1.Effectiveness of posterior single-level osteotomy with 360° release and correction in treatment of osteoporotic vertebral compression fractures with moderate to severe kyphosis.
Peidong QING ; Hongda XU ; Youpeng HU ; Bin XIE ; Tieheng WANG ; Lei ZHANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1574-1579
OBJECTIVE:
To explore the effectiveness of posterior single-level osteotomy with 360° release and correction for the treatment of osteoporotic vertebral compression fractures (OVCF) complicated with moderate to severe kyphosis.
METHODS:
A retrospective analysis was conducted on 11 patients with OVCF complicated with moderate to severe kyphosis between January 2022 and March 2023. There were 4 males and 7 females with an average age of 57 years ranging from 47 to 69 years. The disease duration ranged from 3 to 15 months, with an average of 7 months. Fracture segments included T 11 in 3 cases, T 12 in 5, L 1 in 2, and L 2 in 1. The T value of lumbar spine bone density was -5.0 to -2.0, with an average of -3.5. The preoperative neurological function was grade E according to Frankel grading. The Pfirrmann classification of the intervertebral disc above the injured vertebra was grade Ⅲ in 8 cases and grade Ⅳ in 3 cases. All patients underwent posterior single-level osteotomy with 360° release and correction. The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded. Thoracolumbar local kyphosis Cobb angle, the mean height of the functional spinal unit (FSU), the sagittal vertical axis (SVA), and the sagittal index (SI) were measured. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the improvement of pain and function before operation, at 1 month after operation, and at last follow-up.
RESULTS:
The operation successfully completed in all patients, and there was no obvious complication. The operation time ranged from 100 to 190 minutes, with an average of 153 minutes, and the intraoperative blood loss ranged from 200 to 800 mL, with an average of 468 mL. The length of hospital stay was 8-14 days (mean, 12 days). All patients were followed up 6-24 months, with an average of 12.4 months. At last follow-up, all the 11 patients had bony fusion in the osteotomy area, and there was no displacement or subsidence of the Cage, no complication such as internal fixation failure or pseudarthrosis formation was found. The Cobb angle of local thoracolumbar kyphosis, the mean height of FSU, SVA, and SI significantly improved immediately after operation and at last follow-up when compared with preoperative ones, and the VAS score and ODI also significantly improved at 1 month after operation and at last follow-up ( P<0.05); there was no significant difference in above indexes between the two time points after operation ( P>0.05).
CONCLUSION
Posterior single-level osteotomy with 360° release and correction is an effective surgical method for treating OVCF complicated with moderate to severe kyphosis, with definite early effectiveness.
Humans
;
Kyphosis/etiology*
;
Male
;
Female
;
Osteotomy/methods*
;
Middle Aged
;
Retrospective Studies
;
Aged
;
Spinal Fractures/diagnostic imaging*
;
Fractures, Compression/diagnostic imaging*
;
Osteoporotic Fractures/complications*
;
Treatment Outcome
;
Lumbar Vertebrae/injuries*
;
Thoracic Vertebrae/injuries*
;
Operative Time
;
Fracture Fixation, Internal/methods*
2.Comparison of side-opening and front-opening approach bone cement injectors in percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fractures.
Wei-Xin DONG ; Zhen-Tao CHU ; Yong HU ; Ou-Jie LAI ; Zhen-Shan YUAN ; Xiao-Yang SUN
China Journal of Orthopaedics and Traumatology 2025;38(2):128-133
OBJECTIVE:
To compare clinical efficacy between side-opening and front-opening bone cement injectors in percutaneous kyphoplasty(PKP) for the management of thoracolumbar osteoporotic vertebral compression fractures(OVCFs).
