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Classification of hand degloving injuries and indiviualized treatment

Chinese Journal of Trauma.2009;25(12):1093-1095. doi:10.3760/cma.j.issn.1001-8050.2009.12.346

Objective To evaluate the classification and treatment methods of hand degloving in-juries.Methods Individualized treatment was adopted according to area and depth of degloving inju-ries.The injury was repaired from deep to shallow layer.New techniques such as segment blood vessel re-pair, alternative debridement, local fixation and suturing, local pressure bandaging and sporadic drainageof incision were applied.Results All 76 patients were followed up for 3-48 months, which showed that75 patients were cured, with good shapes of the skins and strong rub resistance.Conclusion Classifi-cation of hand degloving injuries simplifies diagnosis, as facilitates the individulized treatment.Five new techniques mentioned above may help solve the problems encountered during operation.Individulized treatment explores new ways for the treatment of hand degloving injuries.

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Clinical study of five-pointed star lattice sutures in treatment of patellar fractures

Xiaozheng TANG ; Yayun LIU ; Peisheng HE ; Hui LAN ; Lianying HU ; Kunmin YU ; Haigen HUANG ; Feipeng GONG ; Yuxu LI

Chinese Journal of Trauma.2009;25(12):1072-1075. doi:10.3760/cma.j.issn.1001-8050.2009.12.339

Objective To explore a simple and effective operative procedure for treatment of pa-tellar fractures.Methods The clinical data of 108 patients (including 76 males and 32 females) with patellar fractures were analyzed.The age of the patients ranged from 18 years to 82 years.There were 67 patellar fractures on the right extremities and 41 on the left.Fracture types included transfractures in 43 patients, comminuted fractures in 54, torn fractures in eight and longitudinal fractures in three.Period from injury to operation ranged from 3 hours to 10 days.During operation, the broken patella was exposed for reduction and temporary pliers fixation;then, a five-pointed star woven with two absorbable sutures was placed on the broken patella, two semi-circular sutures around the patellar edge were made with su-tures which were through five points of the five-pointed star.When two sutures were pulled and knotted,the five-pointed star was also stretched to fix the patellar fractures firmly.Models of transverse patellar fractures were made in 20 knee joints of catties, which were divided into two groups randomly.Patellar fractures in Group A were fixed with five-pointed star lattice sutures and those in Group B with AO inten-sion bands.Loading test was performed on quadriceps femoris with materials test system for measuring the width of each fractured patella after the test.Results All patients were followed up for 6-60 months (mean 20 months) , which showed that all patellar fractures were healed.According to Bostman scoring system, the efficacy was excellent in 76 patients and good in 32.The experiment showed no statistical difference in the fracture disjunction distance between two methods (P > 0.05).Conclusion For treatment of patellar fractures, five-pointed star lattice sutures have the advantages of simple operation,reliable fixation, early postoperative exercise, fast recovery, satisfactory outcome and free need of reoper-ation for removing internal fixation.

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Strategy for treatment of subtrochanteric femur fractures in children and adolescents

Liaojun SUN ; Hua CHEN ; Xiaoshan GUO ; Jun PAN

Chinese Journal of Trauma.2009;25(12):1068-1071. doi:10.3760/cma.j.issn.1001-8050.2009.12.338

Objective To evaluate the treatment methods for subtrochanteric femur fractures in children and adolescents.Methods Sixty-two patients (at age of 4-16 years) with subtrochanteric fe-mur fractures were managed with traction and delayed hip spica (14 patients, set as nonoperative group) ,titanium elastic nails or pin combined with cast (38 patients, set as less invasive group) and plates (10 patients, set as traditional operative group).The radiologic outcomes, hip joint function and complica-tions of the patients were analyzed.Results According to Beaty scoring, five patients in nonoperative group and 44 in operative group obtained satisfactory early radiologic outcomes.Late radiologic outcome was satisfactory in nine patients from nonoperative group and 46 from operative group according to Theolo-gis scoring, with statistical differences between two groups (P<0.05).Sanders scoring showed excellent results in 11 patients and good in three from nonoperative group, and excellent results in 43 and good in five from operative group, with no statistical differences between two groups (P > 0.05).Less invasive group and traditional operative group showed significantly statistical different in aspects of complications and Sanders scores (P < 0.05).Conclusions Operative treatment provides more satisfactory early and late radiologic results than nonoperative methods.Less invasive operations have better outcomes than tra-ditional operative methods.Selection of treatment modalities based on age, body weight, fracture features and soft tissue conditions of children is the prerequisite for a good outcome.

