Objective To probe the feasibility and efficacy of damage control orthopedics(DCO) in treating multiple injuries.Methods A retrospective analysis was done on clinical data of 41 case with multiple injuries treated by DCO from 1995 to 2005.Results Devascularization of internal iliac arteries was performed in 29 cases with multiple injuries complicated by massive bleeding and fractures of the pelvis,of which 23 were treated with ligation of bilateral internal iliac arteries and eight with angioembolization of bilateral internal iliac arteries.External fixation cage for the pelvis was used in an early period in 10 cases,primary debridement with simple external fixation in 10 with multiple injuries complicated by open femoral fractures and simple laminectomy in two with spinal fractures combined with spinal cord compression.All cases received discriminating internal fixation posterior to resuscitation in ICU.The overall mortality rate was 12.1%(5/41),with average injury severity score(ISS) for 41.4 and with shock and associated injury as the main causes for death.The complications occurred in seven cases including three with acute respiratory distress syndrome(ARDS),one with thrombosis of right common iliac artery,two with subphernic abscess and one with deep wound infection of the lower extremities,all of whom got cured.Conclusions Prompt diagnosis and integration of treatment are key to enhancing the survival rate of multiple injuries.In the meantime,DCO is effective and safe for cases with multiple injuries.

Objective To explore the early diagnosis, option of the surgical procedures, preven-tion and treatment of the complications in patients with pancreatic trauma.Methods All patients with pancreatic trauma during the past 20 years were studied retrospectively in respect of sex, age, cause of injury, grade by AAST, style of operation, therapeutic efficacy, complications and factors for death etc.Statistical analysis was made with Chi-square test.Results In all 148 cases of the present series, 132 underwent surgical interventions including simple suture or external drainage alone, distal pancre-atectomy, distal pancreaticojejunostomy or other internal drainage, diverticularization, Whipple's pro-cedure, and Damage Control Surgery (DCS) etc.Postoperative morbidity was 27.83% with a signifi-cant difference of the incidence of pancreatic fistula between pancreas grade Ⅲ-Ⅴ injuries and grade Ⅰ-Ⅱ(P＜0.01).The mortality rate was 11.49%.The cause of the deaths was mainly massive bleed-ing due to severe associated injuries(76.47%).Among various grades, the difference of the mortality was not significant (P＞0.05).Conclusion To improve the survival rate, it is important to control massive hemorrhage from associated injuries precedes dealing with pancreas trauma.Selection of surgi-cal procedures should be based on whether the main duct is injured.The removing of devitalized tis-sue, adequate external and internal drainage are essential for treatment of pancreatic injuries.Early recognition of pancreatic injury and correct choice of surgical procedures may obviously decrease the in-cidence of postoperative complications.

Objective To assess early diagnosis and treatment experience of colorectal injuries.Methods We retrospectively analyzed the clinical data of 72 patients with colorectal injuries in January 2001 to December 2001.Results In this group of 72 cases,ISS score was 29 ± 18.Forty-five suffered from blunt injuries,27 cases from penetrating wounds,Peritoneal colorectal injuries in 57 cases,extraperitoneal rectal injury in 15 cases.Hemorrhagic shock existed in 28 patients at admission.69 were with multiple injuries.Diagnosis:injury tract probing in 13 cases,digital rectal inspection in 3 cases,microscopy in 1 case,the contrast examination in 2 cases,laparotomy in 53 cases.Treatment:repairment in 46 cases,injuried bowel excision anastomosis in 6 cases,18 cases underwent colostomy.5 cases died postoperatively with ISS score of 43 ± 7,among those 3 cases died of uncontrolled hemorrhagic shock,one of severe craniocerebral injury,one of postoperative SIRS and MODS.Other nonlethal postoperative complications occurred in 13％ (9/67),all were cured.Conclusions Early diagnosis and emergency operation is the key to successful treatment for colorectal injuries.The indication of one stage operation should be strict and accurate.Staged operation should be adopted in cases of extra-abdominal rectal injury.

Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with pancreaticoduodenal fistula were cured by conservative treatment at postoperative month 3 and the other patients were well survived.Conclusions Abdominal puncture and imaging examination such as CT are effective methods for the diagnosis of the duodenal injury.Surgical procedure selection should be based on the type and range of the injury.Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery.

Objective To discuss the application indications of emergency thoracotomy (ET) and the surgical strategy in the treatment of chest trauma .Methods The clinical data of 35 chest trauma patients treated by ET from January 2010 to March 2014 were analyzed retrospectively .Results In 35 cases ,the injury severity score (ISS) was 12-65 ,average 31 .63 .23 cases were pene‐trating injuries and 12 cases were blunt injuries .28 cases (80 .00% ) manifest as shock on admission .Blood loss in all cases was 1 000-5 000 mL ,average 2 400 mL and 20 cases were over 3 000 mL .ET was performed in the emergency room (6 cases) and the operative room (29 cases) .The time of admission to surgery in all cases was<30 min .12 cases (34 .29% ) died ,with average ISS score of 48 .26 .The main causes of death were cardiac tamponade and hemorrhagic shock .23 cases (65 .71% ) survived .The surviv‐al rates of penetrating and blunt injury were 78 .26% (18/23) and 41 .67% (5/12) respectively .The occurrence rate of complications in the survivals was 39 .13% (9/23) .Conclusion Massive bleeding ,ventilation dysfunction and cardiac tamponade caused by severe chest trauma are the important indications of ET ;the patient with chest penetrating injury on high‐risk positions should be actively performed the exploratory thoracotomy ;race against time rapid thoracotomy is the key for successful treatment .

Objective To probe timely diagnosis and surgical intervention of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 161 patients with TDR treated surgically in our department during the past 17 years were analyzed retrospectively in respects of diagnostic methods,accuracy of preoperative judgment of TDR,incidence of diaphragmatic hernia,surgical procedures and outcome,etc. Results There were 139 males and 22 females at a mean age of 32.4 years(9-84 years),with average ISS of 27.8 points(13-66 points).Of all patients,65.2%had shock at admission.For these 161 patients,36 suffered from blunt injuries and 125 from penetrating injuries.For diaphragmatic injury.preoperative diagnostic rate was 88.9%for blunt injuries and 78.4%for penetrating injuries (P＞0.01).The incidence of diaphragmatic hernia was 94.4%in blunt injuries and 14.4%in penetrating injuries(P＜0.05).In this series,thoracotomy was performed in 30 patients,laparotomy in 106,thoracotomy plus laparotomy in 18 and combined thoraco-laparotomy in 7,with overall fatality rate of 10.6%and a mean ISS of 41.6 points.The mortality rate was 22.2%in blunt injuries and 7.2%in penetrating injuries(P＜0.01).The main causes for death were hemorrhagic shock and septic complications; Conclusions Blunt diaphragmatic injury can be diagnosed by radiographic signs of diaphragmatic hernia.According to"offside sign",which implies a thoracic wound with positive physical or radiological signs in the abdomen or in the thorax,penetrating diaphragmatic injury can be recognized.To deal with diaphragmatic hernia,it is important to judge the vitality of viscera.Penetrating injury has a relatively good prognosis.

OBJECTIVE: To improve the quality of management in biliary leakage following liver or bile tract injury. METHODS: All patients with liver and/or bile duct injuries from October 1987 to February 1998 inclusive were studied retrospectively in respects of their age, sex, type and mechanism of injury, the grade of liver trauma, treatment and subsequent complications. RESULTS: In 271 patients with hepatobiliary injuries, 14 (5.17%) developed a bile leak, which fell into 2 main types: Type I, injuries involving extrahepatic or first-order bile ducts (6 patients);Type II, injuries of more peripheral biliary radicles (8 patients). Most bile leakages in this series closed spontaneously in 7-14 days postoperatively. Intra-abdominal infection (28.57%) was a frequent complication which required active intervention. CONCLUSIONS: In the management of biliary leakage, it is important that (1) the leakage should be well localized; (2) adequate abdominal drainage plays a key role in controlling any type of biliary leakage; (3) decompression of the biliary tract favors the healing of injured biliary tree, especially in Type I leakage.