METHODS:
A retrospective cohort study was conducted, comprising 62 patients with single-segment thoracolumbar OVCFs (T11-L2), who underwent bilateral PKP at our department during the period from June 2020 to October 2021. Patients were categorized into two groups based on the specific bone cement injector employed during the surgical procedure: the side-opening group (n=29) and the front-opening group (n=33). Among them, the side-opening group consisted of 6 male and 23 female patients, with a mean age of (73.32±9.11) years. The front-opening group included 7 male and 26 female patients, with a mean age of (71.29±10.39) years. The variables encompassed essential patient characteristics were recorded, such as gender, age, bone mineral density (BMD), and fracture level (T11-L2), as well as procedural aspects, including operation duration, cement injection volume, cement distribution type (lobular or diffuse), occurrence of cement leakage, pre-and post-operative visual analogue scale (VAS) pain scores, and vertebral compression ratio.
RESULTS:
All patients underwent successful surgery, with a mean follow-up duration of (15.37±3.03) months. There were no statistically significant differences in gender, age, BMD, fracture level, preoperative vertebral compression degree, and VAS scores between the side-opening group and the front-opening group (P>0.05). The operation time, the mean cement injection volumes, the distribution of bone cement within the vertebrae has no statistically significant difference between two groups(P>0.05). Both the side-opening and front-opening groups showed significant improvements in VAS scores at 3 days and 6 months after operation (P<0.05). However, there was no significant difference in VAS scores between the two groups at both 3 days and 6 months after the operation (P>0.05).
CONCLUSION
Side-opening bone cement injectors in bilateral PKP surgery for single-segment thoracolumbar OVCF achieve similar clinical efficacy as front-opening injectors, without significant improvement in cement distribution and containment.
Humans
;
Female
;
Male
;
Kyphoplasty/instrumentation*
;
Aged
;
Bone Cements
;
Fractures, Compression/surgery*
;
Retrospective Studies
;
Spinal Fractures/surgery*
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
;
Osteoporotic Fractures/surgery*
;
Middle Aged
;
Aged, 80 and over
3.Clinical application of angle-settable linear laser auxiliary instrument in vertebral puncture.
Li-Qi RUAN ; Ling WANG ; Jin-Tao HU ; Pi-Sheng QU
China Journal of Orthopaedics and Traumatology 2025;38(11):1139-1144
OBJECTIVE:
To compare the effects of bilateral vertebral puncture guided by an angle-adjustable linear laser auxiliary device versus free-hand bilateral vertebral puncture.
METHODS:
A retrospective analysis was conducted on the clinical data of 47 patients who underwent thoracolumbar percutaneous kyphoplasty(PKP) from July 2022 to July 2023. All patients received bilateral percutaneous kyphoplasty, among whom 27 cases underwent conventional free-hand puncture (conventional puncture group) and 20 cases underwent puncture guided by a laser auxiliary device (auxiliary puncture group). In the conventional puncture group, there were 11 males and 16 females, with an average age of (69.6±5.1) years and a disease duration of (6.5±3.8) days;the fractured vertebrae were T11-T12 in 13 cases and L1-L2 in 14 cases. In the auxiliary puncture group, there were 7 males and 13 females, with an average age of (70.8±5.6) years and a disease duration of (6.4±3.8) days;the fractured vertebrae were T11-T12 in 7 cases and L1-L2 in 13 cases. The operation time, total blood loss, intraoperative fluoroscopy times, fluoroscopy duration, radiation dose, puncture success rate, and surgical complications were compared between the two groups. The visual analogue scale (VAS) was used to evaluate low back pain before surgery, 2 days after surgery, and 1 year after surgery.
RESULTS:
All patients achieved successful puncture, with good postoperative wound healing and no complications. The operation time of the auxiliary puncture group was (12.1±2.6) minutes, which was shorter than that of the conventional puncture group (14.1±2.8) minutes. The total blood loss of the auxiliary puncture group was (228.5±35.8) ml, less than that of the conventional puncture group (257.0±48.3) ml. The fluoroscopy times, fluoroscopy duration, and radiation dose of the auxiliary puncture group were (5.4±1.3) times, (15.9±3.3) seconds, and (159.4±37.4) μSv, respectively, all lower than those of the conventional puncture group (6.4±1.6) times, (18.8±4.6) seconds, (192.2±48.5) μSv, with statistically significant differences(P<0.05). There were no statistically significant differences in low back VAS scores between the two groups before surgery, 2 days after surgery, or 1 year after surgery(P>0.05).
