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中华创伤杂志（英文版）

中华创伤杂志（英文版）

Chinese Journal of Traumatology
中华医学会主办，中华医学会创伤学分会承办。本刊是全英文高级学术刊物，是中华医学会系列杂志之一。主要对外报道我国创伤学及相关学科的成果与进展，全面反映我国创伤医学的成就与水平，促进和指导我国创伤学研究的发展，提高临床救治水平；同时将国外相应领域进展及动态介绍给中国读者。它使中国的创伤医学走向世界，使外国读者了解中国，促使国内外创伤医学的交流与合作。
  • 发文量：1895
  • 被引量：418
  • H指数：2
  • 开始收录时间：1998,1(1)
  • CNKI综合因子：0.471
  • 维普期刊影响因子： 0.506
  • 万方期刊影响因子：0.62
  • 创刊时间：1998
  • 国内刊号/CN：50-1115/R
    国际刊号/ISSN：1008-1275
  • 发行周期：双月刊
    邮发代号：78-81
  • 主管单位：中国科学技术协会
    主办单位：中华医学会
中华创伤杂志（英文版）-联系信息
  • 主编：Jian-Xin Jiang
  • 电话：010-51322059
  • 邮箱：office@cma.org.cn
  • 地址：42 Dongsi Xidajie, Beijing
  • 邮编：100710
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中华创伤杂志（英文版） >2021年第6期

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  • 摘要：Purpose: Early diagnosis of traumatic brain injury (TBI) is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale (GCS) of 12 or less can predict the presence of TBI and the severity of associated injuries in blunt trauma patients. Methods: A retrospective cohort study including 303, 435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National Trauma Registry maintained by Israel's National Center for Trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant. Results: There were 303, 435 blunt trauma patients, 8731 (2.9％) of them with GCS of 3-12 that including 6351 (72％) patients with GCS of 3-8 and 2380 (28％) patient with GCS of 9-12. In these 8731 patients with GCS of 3-12, 5372 (61.5％) patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12, 1256 (89％) patients with GCS 3-8, 148 (11％) patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4％ of them had no TBI. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1％. In the unstable patients with GCS 3-8, 60.5％ of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2％ suffered from TBI. Conclusion: The utility of a GCS 12 and less is limited in prediction of brain injury in multiple trauma patients. Significant proportion of trauma victims with low GCS had no TBI and their impaired neurological status is related to severe extra-cranial injuries. The findings of this study showed that using of GCS in initial triage and decision making processes in blunt trauma patients needs to be re-evaluated.
  • 摘要：Purpose: The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. Methods: This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients' demographics, prehospitalization residential status, prefracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. Results: The average age was 83 years, 73％ female, and 57％ of them sustained a femoral neck fracture. In 62.8％ of patients, the number of pre-fracture baseline comorbidities was >2. The in-hospital mortality rate was 11.4％. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed. Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality (c-statistic 0.77). Conclusion: Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.
  • 摘要：Purpose: To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. Methods: From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20 -65 years). The causes of the fractures included traffic accidents (13 cases), falls from a height (four cases), heavy lifting injuries (three cases), and sport injury (one case). All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. Results: The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36-76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1％. Conclusion: The mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient's joint function and quality of life.
  • 摘要：Purpose: Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. Methods: Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords "acetabular", "fracture", "arthroplasty", and "post traumatic arthritis" published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. Results: With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28％ -63％), implant loosening (1％-24％), and infection (0％-16％). The minimum 5-year survival of implants ranged from 70％ to 100％. Revision rates ranged from 2％ to 32％. Conclusion: Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.
  • 摘要：Traumatic injury of the central nervous system (CNS) including brain and spinal cord remains a leading cause of morbidity and disability in the world. Delineating the mechanisms underlying the secondary and persistent injury versus the primary and transient injury has been drawing extensive attention for study during the past few decades. The sterile neuroinflammation during the secondary phase of injury has been frequently identified substrate underlying CNS injury, but as of now, no conclusive studies have determined whether this is a beneficial or detrimental role in the context of repair. Recent pioneering studies have demonstrated the key roles for the innate and adaptive immune responses in regulating sterile neuroinflammation and CNS repair. Some promising immunotherapeutic strategies have been recently developed for the treatment of CNS injury. This review updates the recent progress on elucidating the roles of the innate and adaptive immune responses in the context of CNS injury, the development and characterization of potential immunotherapeutics, as well as outstanding questions in this field.
