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Risk factors for failure of replantation of severed distal finger

Jing LI ; Qingsheng ZHU ; Guangyue ZHAO ; Guohua NI

Chinese Journal of Trauma.2003;0(09):-.

Objective To investigate the most important risk factors leading to failure of replantation of severed distal fingers so as to provide theoretic foundation for an improvement of survival rate. Methods Medical records of 65 amputated distal fingers underwent replantation were retrospectively studied to determine the independent risk factor for failure by using univariate and multivariate statistical analyses. Results Of 65 fingers treated with replantation, 8 (12%) failed. Univariate analysis showed that the increase of platelet level was the risk factor leading to failure of replantation (P= 0.041) . Manner of venous drainage (? 2=12.483, P=0.002), injury cause (? 2= 7.992, P= 0.018) , reconstruction of arteries (? 2=4.158, P=0.041) and preservation of the severed finger (? 2=6.240, P=0.044) were significantly correlated with the failure of replantation. However, multivariate logistic regression analyses showed that platelet level (OR=1.020, P=0.046) and manner of venous drainage (OR=0.154, P=0.040) were the significant independent predictors for failure of replantation. Six (38%) out of 16 amputated fingers replantation by means of single venous anastomosis resulted in failure. Of 26 amputated fingers treated with single venous drainage by bloodletting of finger tip, one (4%) failed. However, only one finger (4%) failed when 23 amputated fingers were treated with venous reflux by a combination of these two ways. Conclusions High level of platelet and venous reflux through anastomosis are the independent predictors affecting replantation of the severed fingers. Augmentation of anticoagulation as well as venous drainage determined by concrete lesion condition contribute to a higher clinical survival rate of replantation.

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Clinical results of shoulder arthroplasty with the UNIVERS 3-D prosthesis in treatment of post-traumatic gleno-humeral arthritis

Kanglai TANG ; Qihong LI ; Liu YANG ; Habermeyer PETER

Chinese Journal of Trauma.2003;0(09):-.

Objective To evaluate clinical results of arthroplasty with the UNIVERS 3-D shoulder prosthesis in post-traumatic gleno-humeral arthritis. Methods A total of 54 cases (age range of 31-84 years, mean 67.07 years) with post-traumatic gleno-humeral arthritis were treated by the arthroplasty with the UNIVERS 3-D prosthesis. Constant score and normalised Constant score were used to strictly evaluate the preoperative function of 45 cases, of which 30 cases were reviewed by Constant score and normalised Constant score postoperatively with an average follow-up of 12-68 months. Of all, 44 cases were strictly followed up in respect of preoperative and postoperative X-ray including anteroposterior, axial and Y-shaped positions. Results Compared with the pre-operation, there was a significant increase in post-operative pain, activity, mobility and strength as well as the postoperative Constant score and normalized Constant score. Total shoulder arthroplasty (TSA) provided better score for daily life and mobility than hemiarthroplasty, with a significant difference (P

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Clinical analysis of severe craniocerebral injuries complicated by upper cervical vertebral injuries

Yingjiao YU ; Yibin BAI ; Zhide WU ; Yonghua HUANG

Chinese Journal of Trauma.2003;0(09):-.

Objective To study clinical features of severe craniocerebral injuries complicated by upper cervical vertebral injuries so as to have a deeper understanding and higher vigilantness. Methods Twenty-nine cases of severe craniocerebral injuries complicated by upper cervical vertebral injuries were clinically analyzed. Results Injury causes included traffic accident in 26 cases, fall in one, rolling down in one and mine collapse in one. Treatment results showed that 16 cases survived and 13 died. As for Glasgow Outcome Scale (GOS) score, two cases were ranked at grade Ⅴ, seven at grade Ⅳ, six at grade Ⅲ, one at grade Ⅱ and 13 at grade Ⅰ. Conclusions The severe craniocerebral injuries complicated by upper cervical vertebral injuries are critical and complex mainly because the severe craniocerebral injuries can be paid more attention and diagnosed and treated early while the upper cervical vertebral injuries are easy to be neglected, as gives rise to missed injuries, lack of timely management and high mortality. Therefore, various severe complications are liable for deaths.

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Therapy for epidural hematoma in children

Jian XIE ; Shiqi LUO ; Zhenyu MA ; Yuqi ZHANG

Chinese Journal of Trauma.2003;0(09):-.