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Anesthetic method for seismic patients in 2008 Wenchuan earthquake

Yongda MA ; Zhen WANG ; Hengjiang GE ; Liyong CHEN ; Yi PEN

Chinese Journal of Trauma.2009;25(9):849-852. doi:10.3760/cma.j.issn.1001-8050.2009.09.269

Objective To analyze the anesthetic methods and surgical procedures in the treatment of inpatients in N 2 People' s Hospital of Deyang after Wenchuan earthquake. Methods More than 900 patients were sorted for injury triage, among whom 83 patients received emergency surgery within 72 hours after earthquake, and 21 received surgery after 72 hours. After 10 days of the earthquake, the hospitalized patients needing further surgery have been transferred to hospitals in safe regions. Of all patients, 89 (85.58%) were with injuries of extremities, 11 (10.6%) with cerebral trauma, 3 with thoracic injury, and 1 (1.0%) with abdominal trauma. Perioperative noninvasive blood pressure, electrocardiogram, pulse and oxygen saturation were detected during the surgery. All patients were cured except that one patient with traumatic flail chest died 12 hours after the surgery. Results Of all patients undergone surgeries, 35 patients (33.7%) received combined spinal-epidural anesthesia (CSEA), 33 (31.7%) received nerve plexus block (NPB), 5 (4.8%) had CSEA plus NPB, 28 were under general anesthesia (GA) [17 (16.3%) were intubated and 11(10.6%) were non-intubated] and 3 (2.8%) received monitored anesthesia care (MAC). The average ratios of operation time to time for patients stayed in operation room were (51.29±12.38)% in GA group, (53.24±11.39)% in NPB group, (58.43±9.26)% in CSEA group and (77.15±9.27)% in CSEA plus NPB group. There was a significant difference between CSEA + NPB group and the other three groups (P<0.01), and there was no significant difference among GA group, NPB group and CSEA group (P > 0.05). Conclusions During the initial period of rescue, the most common type of injuries are fractures. CSEA plus NPB is encouraged to use as they have the advantages of shorter operation time, higher operation throughput, safety and faster convalescence of the victims.

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Effect of craniotomy on blood-brain barrier in rats

Guoliang JIN ; Rongxiao DAI ; Xuebin YU ; Jinquan LI ; Tianlun QIU ; Gang WANG ; Jianli WANG

Chinese Journal of Trauma.2009;25(9):807-810. doi:10.3760/cma.j.issn.1001-8050.2009.09.257

Objective To investigate whether the macromolecular materials could enter cerebrospinal fluid and brain tissues in craniotomy with incision or non-incision of dura and arachnoid. Methods Adult male SD rats were randomly divided into three groups according to the random number table. The dura and arachnoid of rats in group A were cut open during craniotomy after general anesthesia; epidural craniotomy was done in rats in group B after general anesthesia; rats in group C (control group) were only generally anesthetized. All the rats were injected with Evans blue, a tracer used to detect the results, half an hour before each time point (1,3, 6, 12, 24, 72 hours and 1 week) via vein. The rats were executed at each time point to obtain the specimens of brain. The content of Evans blue in brain tissue was measured by fluorescence spectrophotometer for statistical analysis. The water content in the brain tissue was measured in a part of rats selected in groups A and B preoperatively and at postoperative 3 and 27 hours. Results It was found that some regions of the brain tissue were stained light blue in group A at 1,3, 6 and 24 hours. The blue was much lighter in brain tissue obtained at 72 hours in group A, and no blue stained at 1 week in group A . The contents of Evans blue in the brain tissues of rats in group A at 1,3, 6, 12, 24, 72 hours and 1 week were (18.07±1.25) μg/ml, (36.21±0.78) μg/ml, (25.73±1.14) μg/ml, (16.53±0.84) μg/ml, (23.34±1.91) μg/ml, (43.34±2.25) μg/ml and (25.27±1.88)μg/ml respectively, which were significantly higher than (3.15±0.45)μg/ml, (3.36±0.33)μg/ml, (2.98±0.54)μg/ml, (3.47±0.55)μg/ml, (3.54±0.37) μg/ml, (2.88± 0.42) μg/ml and (2.85±0.22) μg/ml respectively in group B and (2.97±0.37)μg/ml in group C (P<0.01). There was no significant difference in water content in brain tissue before and after operation (P>0.05). Conclusion After craniotomy with incision of dura and arachnoid, some macromolecular materials can enter the subarachnoid space and the brain parenehyma through blood-brain barrier of the wound of the scalp if the dura is sutured loosely.

