转、复合伤情况及治疗结果加以分析。结果表明:膝关节外侧副韧带损伤为较少见损伤,占膝韧带伤的2.4％,受伤项目以摔跤、柔道、足球、跳远为多见,伸直内翻伤的复合伤发生率明显高于屈曲内翻伤(p=0.02);强调了对复合伤及时、全面诊断与处理的重要性;强调了运动员膝外侧副韧带断裂手术治疗的必要性;并介绍了一种膝外侧副韧带下止点断裂前移固定于胫骨的手术方法。     

Ocular BB injuries

Data from the United States Consumer Product Safety Commission indicate that air-powered guns were responsible for 22,800 injuries treated in emergency rooms during 1981, of which 1255 were eye injuries. From 1970 to 1981, 32 patients have undergone surgical intervention at the Wilmer Eye Institute for airgun-related eye injuries. Of the 22 patients with penetrating injuries from the pellets, 19 eyes were enucleated; final vision in the three remaining eyes was worse than 5/200. Of seven patients with nonpenetrating injuries, six had final vision of 20/40 or better. All three patients with penetrating injuries from shattered spectacle lenses had final vision of 20/40 or better. Histopathologic examination of the enucleated specimens demonstrated severe disruption of intraocular contents, particularly posteriorly. Despite the potential ocular dangers of airguns, only 11 states have enacted legislation that regulates their sale or use. BB injuries represent a devastating form of ocular trauma which can be prevented by adoption and enforcement of appropriate legislation.     

以三脑室扩大为标准对重型颅脑损伤实施分流术

目的：以三脑室扩大作为外伤性脑积水早期诊断标准，探讨以此指征积极行脑室腹腔分流术对重型颅脑损伤意识障碍恢复的价值。方法：重型颅脑损伤意识障碍患者，早期定期行头颅计算机体层摄影（ＣＴ）或核磁共振（ＭＲ）检查，若发现三脑室宽度超过６ｍｍ或三脑室进行性扩大即行脑室腹腔分流术。结果：手术８例，无手术并发症，７例意识转醒，１例变化不大，随访３～２１月，２例可进行轻体力工作，３例生活自理，２例生活靠别人帮助，１例仍昏迷。结论：以三脑室宽度超过６ｍｍ或进行性扩大为手术指征，早期行脑室腹腔分流术，对重型颅脑损伤意识障碍患者的意识恢复是有益的     

颈部贯通伤远达效应的病理变化及致伤机理探讨

用2.74g和1.03g钢球分别射击10只猪的颈背部,造成软组织贯通伤。位于伤道外的脊髓(10只)、脑(10只)、心脏(9只)和肺(3只)见到出血和肺大泡(1只),其中2.74g组伤情较1.03g组更为严重。2只实验猪分别于伤后3和5min死于严重的脑脊髓震荡伤(脊髓休克)。分析了颈部贯通伤远达效应病变特点:脑脊髓致伤机率增加,脑脊髓出血波及范围广泛,出血病变呈跳跃式分布,预后较差,多见早期死亡。前颅腔内压力峰值可达到1300～1810kPa,其压力值与邻近的颈后部软组织内压力值(1600～1810kPa)接近。认为颈部椎管外贯通伤时,伤道外脑脊髓病变的致伤机理主要是压力波和瞬时空腔作用的结果,但作用途径有差别。     

Smoking as a Risk Factor for Injury Death: A Meta-Analysis of Cohort Studies

Background.Injury and tobacco effects represent one-quarter of the global burden of disease. Understanding the causes of injury and the effects of smoking may help reduce those burdens. Some smokers have high risks of injury. We provide an initial meta-analysis of cohort associations between smoking and fatal injury.Methods.Three authors independently searched MEDLINE, and bibliographies of the pertinent studies found, for cigarette smoker-specific injury death data which allowed estimation of an appropriate relative risk (RR) and 95% confidence interval (CI). Relative risks and dose response were summarized by fixed effects and Poisson modeling, respectively.Results.Six studies covering 10 pertinent cohorts were located. Associations between smoking and injury death have been significant after adjustment or, in effect, stratification for age, race, sex, country, and, respectively, alcohol, marriage, education, and body mass; job and time period; job, alcohol, and exercise; etc. Summary-dose response trends were significantly positive (P< 0.00005). Cigarette smoking predicted summary injury death crude RRs of 1.61 (CI 1.44–1.81) vs never smokers and 1.39 (CI 1.25–1.55) vs ex-smokers.Conclusions.Smoking has significant, consistent, dose-response, often strong and independent, prospective associations with injury death, internationally.     