  • 摘要：Septic arthritis of acromioclavicular (AC) joint is a rare entity. It is generally seen in patients who are immunocompromised. Only 15 cases have been reported till now, with only one case series of 6 patients. We report a case of septic arthritis of AC joint in an immunocompetent child. A 9 years old girl presented with history of pain in left shoulder for 4 days associated with fever. No history suggestive of any immunocompromised state was complained. On local examination, a swelling of around 3 cm in diameter was found over left AC joint region with raised local temperature, tenderness on palpation and positive response in fluctuation test. Total leukocyte count was 18.7 × 109/L with 80％ of neutrophils. Erythrocyte sedimentation rate (ESR) was 28 mm/1 h. C-reactive protein (CRP) was 12 mg/L X-ray showed enlarged left AC joint space. Ultrasound revealed hypoechoic collection in the AC joint and the surrounding area. The aspirate was thick and purulent in nature, revealing Gram positive cocci at staining. Arthrotomy and thorough lavage of AC joint was done. Culture of the aspirate showed Methicillin Resistant Staphylococcus Aureus (MRSA) after 48 hours that was sensitive to amikacin, gentamicin, erythromycin and teicoplanin. Patient was symptom-free at 2 months of follow-up with no signs of osteomyelitis on the radiographs. Thus this is the first case of AC joint septic arthritis in healthy individual. Being proximal to the shoulder joint, AC joint septic arthritis can be confused with the shoulder joint septic arthritis. Thus, high index of suspicion is required for accurate diagnosis.
  • 摘要：Purpose:To evaluate the quality of life among survivors after sepsis in 2 years,comparing with critical patients without sepsis and the general people,analyze the changes and the predictors of quality of life among septic survivors.Methods:This prospective case-control study screened the intensive care unit (ICU) patients in Tianjin Third Central Hospital from January 2014 to October 2017,and the Chinese general population in the previous studies was also included.According to inclusion criteria and exclusion criteria,306 patients with sepsis were enrolled as the observation group,and another 306 patients without sepsis in ICU during the same period,whose ages,gender and Charlson Comorbidity Index matched with observation group,were enrolled as the control group.At 3 mo,12 mo,and 24 mo after discharge,the Mos 36-item Short Form Health Survey (SF-36),the Euroqol-5 dimension (EQ-5D),and the activities of daily living (ADL) were evaluated in face-to-face for the quality of life among survivors.Results:There were 210 (68.6％) septic patients and 236 (77.1％) non-septic critically ill patients surviving.At 3 months after discharge,the observation and control groups had the similar demographic characteristics (age:58.8 ± 18.1years vs.57.5 ± 17.6 years,p =0.542;male:52.0％ vs.51.4％,p =0.926).However,the observation group had higher acute physiology and chronic health evaluation Ⅱ (APACHEII) scores,higher sequential organ failure assessment (SOFA) scores,longer hospital stay,and longer ICU stay than the control group did (p ＜ 0.05).There were no significant differences in the eight dimensions of the SF36 scale,the EQ-5D health utility scores,and the activities of daily life scores between septic survivors and non-septic survivors (p ＞ 0.05).In addition,compared with the quality of life of the Chinese general population (aged 55-64 years),the quality of life of septic patients were significantly lower at 3 months after discharge (p ＜ 0.05).Comparing the quality of life of the ill patients who had been discharged at 3 mo and 24 mo,the general health improved statistically (p =0.000) and clinically (score improvement ＞ 5 points).Older age (OR,1.050;95％ CI,1.022-1.078,p =0.000),female (OR,3.375;95％ CI,1.434-7.941,p =0.005) and longer mechanical ventilation time (OR,3.412;95％ CI,1.413,8.244,p =0.006)were the risk factors for the quality of life of septic survivors.Conclusion:The long-term quality of life of septic survivors was similar to that of non-sepsis critically ill survivors.After discharge,the general health of sepsis improved overtime.Age,female and mechanical ventilation time (＞5 days) were the predictors of the quality of life after sepsis.