CONCLUSION
Both laser auxiliary device-guided vertebral puncture and free-hand vertebral puncture have high success rates and similar postoperative curative effects. However, the laser auxiliary device-guided puncture has shorter operation time, less blood loss, and lower radiation hazard.
Humans
;
Male
;
Female
;
Aged
;
Retrospective Studies
;
Middle Aged
;
Punctures/methods*
;
Kyphoplasty/instrumentation*
;
Spinal Fractures/surgery*
;
Lasers
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
4.Research on the correlation between rib fracture characteristics and the risk of intrathoracic and intra-abdominal injuries.
Hang CAO ; Qiang CHEN ; Yan DING ; Llion ROBERTS
Chinese Journal of Traumatology 2025;28(6):509-512
PURPOSE:
Intrathoracic and intra-abdominal injuries in patients with rib fractures are often overlooked, leading to delayed and ineffective treatment. However, the relationship between rib fractures and organ damage has been rarely studied. The purpose of this study was to analyze the risk factors associated with intrathoracic and intra-abdominal injuries in patients with rib fractures.
METHODS:
This retrospective observational study included 1269 patients diagnosed with rib fractures from September 2020 to April 2023. Patient data were collected, including gender, age, body mass index, systolic blood pressure, heart rate, type of rib fracture, number of fractured ribs, location of the rib fracture, and the presence of thoracic and abdominal organ injuries. Patients without imaging examinations, the patient with rib fractures from iatrogenic causes or mental illnesses or rheumatic immune diseases was excluded. The primary outcomes were intra-thoracic and intra-abdominal injuries. Multivariate logistic regression analysis was conducted to identify the risk factors for these injuries in patients with rib fractures.
RESULTS:
The rib fracture characteristics in the occurrence group included bilateral fractures, higher number of fractures (≥3), and fractures located anteriorly, posteriorly, and laterally, as well as greater fracture displacement, compared to the non-occurrence group. The results of the multivariate logistic regression analysis indicated that age (p=0.016, odds ratio (OR)=0.95, 95% confidence interval (CI: 0.92-0.98), the number of rib fractures (≥3, p=0.001, OR=1.46, 95% CI: 1.13-1.89), rib type (bilateral rib fractures, p=0.043, OR=2.63, 95% CI: 2.16-3.12), and rib fracture location (lateral rib fractures, p=0.041, OR=2.85, 95% CI: 1.31-4.97; posterior rib fractures, p=0.022, OR=3.25, 95% CI: 1.46-6.92) were independent risk factors for thoracic and abdominal organ injuries in patients with traumatic rib fractures.
CONCLUSIONS
Patients with rib fractures resulting from blunt trauma, particularly those with lateral or posterior rib fractures, fractures involving more than 3 ribs, and bilateral rib fractures, are at an increased risk for significant intrathoracic and intra-abdominal injuries. These findings warrant attention and the implementation of appropriate preventive measures during treatment.
Humans
;
Rib Fractures/complications*
;
Male
;
Female
;
Retrospective Studies
;
Middle Aged
;
Thoracic Injuries/epidemiology*
;
Abdominal Injuries/epidemiology*
;
Risk Factors
;
Adult
;
Aged
;
Logistic Models
;
Young Adult
5.Correlation analysis of the effect of postoperative drainage on surgical efficacy of thoracolumbar fractures through multifidus interspace approach.
China Journal of Orthopaedics and Traumatology 2024;37(11):1062-1068
OBJECTIVE:
To investigate correlation of the effect factors on surgical efficacythe of whether postoperative drainage through the multifidus interspace approach in the treatment of thoracolumbar fractures.
