外伤性前牙脱位再植后的疗效观察

目的：探讨前牙外伤性牙脱位再植的临床疗效。方法：回顾性分析68颗外伤性前牙脱位后行再植术的过程及术后随访情况。结果：随访1～3年,55颗患牙存活,13颗牙再植失败拔除。患牙牙根吸收率与离体时间成正相关。结论：外伤性前牙脱位再植的效果与脱位牙离体时间长短、体外保存方式及固定方式等有密切关系。     

儿童颅脑损伤的临床特点及手术策略（附257例分析）

目的分析总结儿童颅脑损伤的临床特点及手术方法。方法回顾性分析我院2003年1月～2010年12月收治的257例颅脑损伤患儿的临床资料,平均年龄6.3（1～14）岁,其中小于3岁者52例,3～6岁者98例,7～14岁者107例;闭合性颅脑损伤217例,开放性颅脑损伤40例。按GCS评分：13～15分92例,9～12分62例,6～8分87例,3～5分16例。其中,轻型颅脑损伤90例,中型颅脑损伤57例,重型颅脑损伤89例,特重型颅脑损伤21例。手术治疗97例,包括颅内血肿清除＋保留颅骨62例（其中环钻开颅14例）、颅内血肿清除＋去骨瓣减压术11例、颅内血肿清除＋凹陷骨折复位术18例、开放性颅脑损伤清创术或颅内异物摘除术等6例。21例患儿施行气管切开术。非手术治疗160例。结果术后按照GOS评估预后：恢复良好212例（82.5%）;中残18例（7.0%）;重残8例（3.1%）;植物生存2例（0.8%）,死亡17例（6.6%）。本组住院时间平均29（11～195）d。95例患儿获随访,随访时间6个月～2年。出现癫痫症状26例,硬膜下积液20例,交通性脑积水11例。结论儿童因解剖、生理、病理生理等与成人有所不同,容易导致颅脑损伤后原发损伤重、临床症状重、病情变化快;强调对每个患儿行个体及规范化治疗,积极预防术后并发症及癫痫的发生,及时、恰当的综合治疗,可降低病死率及致残率,且小儿神经系统修复能力强,与成人相比多预后良好。     

Unusual Traumatic Midthoracic Spondyloptosis and Its Surgical Management: Case Report

Posttraumatic spondyloptosis develops as a result of complete subluxation of the vertebral bodies and causes complete transection of the spinal cord. Severe trauma-related spondyloptosis of the upper-mid thoracic region is a rare form of spinal trauma. Traumatic midthoracic spondyloptosis is quite rare, and radiology plays an important role in the diagnosis and treatment of this condition. Surgical reconstruction and stabilization are required for early mobilization and rehabilitation of patients with this injury. Here, we report the clinical features, radiographic findings, and management of an unusual case of traumatic midthoracic spondyloptosis that showed complete spinal cord transection and was operated.     

Statement of severe trauma management in France; teachings of the FIRST study

IntroductionThe blunt trauma victim management is still a matter of debate and comparing studies involving different emergency medical services and health care organization remains fictitious. Hence, the French Intensive care Recorded in Severe Trauma (FIRST) was conducted in order to describe the severe blunt trauma management in France. The present paper aimed at recalling the main results of FIRST study.MethodsThe FIRST study was based on a multicenter prospective cohort of patients aged 18 or over with severe exclusive blunt trauma requiring admission to university hospital care unit within the first 72 h and/or managed by medical-Staffed Emergency Mobile Unit (SMUR). Multiple data were collected about patient characteristics, clinical initial status, typology of trauma and the main endpoints were 30-day mortality.ResultsSixty-one percent of trauma patients were road traffic victims and 30% were domestic, sport or leisure trauma. Patients who benefited from medical pre-hospital management were globally more severely injured than those who received basic life support care by fire brigades. Therefore, they were delivered more aggressive treatment in the pre-hospital setting and the median time for their hospital admission was lengthened. However, their 30-day mortality was significantly reduced. The probability of death was also decreased when casualties were transported by SMUR helicopter directly to the university hospital. In the in-hospital setting, the performance of a whole-body computed tomography (CT) was associated with a significant reduction in the mortality risk compared with a selective CT.ConclusionThe FIRST study suggests the benefit of a medical management in the pre-hospital setting on the survival of trauma patients. The emergency physician (EP) expertise in the pre-hospital and initial hospital phases would lead to the concept of the appropriate care for the appropriate trauma patient. It also highlights the necessity to set up organized regional sectors of care and registries.     