  • 摘要：This case report reveals the implementation of sensorimotor adaptation and learning process for rehabilitation in a patient with traumatic brain injury to achieve optimum recovery which is permanent in nature in compliance to the disability rating scale.A twenty two year old gentleman who had a history of fall was diagnosed as having subarachnoid hemorrhage along with diffuse axonal injury of the brain and bilateral lung contusion with pneumothorax.He underwent a total of ten months of sensorimotor adaptation and learning process for rehabilitation,which achieved functional mobility with a walker.
  • 摘要：Purpose:To investigate the effects of estrogen G protein-coupled receptor 30 (GPR30) agonist G1 on hippocampal neuronal apoptosis and microglial polarization in rat traumatic brain injury (TBI).Methods:Male SD rats were randomly divided into sham group,TBI + vehicle group,TBI + G1 group.Experimental moderate TBI was induced using Feeney's weigh-drop method.G1 (100μg/kg) or vehicle was intravenously injected from femoral vein at 30 min post-injury.Rats were sacrificed at 24 h after injury for detection of neuronal apoptosis and microglia polarization.Neuronal apoptosis was assayed by immunofluorescent staining of active caspase-3.M1 type microglia markers (iNOS and IL-1 β) and M2 type markers (Arg1 and IL-4) were examined by immunoblotting or ELISK Total protein level of Akt and phosphorylated Akt were assayed by immunoblotting.Results:G1 significantly reduced active caspase-3 positive neurons in hippocampus.Meanwhile G1 increased the ratio of Arg1/iNOS.IL-1β production was decreased but IL-4 was increased after G1 treatment.G1 treatment also increased the active form of Akt.Conclusions:GPR30 agonist G1 inhibited neuronal apoptosis and favored microglia polarization to M2 type.
  • 摘要：The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection.The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction.Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair.While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover.As the injuries become more complex this involves progressively more complex soft tissue reconstruction and may even requiring urgent free tissue transfer requiring close co-operative care between orthopaedic and plastic surgeons.Data suggests that the best results are obtained when the whole surgical reconstruction is completed within 48-72 h.
  • 摘要：Purpose:To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period.Five kinds of flaps were used.Each flap was presented with detailed information regarding indication,blood supply,skin territory and technique.Methods:Altogether 26 patients underwent lower leg reconstruction were included in this study.The reconstructive procedures applied five flaps,respectively distally based posterior tibial artery perforator flap (n =8),distally based peroneal artery perforator flap (n =4),distally based sural flap (n =6),medial planter artery flap (n =2) and cross leg flaps (n =6).Results:In all cases,there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps.Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient.The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily.One cross leg flap had distal necrosis.Conclusion:Would at lower third of leg can be efficiently covered by posterior tibial,peroneal artery and sural flaps.Heel can be best covered by nearby tissues such as medial planter flap.In presence of vascular compromise of the affected limb or exposure of dorsum of foot,cross leg flap can be used.
  • 摘要：Purpose:Microgravity is known to cause endothelium dysfunction in astronauts returning from spaceflight.We aimed to reveal the regulatory mechanism in alterations of human endothelial cells after simulated microgravity (SMG).Methods:We utilized the rotary cell culture system (RCCS-1) to explore the subsequent effects of SMG on human umbilical vein endothelial cells (HUVECs).Results:SMG-treated HUVECs appeared obvious growth inhibition after return to normal gravity,which might be attributed to a set of responses including alteration of cytoskeleton,decreased cell adhesion capacity and increased apoptosis.Expression levels of mTOR and its downstream Apaf-1 were increased during subsequent culturing after SMG.miR-22 was up-regulated and its target genes SRF and LAMC1 were down-regulated at mRNA levels.LAMC1 siRNAs reduced cell adhesion rate and inhibited stress fiber formation while SRF siRNAs caused apoptosis.Conclusion:SMG has the subsequent biological effects on HUVECs,resulting in growth inhibition through mTOR signaling and miR-22-mediated mechanism.