OBJECTIVE: To present the managing experience of the patients with penetrating cardiac injuries for improving the treatment outcome. METHODS: The data of 61 cases with penetrating wounds of the heart were retrospectively studied, and the study covered a period of 11 years. RESULTS: In this series, stab wounds accounted for 61 cases (84%), among which, 9 cases with stable hemodynamics were managed conservatively, and the rest 52 underwent thoracotomy. The amount of preoperative infusion was less than 1000 ml in 65% of the latter cases. Only in two patients, preoperative pericardiocentesis was done, yielding false negative in one. Four cases sustaining cardiac arrest soon after arrival were subjected to emergency thoracotomy resulting in three survivals. Among 52 patients undergoing surgery, two deaths occurred after operation from associated abdominal injuries or failure of cerebral resuscitation. In the present series of 61 cases, the overall survival rate was 96.7%. CONCLUSIONS: Early establishment of diagnosis and prompt thoracotomy are the fundamental factors affecting the outcome of penetrating cardiac injuries. Preoperative massive transfusion and pericardiocentesis are not advocated.

Objective To investigate the effect and mechanism of tripterygium wilfordii combined with aescine in treatment of acute lung injury (ALI) following trauma.Methods A total of 120 patients with posttraumatic ALI were divided into four groups:tripterygium wilfordii + aescine group (combined group),tripterygium wilfordii group,aescine group,and control group according to random number table,with 30 patients per group.Regardless of the same conventional therapy,the patients in combined group were treated by orally or gastrically administered tripterygium wilfordii multiglycoside as well as aescine intravenously,once a day for 12 days; on the contrary,the same method but only with tripterygium wilfordii or aescine was respectively performed in tripterygium wilfordii and aescine groups.Blood gas analysis before and after treatment,length of ICU stay,fatality rate and incidence of ARDS in each group were observed.Changes in levels of inflammatory mediators (TNF-oα,IL-1,IL-6 IL-8,etc)were detected at days 4,8,and 12 after medication.Results Shorter length of ICU stay and lower ARDS incidence as well as 12-day fatality rate were detected in each treatment group as compared with control group,especially in combined group (P ＜ 0.05).Respiratory rate,PaO2 and oxygenation index (PaO2/FiO2) in each treatment group presented better amelioration than those in control group and especially better results were observed in combined group (P ＜ 0.05).Plasma levels of TNF-α,IL-1,IL-6,and IL-8 in each treatment group were lower than those in control group (P ＜ 0.05).Conclusions Tripterygium wilfordii and aescine havetherapeutic effect on posttraumatic ALI.Moreover,synergetic use of the two drugs achieves synergistic effect and better outcome.

Objective To investigate the effect and significance of AIS-ISS in assessing injury severity and prognosis of aged trauma patients.Methods A retrospective study was done on data of 2 599 patients hospitalized over 24 hours from October 2009 to September 2012.There were 597 patients aged 60 years or over (aged group) and 2 002 patients aged below 60 years (non-aged group).Injury causes,ISS,complication incidence,emergency operation rate,and ICU treatment were compared between the two groups.Results Similar in causes of injury,the two groups were mainly injured from traffic accidents and falls on the ground or from height.ISS was (10.7 ± 7.8) points in aged group and (10.4 ± 8.3) points in non-aged group,with no significant difference (t =0.653,P ＞ 0.05).Incidence of major complications was higher in aged group than in non-aged group (P ＜ 0.01).Top three complications were pulmonary infection or atelectasis (4.36％),shock (4.19％),and urinary infection (3.52％).Lower emergency operation rate (21.44％ vs 30.57％,P ＜ 0.01),higher ICU treatment (75.71％ vs 36.26％,P ＜ 0.05),and higher mortality (3.85 ％ vs 2.25％,P ＜ 0.05) were observed in aged group when compared to non-aged group.Conclusions AIS-ISS should be carefully selected to evaluate injury severity and prognosis of the aged trauma patients.Early total care should be performed for the aged trauma patients even if AIS-ISS is relatively low.