Update on prehospital emergency care of severe trauma patients

The prognosis of severe trauma patients is determined by the ability of a healthcare system to provide high intensity therapeutic treatment on the field and to transport patients as quickly as possible to the structure best suited to their condition. Direct admission to a specialized center (“trauma center”) reduces the mortality of the most severe trauma at 30 days and one year. Triage in a non-specialized hospital is a major risk of loss of chance and should be avoided whenever possible. Medical dispatching plays a major role in determining patient care. The establishment of a hospital care network is an important issue that is not formalized enough in France. The initial triage of severe trauma patients must be improved to avoid taking patients to hospitals that are not equipped to take care of them. For this purpose, the MGAP score can predict severity and help decide where to transport the patient. However, it does not help predict the need for urgent resuscitation procedures. Hemodynamic management is central to the care of hemorrhagic shock and severe head trauma. Transport helicopter with a physician on board has an important role to allow direct admission to a specialized center in geographical areas that are difficult to access.     

Trauma network for severely injured patients

Survival after severe trauma may depend on a structured chain of care from the management at the scene of trauma to hospital care and rehabilitation. In the USA, the trauma system is organized according to a pre-hospital triage by paramedics to facilitate the admission of patients to tertiary trauma centres. In France, trauma patients are transported to the most suitable facility, according to the on-scene triage by an emergency physician. Because French hospital's resources become scarce and expensive, the access to all techniques of resuscitation after severe trauma is restricted to tertiary trauma centres, at the expense of prolonged duration of transfer to these centres with a possible impact on mortality. The Northern French Alps Emergency Network created a regional trauma network system in 2008. This organization was based upon the interplay between the resources of each hospital participating to the network and the categorization of trauma severity at the scene. A regional registry allows the assessment of trauma system, which has included 3,690 severe trauma patients within the past 3 years. Bystanders, medical call dispatch centres, and interdisciplinary trauma team should form a structured and continuous chain of care to allocate each severe trauma patient to the best place of treatment.     

Comparison of Near-Infrared Spectroscopy and Laser Doppler Flowmetry for Detecting Decreased Hepatic Inflow in the Porcine Liver

Hepatic artery and portal vein thrombosis are devastating complications of partial liver transplantation. Early detection of inflow complications is important, as re-reconstruction can salvage the graft. Near-infrared spectroscopy or laser Doppler flowmetry can be used to detect tissue oxygenation or microcirculation on the liver surface. The aim of this study was to examine which of these two methods better detects changes in hepatic inflow. Sangen-strain pigs (n = 5) were used. The tips of the near-infrared spectroscopy and laser Doppler flowmetry probes were placed separately on the surface of the right liver. Inflow to the liver was controlled during the following seven conditions: control (not clamped), half- and totally clamped portal vein, half- and totally clamped hepatic artery, and half- and totally clamped portal vein and artery. Tissue blood flow was calculated using laser Doppler flowmetry. Oxyhemoglobin, deoxyhemoglobin, and the tissue oxygenation index were measured and calculated using a near-infrared spectroscopy system. The tissue blood flow and oxygenation index could not be used to differentiate between the half-clamped portal vein, half-clamped hepatic artery, and totally clamped portal vein conditions. The oxyhemoglobin minus deoxyhemoglobin value was significantly decreased after half or total clamping of the portal vein or hepatic artery (p <. 001 for each condition). The findings of the present study indicate that near-infrared spectroscopy was more sensitive than Doppler flowmetry for detecting changes in hepatic tissue inflow from the liver surface.     

计算机辅助骨科手术导航系统在芦山地震骨盆骨折治疗中的应用

目的 探讨计算机辅助骨科手术导航系统(CAOS)在芦山地震骨盆骨折治疗中的应用.方法 回顾性分析2013年4月20日至5月3日芦山地震中应用CAOS引导下手术治疗的6例骨盆骨折患者资料,男3例,女3例;年龄20 ～54岁,平均39.7岁.骨折按Tile分类:B型2例,C型4例.合并伤:双侧胫骨开放性骨折1例,肋骨骨折2例,股骨骨折3例,腰椎骨折2例,髌骨、肱骨骨折各1例,皮肤挫裂伤5例.6例患者于伤后3～10d(平均6d)均在CAOS引导下行手术治疗.术后复查骨盆X线片,并根据Matta标准评定疗效. 结果 6例患者共置入空心钉11枚,其中骶髂螺钉6枚(S15枚,S2l枚),耻骨支螺钉5枚(顺行2枚,逆行3枚).所有患者手术均顺利,术中无明显神经及血管损伤,术中置入每枚螺钉的平均出血量约为20 mL,术中平均总出血量为110 mL,术中平均置入每枚螺钉的透视时间为10 s,平均手术时间为110 min,术后复查骨盆X线片示骨折均复位满意,根据Matta标准评定疗效:优4例,良2例.手术切口均一期愈合,无切口感染、深静脉血栓形成、多器官功能障碍综合征等并发症发生. 结论 CAOS引导下手术由于其微创、术中出血量少、手术准确度高、术中透视时间短、手术时间相对较短等特点,可有效进行严重骨盆损伤、多发伤患者的损伤控制,可早期固定骨折,是治疗地震伤骨盆骨折的一种可行、安全、有效的方法.