  • 摘要：Purpose:To investigate the early and mid-term results of open reduction and internal fixation (ORIF)with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type Ⅳ equivalent (SER Ⅳ E) ankle fractures (AO/OTA classification 44-B 3.1)and provide evidence for clinical practice.Methods:This study cohort consisted of 22 patients with SER Ⅳ E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014.There were 13 males and 9 females,mean age 38.9 years (range,17-73 years).Eight cases involved the left side and 14 the right side.The causes of fractures included road traffic accidents (11 cases),falling from height (6 cases) and sports injuries (5 cases).The mean period of hospitalization was 9.8 days (range,6-14 days).For all the patients,MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups.The external frame was kept for 8-10 weeks.The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400,the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058.Patients' main complaints about inconvenience of daily life were also recorded.Results:All the 22 patients were followed up for 24-63 months (mean,33.6 months).None of them developed nonunion during the follow-up;pin site infection was observed in one patient and posttraumatic osteoarthritis in another.At the final follow-up,the average AOFAS score,SF-36 score and VAS score were respectively 90.59 ± 5.096,79.59 ± 5.394 and 1.82 ± 1.181,which were significantly improved compared with the preoperative data (t =26.221,p ＜ 0.001;t =11.910,p ＜ 0.001;t =11.571,p ＜ 0,001).The therapeutic effect was excellent in 13 cases,good in 7 cases and fair in 2 cases,with a good-excellent rate of 90.9％.Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases).Conclusion:In the treatment of SER Ⅳ E ankle fractures,ORIF with TEF but no DLR can achieve satisfactory outcome,but long-term effect should be confirmed by large sample randomized controlled trials.
  • 摘要：Purpose:Wrist has a complex anatomy and undergoes complex injuries.Scaphoid fracture is one of such injuries.It is the most common fracture in carpal bone.Most of the scaphoid fractures are missed on initial X-rays.Magnetic resonance imaging (MRI) is considered as a gold standard for diagnosing scaphoid fractures.Ultrasonography (USG) is emerging as a good alternative to make an early diagnosis of scaphoid fractures.Our aim is to throw light upon the role of USG in detection of scaphoid fractures.Methods:The study was centered upon 114 patients in the age range 10-65 years,with traumatic wrist injury and were clinically suspected to have scaphoid fractures.Patient with non-traumatic history,bilateral wrist injury and late presentation were excluded.X-rays,USG using high frequency probe and MRI were done for all patients.MRI was considered to be the gold standard test.Patients were followed up at 6 weeks.Results:Of the 114 patients,X-ray could diagnose scaphoid fractures in 48 patients,30 of which were confirmed by MRI.USG results were positive in 74 patients,of which MRI was positive in 67 patients.The accuracy of scaphoid fracture detection with USG was 98.04％ in comparison to X-ray (20.58％),which was statistically significant.Conclusion:USG provides a more accurate and reliable method of making an early diagnosis of scaphoid fracture than X-rays.It is non-invasive,non-expensive and allows better visualisation of cortical disruption.
  • 摘要：Developmental dysplasia of the hip (DDH) is one of the most common congenital disorders in childhood.Its diverse pathological changes require different treatments and result in different outcomes.Although many studies have been conducted on DDH,some special pathology is still unrecognized.We here presented a rare case of a one-year and eleven-month old girl with DDH;a half-free intra-articular osteocartilaginous tissue was found in her right hip joint.X-ray,computer assisted tomography (CT) and magnetic resonance imaging (MRI) were performed to evaluate the pathological changes.MRI revealed some positive findings.The patient experienced open reduction and histopathological examination of the small tissue.Through gross anatomy it is a half-free intra-articular osteocartilaginous tissue,which can fully match a fossa observed at the femoral head.Histopathological examination found that the tissue was composed of collagenous fiber and cartilage-like tissue.Interestingly,we found the expression of type Ⅰ collagen according to immunohistochemical analysis,which indicated that the cartilage-like tissue was formed due to laceration of the articular cartilage.This kind of disorder should be included as one of the pathologies of DDH.The most possible origin of this tissue is the femoral head which we speculate may have been fractured before.