METHODS:
A total of 66 patients with thoracolumbar fractures admitted from January 2017 to December 2021 were retrospectively analyzed. According to whether postoperative drainage, 36 patients were in drainage group and 30 patients were in no drainage group. In the drainage group, there were 17 males and 19 females with an average age of (55.4±9.5) years old ranging from 23 to 68 years old;in the no drainage group, there were 16 males and 14 females with an average age of (53.9±8.3) years ranging from 30 to 69 years old. A multifidus interspace approach was used in both groups. Then factores of age, gender, fracture site, injured segment, operation time, intraoperative blood loss, preoperative Cobb angle, preoperative vertebral anterior height ratio, preoperative Japanese 0rthopaedic Association(J0A) score, preoperative visual ana1ogue scale(VAS), preoperative Oswestry Disability Index(ODI) score may affect the postoperative drainage, using univariate and multivariate Logistic regression analysis to study their influence on the prognosis. The postoperative Cobb angle, anterior vertebral height ratio, JOA score, VAS and ODI were compared between the two groups.
RESULTS:
Univariate analysis showed that whether postoperative drainage may be related to patient age, whether injury to multiple segments, operation time, and intraoperative blood loss(P<0.05). The multivariate analysis showed that age, operation time were the main factors affecting postoperative drainage(P<0.05). There was no significant difference in Cobb angle, anterior vertebral height loss rate, JOA score, VAS score and ODI score between the two groups at the postoperative follow-up(P>0.05). In terms of complications, the total incidence of postoperative low back pain in the no drainage group was lower than that in the drainage group(P<0.05). There was no significant difference in postoperative infection and postoperative nerve loss between the two groups(P>0.05).
CONCLUSION
Age and operation time are the main factors affecting the postoperative drainage through multifidus interspace approach for thoracolumbar fractures. And no drainage does not affect the long-term effect of the operation, on the contrary, no drainage can reduce the method of low back pain and obtain more benefits.
Humans
;
Male
;
Female
;
Middle Aged
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
;
Adult
;
Spinal Fractures/surgery*
;
Aged
;
Drainage/methods*
;
Retrospective Studies
;
Young Adult
;
Treatment Outcome
6.Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures.
Piyao JI ; Huanyu JIANG ; Yan ZHOU ; Jianghua MING ; Qing CHEN ; Ming DENG ; Yaming LI ; Yonggang MA ; Shiqing LIU
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(10):1246-1252
OBJECTIVE:
To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures.
METHODS:
A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle.
RESULTS:
There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones ( P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation ( P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group ( P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation ( P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up ( P<0.05).
CONCLUSION
The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.
Humans
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
;
Retrospective Studies
;
Blood Loss, Surgical
;
Treatment Outcome
;
Pedicle Screws
;
Spinal Fractures/surgery*
;
Kyphosis
;
Fracture Fixation, Internal
;
Fractures, Compression/surgery*
7.Effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture.
Yadong ZHANG ; Wentao WANG ; Haiping ZHANG ; Houkun LI ; Xukai XUE ; Lequn SHAN ; Dingjun HAO
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(12):1489-1495
OBJECTIVE:
To explore the safety and effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation in the treatment of ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture.
METHODS:
A clinical data of 20 patients with ankylosing spondylitis kyphosis combined with acute thoracolumbar spine fracture, who were treated with one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation between April 2016 and January 2022, was retrospectively analyzed. Among them, 16 cases were male and 4 cases were female; their ages ranged from 32 to 68 years, with an average of 45.9 years. The causes of injury included 10 cases of sprain, 8 cases of fall, and 2 cases of falling from height. The time from injury to operation ranged from 1 to 12 days, with an average of 7.1 days. The injured segment was T 11 in 2 cases, T 12 in 2 cases, L 1 in 6 cases, and L 2 in 10 cases. X-ray film and CT showed that the patients had characteristic imaging manifestations of ankylosing spondylitis, and the fracture lines were involved in the anterior, middle, and posterior columns and accompanied by different degrees of kyphosis and vertebral compression; and MRI showed that 12 patients had different degrees of nerve injuries. The operation time, intraoperative bleeding, intra- and post-operative complications were recorded. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the low back pain and quality of life, and the American spinal cord injury association (ASIA) classification was used to evaluate the neurological function. X-ray films were taken, and local Cobb angle (LCA) and sagittal vertical axis (SVA) were measured to evaluate the correction of the kyphosis.