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Diagnoses and treatment of severe traumatic brain injury in 4 462 cases: a retrospective study

Zhou FEI ; Xiang ZHANG ; Dakuan GAO ; Weiping LIU ; Bing LI ; Luoan FU ; Jianning ZHANG ; Xiaofan JIANG ; Xiaosheng HE ; Yangang WANG

Chinese Journal of Trauma.2009;25(7):583-586. doi:10.3760/cma.j.issn.1001-8050.2009.07.187

Objective To analyze and summarize the experiences in diagnosis and treatment of patients with severe traumatic brain injury (sTBI) so as to increase the cure rate and survival rate. Methods A retrospective study was made on the diagnoses and treatment of 4 462 cases of sTBI inclu-ding 3 298 males (73.9%) and 1 164 females (26.1%). The most frequent cause for injury was traffic accident, accounting for 35.5% (1 583/4 462). Closed bead injury ocurred in 3 654 cases (81.9%) and open head injury in 808 (18.1%). The most commen clinical manifestations included unconscious-ness, changes of pupils and life signs. Of all, 1 158 cases (26.0%) were found with combined injury and 1 356 (30.4%) with complications. Treatment measures included first aid, surgery or conventional treatment. Emphasis was put on the treatment of secondary insults. Results Surgery was performed in 3 023 cases (67.7%) including craniotomy for hematoma clearance in 856 cases and hematoma clearance plus decompression in 2 167, with mortality rate of 17.9%. Conventional treatment was carried out in 1 439 cases (32.3%), with mortality rate of 23.7%. There were 2 462 eases (55.2%) with fair recov-ery, 508 (11.4%) with mild disability, 339 (7.6%) with severe disability, 272 (6.1%) under vege-tative state and 881 (19.7%) deaths on discharge according to the Glasgow Outcome Scale. Conelu-sions Active diagnoses and treatment, strict medication rules and prevention and treatment of secondary insults may be key to higher eure rate as well as lower morbidity and mortality of sTBI.

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MRI evaluation of acute spinal cord injury

Kang LI ; Furong Lü ; Qianhong MA ; Qingjun YANG ; Fajin Lü ; Tianyou LUO

Chinese Journal of Trauma.2009;25(6):530-532. doi:10.3760/cma.j.issn.1001-8050.2009.06.165

Objective To assess the clinical value of MRI in evaluation of acute spinal cord in-jury. Methods A total of 50 patients with acute spinal cord injury were examined with magnetic reso-nance (MRI), X-ray and CT. Of all, 15 patients for spinal MR imaging were examined with axial and sngittal spin-echo and fast spin-echo imaging and 17 with coronal imaging. All imaging was performed on 1.5T superconducting system (GE/SIEMENS) with spine surface coil. Results Among 50 patients with acute spinal cord injury, spinal cord edema was detected by MRI in 16 patients, by CT in four but none by X-ray. Intraspinal cord hemorrhage was detected by MRI in 21 patients, by CT in 11 but none by X-ray. Compression and dislocation were detected by MRI in 34 patients, by CT in 15 but none by X-ray. Incomplete and complete transection of spinal cord was found by MRI in 10 patients, by CT in three but none by X-ray. Conclusion MRI is superior to CT scanning and X-ray in detection and evaluation of a-cute spinal cord injury and is the optimal method for examination and diagnosis of acute spinal cord injury.