  • 摘要：The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker.Increasingly,both high energy injuries and atypical osteoporotic fragility failures have led to more complex,unusual and previously undescribed fracture patterns being recognized.We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation.We highlight the challenges confronted and present the management and the outcomes of his injury.A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level 1 major trauma centre emergency department.His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation.The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system.The patient received a spanning external flxator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode.A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively.At the 6 months follow up,the patient walks without aids and with no limp.Examination revealed a stable joint and full range of motion.Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable.High energy injuries can lead to more complicated fracture pattems,which challenge the orthopaedic surgeons in their management.It is crucial to understand the individual fracture pattern and the possible challenges that may occur.This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker Ⅳ type fracture.
  • 摘要：It is estimated that 15％ of traffic accidents cause trauma to large vessels.In about 70％-95％ of cases,aortic rupture took place in the distal ligament of the left subclavian artery,whereas in the remaining cases rupture occurred in the ascending aorta above the aortic valve.Trauma to the aortic sinus and coronary arteries is rarely found in traffic accident victims.Therefore,coronary artery trauma is often misdiagnosed as coronary atherosclerotic heart disease.The present case is a 42 years old male who survived from a traffic accident.He presented with aortic sinus and left coronary artery trauma.He was misdiagnosed as having coronary atherosclerotic heart disease,and therefore wrongly given antiplatelet medicine,such as aspirin,in another hospital.Definite diagnosis was achieved in our hospital,and the patient underwent Bentall and mitral valve replacement,as well as tricuspid valvuloplasty.The aortic occlusion time during surgery was 47 min,and the total cardiopulmonary bypass time was 63 min.After surgery,transthoracic echocardiography confirmed that all the artificial valves worked sufficiently,The patient felt good and symptoms such as asthma and decreased exercise tolerance disappeared,This case taught us that acute aortic syndrome cannot be ignored when patients present with pectoralgia;antiplatelet medication should not be given before definite diagnosis.
  • 摘要：Purpose:The administrative data from trauma centers could serve as potential sources of invaluable information while studying epidemiologic features of car accidents.In this cross-sectional analysis of Shahid Rajaee hospital administrative data,we aimed to evaluate patients injured in car accidents in terms of age,gender,injury severity,injured body regions and hospitalization outcome in the recent four years (2011-2014).Methods:The hospital registry was accessed at Shiraz Trauma Research Center (Shiraz,Iran) and the admission's unit data were merged with the information gathered upon discharge.A total number of 27,222 car accident patients aged over 15 years with International Classification of Diseases 10th revision (ICD-10) external causes of injury codes (V40.9-V49.9) were analyzed.Injury severity score and injured body regions were determined based on converting ICD-10 injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm.A binary logistic regression model was applied to the data to examine the contribution of all independent variables to in-hospital mortality.Results:Men accounted for 68.9％ of the injuries and the male to female ratio was 2.2:1.The age of the studied population was (34 ± 15) years,with more than 77.2％ of the population located in the 15-45 years old age group.Head and neck was the most commonly injured body region (39.0％) followed by extremities (27.2％).Injury severity score (ISS) was calculated for 13,152 (48.3％) patients,of whom,80.9％ had severity scores less than 9.There were 332 patients (1.2％) admitted to the intensive care units and 422 in-hospital fatalities (1.5％) were recorded during the study period.Age above 65 years [OR =7.4,95％ CI(5.0-10.9)],ISS above 16 [OR =9.1,95％ CI(5.5-14.9)],sustaining a thoracic injury [OR =7.4,95％ CI(4.6 -11.9)] and head injury [OR =4.9,95％ CI (3.1-7.6)] were the most important independent predictors of death following car accidents.Conclusion:Hospital administrative databases of this hospital could be used as reliable sources of information in providing epidemiologic reports of car accidents in terms of severity and outcomes.Improving the quality of recordings at hospital databases is an important initial step towards more comprehensive injury surveillance in Fars,Iran.