Objective To explore the clinical characteristics of epidural hematoma in children. Methods A total of 120 children with epidural hematomas within recent three years were reviewed. Results The main cause of injury in infants and preschool children was falling or sliping, but traffic accident was the predominant cause in children over seven years old. About 65.8% children were complicated by skull fractures, with average Glasgow Coma Scale (GCS) score of 13.6. Except for acute hematoma treated with emergency surgical operation, the other hematoma was rechecked with CT scan at days 1 and 3 or so after it was found for the first time. Patients receiving operation accounted for 57.5% and those with hematoma due to diploe bleeding for 43.9%. Conclusions The primary cerebral injury is not severe relatively in children with epidural hematoma, in which the incidence of skull fracture is lower than that in adults. The main cause for hematoma formation is diploe bleeding. Sound prognosis can be obtained through recheck of CT scan and suitable therapy.

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Value of interleukin-18 changes in early warning of organ dysfunction after trauma

Jingqu LIU ; Zhongjie HE ; Hongyuan LIN ; Yongming YAO ; Zhiyong SHENG

Chinese Journal of Trauma.2003;0(09):-.

Objective To detect the changes of interleukin-18 (IL-18) in plasma of trauma patients and evaluate their value in early warning of organ dysfunction. Methods A prospective study was carried out in 54 trauma patients admitted in from March 2001 to September 2002, which were divided into low injury severity score(ISS) group (Group L-ISS) and high ISS group (Group H-ISS). ELISA was applied to measure the level of IL-18 of blood samples that were collected on arrival, at days 4, 7 and 14 following admission. In the meantime, IL-18 level of plasma samples from patients with systemic inflammatory response syndrome (SIRS), sepsis and multiorgan dysfunction syndrome (MODS) was retrospectively analyzed so as to calculate the critical value of IL-18 in predicting organ dysfunction. Results After trauma, IL-18 concentration of plasma reached peak at days 4 and 7, and decreased gradually at day 14, which was significantly related to SIRS, sepsis and MODS, respectively. The IL-18 level was high relatively in plasma from patients with organ dysfunction. The higher IL-18 level in plasma within seven days after trauma indicated the severer organ dysfunction. Conclusion IL-18 is sensitive in early warning of organ dysfunction after trauma.

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Investigation of injury spectrum and traumatic condition spectrum of trauma of abdominal organs

Yongzheng WANG ; Xihong WANG

Chinese Journal of Trauma.2003;0(09):-.

Objective To discuss the injury spectrum and traumatic condition spectrum of trauma of abdominal organs in recent years. Methods Data of 247 cases with trauma on abdominal organ admitted in our hospital from 1999 to 2001 were analyzed in respects of injury spectrum, sex, age, vocation and injury causes of the cases with trauma of abdominal organs. Traumatic condition was evaluated by abridged injury score-injury severity score (AIS-ISS). Results There were 54 cases with trauma of abdominal organs in 1999, 72 in 2000 and 121 in 2001. Of all, 241 cases were cured but 6 died, with a fatality rate of 2.5%. The occurrence frequency of trauma of abdominal organs could be ranked in turn as follows: the spleen (43.2%), the kidney (18.8%), the liver (13.7%), the small intestine (6.5%),the bladder (4.8%), the pancreas (3.8%), the colon (3.8%), the stomach, the duodenum and the rectum. A total of 192 cases at age under 40 years accounted for 77.7% . Three injury causes ranked the first three places were traffic accident in 95 cases (38.5%), fall in 54 (21.9%), kick and boxing in 36 (14.6%), respectively. Of all, 168 cases had only intraabdominal injuries, of which 80 (47.6%) were with AIS=3, 32 (19.0%) with AIS=4 and 10 (6.0%) with AIS=5; and the other 79 cases (32.0%) were complicated by multiple trauma, with ISS ≥16 in 27 cases (34.2%) and ISS ≥25 in 8 (10.1%). Conclusions With the increase of vehicles and current personnel, the trauma of abdominal organs caused by traffic accident, accidental wound and conflict increases accordingly. People most apt to organ injuries are farmers, students and workers. Three organs ranked first three places are the spleen, the kidney and the liver. More than half cases are injured severely in accordance with AIS. To decrease trauma of abdominal organs, we must strengthen the education on traffic safety to raise their bewareness of injuries.

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Modification of femoral resection in primary total knee arthroplasty and the corresponding clinical results

Shui SUN ; Malzer UDO ; Schuler PETER

Chinese Journal of Trauma.2003;0(11):-.