RESULTS:
All operations were successfully completed and the operation time ranged from 127 to 254 minutes (mean, 176.3 minutes). The amount of intraoperative bleeding ranged from 400 to 950 mL (mean, 722.5 mL). One case of dural sac tear occurred during operation, and no cerebrospinal fluid leakage occurred after repair, and the rest of the patients did not suffer from neurological and vascular injuries, cerebrospinal fluid leakage, and other related complications during operation. All incisions healed by first intention without infection or fat liquefaction. All patients were followed up 8-16 months (mean, 12.5 months). The VAS score, ODI, LCA, and SVA at 3 days after operation and last follow-up significantly improved when compared with those before operation ( P<0.05), and the difference between 3 days after operation and last follow-up was not significant ( P>0.05). The ASIA grading of neurological function at last follow-up also significantly improved when compared with that before operation ( P<0.05), including 17 cases of grade E and 3 cases of grade D. At last follow-up, all bone grafts achieved bone fusion, and no complications such as loosening, breaking of internal fixation, and pseudoarthrosis occurred.
CONCLUSION
One-stage posterior eggshell osteotomy and long-segment pedicle screw fixation is an effective surgical procedure for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. It can significantly relieve patients' clinical symptoms and to some extent, alleviate the local kyphotic deformity.
Humans
;
Male
;
Female
;
Animals
;
Adult
;
Middle Aged
;
Aged
;
Spinal Fractures/surgery*
;
Pedicle Screws
;
Spondylitis, Ankylosing/surgery*
;
Quality of Life
;
Retrospective Studies
;
Egg Shell/injuries*
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
;
Kyphosis/surgery*
;
Osteotomy
;
Fracture Fixation, Internal/methods*
;
Fractures, Compression/surgery*
;
Treatment Outcome
8.Analysis of the clinical effect of percutaneous pedicle screw fixation combined with transpedicular bone grafting in the treatment of thoracolumbar fracture.
Xiang-Qian LI ; Ming-Hu WU ; Dong-Liang GONG ; Jun ZHANG ; Wen-Qin FU ; Ru-Feng GAO ; Nong CHEN
China Journal of Orthopaedics and Traumatology 2023;36(10):936-942
OBJECTIVE:
To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures.
METHODS:
From Janury 2021 to June 2022, 40 patients with thoracolumbar fracture were divided into the experimental group and the control group. There were 26 patients in the experimental group, including 21 males and 5 females with an aberage age of (47.3±12.3) years old, who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting. In the control group, 14 patients received percutaneous pedicle screw fixation only. including 7 makes and 7 females with an average age of (50.2±11.2) years old. The operative time, intraoperative blood loss, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score (VAS), MacNab scores, loosening or broken of the implants. were compared and analyzed.
RESULTS:
There was no significant difference in operation time, intraoperative blood loss, VAS and anterior height ratio of injured vertebrae between the two groups. Compared with the preoperative results, VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05). For Cobb angle of injured vertebra, there was no significant difference between the two groups before surgery (P=0.766). While at 1 week, 3 months and 12 months after surgery, there were statistically differences between the two groups (P values were 0.042, 0.007 and 0.039, respectively). The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery (P<0.001). One year after surgery, the excellent and good rate of Macnab scores was 96.15% in the experimental group and 92.86% in the control group, and there was no statistical differences between the two groups (P=0.648). There was one patient in the control group suffering superficial wound infection on the third day, which was cured by dressing change and anti-infection treatment. There were no postoperative screw loosening and broken in both groups.
CONCLUSION
The two surgical methods have the advantages of less trauma, less pain and quicker recovery, which can restore the height of the injured vertebra, reconstruct the spinal sequence and reduce the fracture of the vertebral body. Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery, thus reducing the possibility of complications such as kyphosis, screw loosening and broken.