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Application of integrative treatment model and damage control theory in management of severe multiple injury

Fan YANG ; Xiangjun BAI ; Zhaohui TANG ; Chengla YI ; Zhanfei LI ; Wei GAO

Chinese Journal of Trauma.2009;25(9):843-846. doi:10.3760/cma.j.issn.1001-8050.2009.09.267

Objective To investigate the clinical therapeutic effect of integrative treatment model and damage control theory in treatment of severe multiple injury. Methods A retrospective study was done on 116 patients with severe multiple injuries who were divided into integrative treatment plus damage control group, integrative treatment group and conventional treatment group. The relationship of correlative factors with mortality rate among three groups was compared before operation, during operation and after operation. Results All the indices in integrative treatment plus damage control group were better than other two groups before operation, during operation and after operation, with lower mortality rate (P<0.05). Conclusions Early use of integrative treatment model and damage control theory can obviously decrease complications, improve prognosis and decrease mortality rate for patients with severe multiple injury.

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Anatomical study and clinical application of minimally invasive internal fixation in the treatment of intra-articular fractures of calcaneum via sinus tarsi approach

Jianzhong KONG ; Licheng ZHENG ; Xiaolong SHUI ; Xiaoshan GUO ; Shi LI

Chinese Journal of Trauma.2009;25(9):822-825. doi:10.3760/cma.j.issn.1001-8050.2009.09.261

Objective To investigate the anatomical features, operative method and efficacy of internal fixation in the treatment of iutra-articular fractures of caleaneum via the sinus tarsi approach. Methods The pathway, branches distribution and anastomosis of perforating descending branch of peroneal artery were observed on 18 adult cadaveric lower limbs. A sinus tarsi approach was designed. From July 2001 to January 2008, 71 intra-articular calcaneal fractures in 68 patients were treated with open reduction and internal fixation via sinus tarsi approach at lateral sides of calcaneus. According to the Sanders classification, there were 26 type Ⅱ fractures, 32 type Ⅲ fractures and 13 type Ⅳ fractures. Results All patients were followed up for a mean period of 39.3 months (13-85 months), and the fractures were completely healed. There was a significant difference in the length, width and height of the calcaneus, Bohler angle and Gissane angle before and after operation (P < 0.01). According to Maryland Foot Score, the operative effect was excellent in 33 feet, good in 29 feet, fair in 6 feet and poor in 3 feet. Conclusion Open reduction and internal fixation via sinus tarsi approach is an effective method for minimally invasive treatment of intraarticular fractures of the calcaneus, with the advantages of good clinical results and causing minimal damage to soft tissues.

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Application of atlantoaxial pedicle screw system in the treatment of upper cervical injury

Lei LI ; Huan WANG ; Shaoqian CUI ; Jingzhu DUAN ; Guoxin JIN ; Gang WANG

Chinese Journal of Trauma.2009;25(9):813-817. doi:10.3760/cma.j.issn.1001-8050.2009.09.259

Objective To investigate the methods, feasibility, outcome and indications of atlantoaxial pedicle screw system in the treatment of upper cervical injury. Methods Thirteen patients with upper cervical injury were treated by atlantoaxial pedicle screw system. There were four patients with old odontoid fractures, two with new odontoid fractures (Aderson ⅡC), three with rapture of the transverse ligament of C1 and four with C1 fracture. Results A total of 26 pedicle screws and 26 pedicle screws were implanted. The mean operation time and perioperative blood loss were 2.6 hours and 470 ml, respectively. No injury to the vertebral artery and spinal cord was observed. All patients were followed up for 4-25 months (mean 13 months). The clinical symptoms were improved to some extent according to Japanese Orthopedic Association scoring system, with improvement rate of 72%-91% (mean 81%). The screws were verified to be fixed in a proper position, and no hardware broken or loosening was observed except for one C1 screw penetrating the medial superior cortex of lateral mass for 3 mm without affecting occipito-aflantal motions. All patients had a solid bony fusion 3-6 months later. Conclusion The atlantoaxial pedicle screw system is feasible in the treatment of upper cervical injury with the advantages of better outcomes and wider indications.

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