Objective To modify femoral resection method in primary total knee arthroplasty and verify the operative results of this modification through measurement of the thickness of the bone resection and clinical follow up. Methods The femoral resection measurement guide was modified so that the resection of the posterior femoral condyle was increased 3 mm in thickness. A total of 81 cases undergoing total knee replacement were divided into varus group and valgus group, in which the thickness of various resections were measured and compared with that of the prosthetic implants. The average follow-up time was 27.1 months. Results On average, the thickness of bone resection in both the flexion and the extension gaps was smaller than that of the prosthesis. In both groups, except for the thickness of the posterior femoral condyle, there were significant differences in other indices ( P

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Delayed open reduction and internal fixation for Rud?i Ⅲ Pilon fractures

Zhenjun YAO ; Chi ZHANG ; Xiaogang ZHOU ; Zhengrong CHEN

Chinese Journal of Trauma.2003;0(12):-.

Objective To evaluate the clinical use of delayed open reduction and internal fixation technique in the treatment of Rud?i Ⅲ Pilon fractures. Methods From May 1997 to June 2003, 38 patients with Rud?i Ⅲ Pilon fractures underwent immediate calcaneal traction as well as treatment with methylprednisolone and mannitol. After 5-8 days, all patients underwent regular open reduction and internal fixation with cloverleaf buttress plates. One week after the operation, ankle joint began to exercise with no weight bearing. Results All patients were followed up for average 18 months and evaluated subjectively and objectively by using systems of Teeny and Wiss, which showed good results for 74 %, mild for 21% and poor for 5%. All fractures healed within an average of 5.7 months except for two cases of infections and one soft tissue complication. Conclusion Delayed open reduction and internal fixation offers acceptable way for treatment of severe Pilon fractures.

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Evaluation of mesenteric injury with computed tomography

Zhaopu TANG ; Xinchu QIAN ; Sanjun LIU

Chinese Journal of Trauma.2003;0(12):-.

Objective To evaluate the value of the abdominal computed tomography (CT) in diagnosing mesenteric injury. Methods Fourteen patients with mesenteric injury proven by surgery were selected as the study objects. A retrospective analysis was done on the clinical medical records and CT examination results including free intra-peritoneal fluid collection, infiltration of mesenteric fat, intra-mesenteric hematoma, extravasation of contrast media and thickening and enhancement of bowel wall. Meanwhile, in combination with surgical findings, the sensitivity of CT in diagnosis of mesenteric injury was determined. Results CT images showed free peritoneal fluid or hemoperitoneum and infiltration of mesenteric fat in all 14 patients, of which 12 had intra-mesenteric hematoma, two showed thickening and enhancement of bowel wall and one did extravasation of contrast material. CT findings accorded with surgical results. Conclusion CT is sensitive in diagnosis of mesenteric injury and helpful for identification of the injury site.

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Creation and evaluation of calibrated animal model for graded optic nerve injury in rats

Houbin HUANG ; Maonian ZHANG ; Zhizhong MA

Chinese Journal of Trauma.2003;0(12):-.

Objective To create a calibrated animal model of graded optic nerve injury (ONI) in rats, focusing on quantification of injury intensity, injury severity and the correlation between them. Methods A pair of cross-action forceps with pressure of 148.0 g was used to clip rat optic nerves for 3, 6, 30 and 60 seconds, or a pair of artery clips with constant pressure (32.4 g) used to clip rat optic nerves for 5, 10 and 15 seconds in order to create graded ONI animal models. Transcranial FluoroGold-labeled retinal ganglion cell (RGC) was used to observe the changes of RGC one month after injury, which then could be used to evaluate the injury severity. Ocular blood supply was evaluated by transcardiacly perfused Luxol Fast Blue post-injury. Results The graded ONI animal models were successfully created in rats without retinal ischemia post-trauma. The injury intensity could be well-defined by impulse or averaged impulse, while injury severity could be evaluated by the count of FluoroGold-labeled RGCs. The averaged impulse produced by artery clips clipping rat optic nerves for 15 seconds equalized with that produced by cross-action forceps for three seconds. The severer injury intensity begot less number of RGCs. The correlation between injury impulse and RGCs was fit for power function. Short time clipping of optic nerves could not lead to ischemic injury of the retina. Conclusions A calibrated graded ONI animal model is successfully created by clipping optic nerves with a pair of cross-action forceps. The model can be evaluated with RGCs count, impulse and averaged impulse, the latter two of which stand for injury intensity and injury severity, respectively.

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