  • 摘要：Adrenal hemorrhage following blunt abdominal trauma is extremely rare.Most of the lesions are unilateral and right sided.Although often asymptomatic,life-threatening adrenal insufficiency may develop in the bilateral adrenal gland hemorrhage.Isolated adrenal injuries are very rare.They are often associated with other organ injuries.The mortality rates of patients range from 7％ to 32％.In this report,we present the computed tomography and magnetic resonance imaging findings of unilateral adrenal hemorrhages in two patients with a history of fall from a height.
  • 摘要：A variety of techniques and materials for the rehabilitation and reconstruction of traumatized maxillary ridges prior to dental implants placement have been described in literature.Autogenous bone grafting is considered ideal by many researchers and it still remains the most predictable and documented method.The aim of this report is to underline the effectiveness of using ailogeneic bone graft for managing maxillofacial trauma.A case of a 30-year-old male with severely atrophic maxillary ridge as a consequence of complex craniofacial injury is presented here.Augmentation procedure in two stages was performed using allogeneic and autogenous bone grafts in different areas of the osseous defect.Four months after grafting,during the implants placement surgery,samples of both sectors were withdrawn and submitted to histological evaluation.On the examination of the specimens,treated by hematoxylin and eosin staining,the morphology of integrated allogeneic bone grafts was revealed to be similar to the autologous bone.Our clinical experience shows how the allogeneic bone graft presented normal bone tissue architecture and is highly vascularized,and it can be used for reconstruction of severe trauma of the maxilla.
  • 摘要：Objective:To assess the early curative effect of epidural or intravenous administration of steroids during a percutaneous endoscopic lumbar discectomy (PELD).Methods:28 consecutive patients who underwent PELD due to large lumbar disc herniation between November 2014 and January 2016 were followed up for 6 months.These patients were divided into two groups according to the treatment they received after PELD.14 patients (Group A) were treated by PELD and epidural steroids,while the other 14 patients (Group B) were treated by PELD and intravenous steroids.We evaluated the effectiveness by the preoperative and postoperative visual analogue scale (VAS) scores for back and leg pain,and the postoperative Oswestry disability index (ODI) at 3 weeks after surgery via the clinical charts and telephone interview.Postoperative hospital stay and time return to work were investigated as well.Results:There is a significant decrease in VAS (back,leg),ODI,and time return to work (p ＜ 0.05).For VAS (back),Group A showed a significant decrease compared with Group B at 1 day and 1 week after surgery (p =0.011,p =0.017).As for VAS (leg),Group A showed a significant decrease compared with Group B at 1 day,1 week,3 weeks,and 3 months follow-up examinations (p =0.002,p =0.006,p ＜ 0.001,p ＜ 0.001).For ODI,Group A showed a notable decrease compared with Group B (p ＜ 0.001).The postoperative hospital stay in two groups was not statistically different (p =0.636).But the time return to work in Group A was significantly shorter than that in Group B (p =0.023).Conclusion:Patients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.
  • 摘要：Purpose:Fractures of the lateral end of the clavicle are relatively uncommon.These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment.At most times the deforming forces are not taken into consideration,and the fracture is not fixed securely.In this study,we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome.Methods:Totally,32 patients with lateral end clavicle fracture (Neer's Type Ⅱ) were included in the study.After the informed consent and preoperative investigations were obtained,open reduction and internal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia.Postoperative X-rays were done on day 1 and every 6 weeks after operation,until radiological union was achieved.The postoperative pain was assessed using Visual Analogue Scale (VAS) on postoperative days 1,2 and 10.Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization.Patients were asked to do their daily routine work and avoid lifting heavy weights.The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm,Shoulder and Hand (DASH) scoring.Results:There were no intraoperative complications in the procedure.The mean VAS score on postoperative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10.The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6.There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively.Conclusion:The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle,which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations.It may well be the answer to the fixation questions of the lateral clavicle fractures,although larger comparative studies between the surgical treatment methods are required to confirm the same.