Male
;
Female
;
Humans
;
Adult
;
Middle Aged
;
Pedicle Screws
;
Bone Transplantation
;
Blood Loss, Surgical
;
Lumbar Vertebrae/injuries*
;
Thoracic Vertebrae/injuries*
;
Fracture Fixation, Internal/methods*
;
Spinal Fractures/surgery*
;
Treatment Outcome
;
Retrospective Studies
9.Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries.
Wen-Qiong DU ; Xin ZHONG ; Ren-Qing JIANG ; Zhao-Wen ZONG ; Yi-Jun JIA ; Zhao YE ; Xiao-Lin ZHOU
Chinese Journal of Traumatology 2023;26(1):41-47
PURPOSE:
To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees' performance for emergent and urgent thoracic surgeries.
METHODS:
With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.
RESULTS:
Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.
CONCLUSIONS
Animal model-based simulation training established in the current study could improve the trainees' performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.
Animals
;
Swine
;
Reproducibility of Results
;
Wounds, Penetrating/surgery*
;
Thoracotomy
;
Thoracic Injuries/surgery*
;
Hemorrhage
;
Models, Animal
10.Evaluating the effect of montelukast tablets on respiratory complications in patients following blunt chest wall trauma: A double-blind, randomized clinical trial.
Soleyman HEYDARI ; Hadi KHOSHMOHABAT ; Ali Taheri AKERDI ; Fathollah AHMADPOUR ; Shahram PAYDAR
Chinese Journal of Traumatology 2023;26(2):116-120
PURPOSE:
Patients with multiple traumas are at high risk of developing respiratory complications, including pneumonia and acute respiratory distress syndrome. Many pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic infiltration. Leukotriene-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway inflammation. The present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma patients.
METHODS:
This randomized, double-blind, placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT scan. We excluded patients if they met at least one of the following conditions: < 16 years old, history of cardiopulmonary diseases or positive history of montelukast-induced hypersensitivity reactions. Patients were allocated to the treatment (10 mg of montelukast) or placebo group using permuted block randomization method. The primary measured outcome was the volume of pulmonary contusion at the end of the trial. The secondary outcomes were intensive care unit and hospital length of stay, ventilation days, multi-organ failure, and the in-hospital mortality rate.
RESULTS:
In total, 65 eligible patients (treatment = 31, placebo = 34) were included for the final analysis. The treatment group had more pulmonary contusion volume (mean (SD), mm3) at the right (68726.97 (93656.54) vs. 59730.27 (76551.74)) and the left side (67501.71 (91514.04) vs. 46502.21 (80604.21)), higher initial C-reactive peptide level (12.16 (10.58) vs. 10.85 (17.87)) compared to the placebo group, but the differences were not statistically significant (p > 0.05). At the end of the study, the mean (SD) of pulmonary contusion volume (mm3) (right side = 116748.74 (361705.12), left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56), left side = 25929.12 (47417.13), p = 0.228 and 0.082, respectively). Moreover, both groups have statistically similar hospital (mean (SD), days) (10.87 (9.83) vs. 13.05 (10.12)) and intensive care unit length of stays (mean (SD), days) (7.16 (8.15) vs. 7.82 (7.48)). Of note, the frequency of the in-hospital complications (treatment vs. control group) including acute respiratory distress syndrome (12.9% vs. 8.8%, p = 0.71), pneumonia (19.4% vs. 17.6%, p = 0.85), multi-organ failure (12.9% vs. 17.6%, p = 0.58) and the mortality rate (22.6% vs. 14.7%, p = 0.41) were comparable between the groups.
CONCLUSION
Administrating montelukast has no preventive or therapeutic effects on lung contusion or its complications.
Humans
;
Adolescent
;
Thoracic Wall
;
Pneumonia
;
Wounds, Nonpenetrating
;
Thoracic Injuries/drug therapy*
;
Lung Injury
;
Contusions
;
Respiratory Distress Syndrome/etiology*
;
Inflammation
;
Tablets
;
Treatment Outcome

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