颈髓完全性损伤治疗方法的选择

报告了４２例颈髓完全性损伤非手术治疗的结果。平均年龄２９．７岁。骨折分类：屈曲型２５例，压缩型１０例，过伸型７例。损伤椎节为Ｃ_４～Ｃ_７，平均观察时间为７．８个月。按Ｆｒａｎｋｅｌ分级，仅有４例（９．５％）进步到Ｂ级；按胥少汀对完全性颈髓损伤的修正疗效标准，神经功能改善率为５２．３％。损伤当时截瘫平面高于或等于骨折节段者有较好的恢复率，而低于者无恢复。分析对比了文献报道的早期手术治疗结果，认为：颈髓完全性损伤早期手术与非手术治疗结果无明显差异。强调对完全性损伤早期判断的重要性，建议制定统一的疗效评定标准，并就相关问题进行了讨论。     

Anatomical Basis of Variability in Injuries of the Medial Malleolus and the Deltoid Ligament: II. Clinical Studies

The anatomical concept of the deltoid ligament as being attached to the anterior colliculus of the medial malleolus by its superficial portion, and to the posterior colliculus by its deep portion has been applied to a clinical material. A number of singular and concurrent lesions of the medial malleolus and the deltoid ligament were recognized: fracture of the anterior colliculus, concurrent fracture of the anterior colliculus and rupture of the deep posterior talotibial ligament, fracture of the posterior colliculus, supracollicular fracture, rupture of the deltoid ligament, and chip fracture of the anterior colliculus. The clinical implications of these lesions are discussed.     

Dislocation of the Trapezium (Multangulum Majus): A Case Report A Case Report

A case of complete, closed dislocation of the trapezium is reported. The treatment was open reposition and fixation with two Kirschner wires. No avascular necrosis occurred. Two and a half years after the injury there were no subjective complaints, the mobility and strength of the thumb were normal and there were no radiological signs of arthrosis.     

Predictive validity of driving-simulator assessments following traumatic brain injury: a preliminary study

Objective: To evaluate whether driving simulator and road test evaluations can predict long-term driving performance, we conducted a prospective study on 11 patients with moderate to severe traumatic brain injury. Sixteen healthy subjects were also tested to provide normative values on the simulator at baseline.

Method: At their initial evaluation (time-1), subjects' driving skills were measured during a 30-minute simulator trial using an automated 12-measure Simulator Performance Index (SPI), while a trained observer also rated their performance using a Driving Performance Inventory (DPI). In addition, patients were evaluated on the road by a certified driving evaluator. Ten months later (time-2), family members observed patients driving for at least 3 hours over 4 weeks and rated their driving performance using the DPI.

Results: At time-1, patients were significantly impaired on automated SPI measures of driving skill, including: speed and steering control, accidents, and vigilance to a divided-attention task. These simulator indices significantly predicted the following aspects of observed driving performance at time-2: handling of automobile controls, regulation of vehicle speed and direction, higher-order judgment and self-control, as well as a trend-level association with car accidents. Automated measures of simulator skill (SPI) were more sensitive and accurate than observational measures of simulator skill (DPI) in predicting actual driving performance. To our surprise, the road test results at time-1 showed no significant relation to driving performance at time-2.

Conclusion: Simulator-based assessment of patients with brain injuries can provide ecologically valid measures that, in some cases, may be more sensitive than a traditional road test as predictors of long-term driving performance in the community.