  • 摘要：Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures.However,diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation.We present the case of a 21-years old female treated with excision after radial head fracture,resulting in elbow instability.The patient underwent revision surgery after four weeks.We believe that ligament reconstruction without radial head substitution is a safe alternative choice for Mason Ⅲ radial head fractures accompanied by complex ligament lesions.
  • 摘要：Purpose:New research is focusing on the use of autologous growth factors to increase the effect of bone fracture healing while decreasing the amount of healing time for the patient.Platelets have been demonstrated to be the natural storage vessel for several growth factors and cytokines that promote blood coagulation,tissue repair,and the process of bone mineralization.The present study aims to evaluate the role of platelet-rich plasma (PRP) in healing of acute femoral shaft fractures radiologically.We hypothesize that it provides artificial hematoma and releases various growth factors.Methods:This prospective randomized study was carried out in 72 patients of traumatic fracture of the femoral shaft operated with interlocking nails (closed or open).Patients were divided into two groups:study group A (n =33) treated with intramedullary nailing & PRP injection/gel application in the same setting;and control group B (n =39) treated with intramedullary nailing without PRP application.Both groups were further divided into two subgroups.Study group included subgroup A1 (n =14) operated with closed intramedullary nailing and PRP injection at the fracture site under radiological control,and subgroup A2 (n =19) operated with open intramedullary nailing and PRP gel along with fibrin membrane application at the fracture site;while control group included subgroup B1 (n =16) operated with closed intramedullary nailing,and subgroup B2 (n =23) operated with open intramedullary nailing.Radiological assessment of fracture healing was done by measuring the cortex to callus ratio every month till union at 6 months.Results:Measurements of mean cortex to callus ratio revealed significant difference between the groups A & B at third and fourth months.Measurements of mean cortex to callus ratio did not reveal significant difference between the subgroups at first and sixth months.A statistically significant difference was observed between subgroups A1 & B2 and B1 & B2 at the second month;between subgroups A1 & B2,A2 & B2 and B1 & B2 at the third month;and between subgroups A1 & B2 at fourth and fifth months.Conclusion:PRP has no effect on femoral shaft fracture healing treated with closed intramedullary nailing.However,PRP and matrix scaffold provided by fibrin membrane may provide an artificial hematoma effect in the initial phase of healing in open or failed closed intramedullary nailing.
  • 摘要：Purpose:Traumatic brain injury (TBI) is a leading cause of death and disability.Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate.Therefore,antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH.The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients.Methods:This single-blind randomized controlled trial was conducted on patients with traumatic ICH (with less than 30 ml) referring to the emergency department of Vali-Asr Hospital,Arak,Iran in 2014.Patients,based on the inclusion and exclusion criteria,were divided into intervention and control groups (40 patients each).All patients received a conservative treatment for ICH,as well as either intravenous TA or placebo.The extent of ICH growth as the primary outcome was measured by brain CT scan after 48 h.Results:Although brain CT scan showed a significant increase in hemorrhage volume in both groups after 48 h,it was significantly less in the TA group than in the control group (p-0.04).The mean total hemorrhage expansion was (1.7 ± 9.7) ml and (4.3 ± 12.9) ml in TA and placebo groups,respectively (p ＜ 0.001).Conclusion:It has been established that TA,as an effective hospital-based treatment for acute TBI,could reduce ICH growth.Larger studies are needed to compare the effectiveness of different doses.
  • 摘要：In recent years,recombinant human bone morphogenetic protein-2 (rhBMP-2) has been introduced as a therapeutic option in the treatment of several congenital and acquired craniofacial defects.Although there have been promising clinical results,the international literature still lacks complete guidelines,including limits and indications for the use of rhBMP-2.The possible indications for rhBMP-2 in patients undergoing facial trauma are discussed in this article.

    中华创伤杂志（英文版）的期刊信息

    • 曾用名：中华创伤杂志英文版;Chinese Journal of Traumatology
    • 创刊时间：1998
    • 地区：CN
    • 语言：中文
    • 热门主题：中华医学会
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      4

      Medicine:Orthopedics and Sports Medicine;Surgery;

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