Objective To investigate the method and the effectiveness of open pelvic fractures associated with perineal injury. Methods Between August 2000 and July 2010, 16 cases of open pelvic fractures associated with perineal injury weretreated. There were 12 males and 4 females with an average age of 41 years (range, 17-69 years). Injury was caused by traffic accidents in 9 cases, by falling from height in 6 cases, and by crushing in 1 case. The mean time between injury and admission was 8 minutes (range, 5-20 minutes). According to Tile classification, 2 cases were rated as type A, 6 as type B, and 8 as type C. The wound size ranged from 5 cm × 3 cm to 15 cm × 12 cm. The perineal injured location included intraperitoneal rectal injury in 2 cases and extraperitoneal anorectal injury in 14 cases. The average injury severity score (ISS) was 29 (range, 25-48). The main treatments included emergency resuscitation, colostomy, external fixation of fractures, repeated debridement with pulsatile irrigation followed by intravenous antibiotics, and vacuum seal ing drainage (VSD). Results In 5 deaths, 3 cases died of hemorrhagic shock and 2 cases died of multi ple system organ failure within 4 days of admission. The other 11 cases were followed up 6-46 months (mean, 14 months). The X-ray films showed that bone union was achieved after 2-4 months of operation. Infection in varying degree occurred at perineal wounds; second stage healing of wounds was achieved in 10 cases after debridement and VSD treatment, and wound healed in 1 case after gracil is muscle flap repair. No anal incontinence occurred in the patients having anorectal injury during follow-up. Conclusion For patients with perineal injury and open pelvic fractures, the following treatments should be carried out so as to obtain good effectiveness: early anti-shock, protection of important organ function, treatment of complications, late resistance to infection and stabil ity restoration of the pelvic ring, functional repair and reconstruction of rectum and anal canal and urinary tract.
Objective To retrospectively analyze and classify 23 open fractures that resulted in severe infection, in order to provide evidence that can be used in future disaster scenarios. Methods Based on medical records of 23 cases of open fracture and subsequent bacterial infection, we analyzed the clinical diagnosis, treatment, laboratory tests, bacterial smear of wound secretion, and the bacterial culture of the wound secretion. We then analyzed which antimicrobial agents were used and how they were applied, and the subsequent effect on controlling the serious infection.? Results All cases were related to seismic injury and belonged to class VI open fracture. Eight cases were male and 15 were female. All cases had similar symptoms such as chills, fever, large scale muscle necrosis, and severe infection. A direct smear of the wound showed that the number of cases with one bacterial infection was 6 (26.09%), the number that had double bacterial infections was 12 (52.18%), and the number with multiple bacterial infections was 5 (21.74%).There were 18 strains of 11 types of bacteria recovered from wound samples. Conclusion Early treatment with the joint application of multiple antibacterial agents, early debridement, and adequate drainage all helped to control the infection and avoid nosocomial infection. Employing these strategies in the future will control infection in disaster situations.
Objective To compare the clinical effect of reamed and nonreamed intramedullary interlocking nails on treating open tibial fractures. Methods From February 2002 to February 2004, 92 cases of open tibial fractures (86 patients) were treated with intramedullary interlocking nails. Of the 86 patients, 65 were male and 21 were female. Their age ranged from 18 to 68 years (36.5 on average). Of the 92 cases, 54 were in the reamed group and 38 in the nonreamed group. Patients moved with the support of crutch after their wounds were healed. Results All patients were followed up regularly for 6 to 24months. Infection rate in the reamed group and nonreamed group was 20.3% and 5.3% respectively, and there was significant difference between them (Ｐlt;0.05). The averagehealing time of the fractures was 22.5 weeks in reamed group and 19 weeks in nonreamed group, and there was no significant difference between them (Ｐ＞0.05). Delayed unions occurred in 8 cases and 3 cases in reamed group and nonreamed group respectively. Conclusion Compared with reamed group, nonreamed intramedullary interlocking nails have lowerinfection rate and fewer delayed unions and ununions.
Objective To explore the prediction of postoperative coronal lower limb alignment by the tibia fibular angle (TFA) and femoral fibular angle (FFA) after osteotomy in medial open-wedge high tibial osteotomy (MOWHTO). Methods A clinical data of 20 patients with medial compartment osteoarthritis, who were treated with MOWHTO between September 2019 and September 2020, was retrospectively analyzed. Among them, there were 9 males and 11 females; the age ranged from 46 to 69 years, with an average of 56.0 years. The body mass index (BMI) was 21.3- 35.7 kg/m2, with an average of 26.7 kg/m2. Osteoarthritis involved 11 cases of left knee and 9 cases of right knee; the disease duration was 2-6 years, with an average of 3.8 years. According to the Kellgren-Lawrence classification, there were 7 cases of grade Ⅰ, 9 cases of grade Ⅱ, and 4 cases of grade Ⅲ. The angle and height for open-wedge was planned preoperatively by osteotomy master software, and the TFA and FFA were measured by software after simulated osteotomy. The intraoperative angle for open-wedge was adjusted according to TFA and FFA after simulated osteotomy.The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, TFA, and FFA were measured before operation and at 2 days after operation. The difference (X) between the intraoperative measurement value and the preoperative plan value of TFA/FFA, and the difference (Y) between the postoperative WBL ratio and the target alignment (62.5%) were calculated, and the correlation between the two indicators was analyzed by Pearson’s test. According to the median BMI of patients (25.81 kg/m2), the patients were allocated into high BMI group (>25.81 kg/m2, n=10) and low BMI group (≤25.81 kg/m2, n=10), and the influencing factors of WBL ratio was analyzed by linear regression. Results There was no significant difference between pre- and post-operation in LDFA and JLCA (P>0.05); while there were significant differences between pre- and post-operation in MPTA, mFTA, and WBL ratio (P<0.05). The TFA was (89.5±4.0)° during operation and (87.7±4.7)° after operation, showing significant difference (t=2.991, P=0.008). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of TFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.595, P=0.006). The FFA was (86.9±4.3)° during operation and (85.7±4.4)° after operation, showing significant difference (t=1.760, P=0.094). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of FFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.536, P=0.015). After BMI stratification, X was an influential factor of Y in the low BMI group (P<0.05), but X was not an influential factor of Y in the high BMI group (P>0.05). Conclusion Intraoperative FFA and TFA can predict coronal limb alignment after MOWHTO. FFA and TFA can predict more preciselyfor patients with BMI≤25.81 kg/m2.
Objective To explore the relationship between external branch of superior laryngeal nerve (EBSLN) injury and the approachs of surgery in open thyroidectomy, and to summarize the preventive methods. Methods The clinical data of 985 patients who had consecutively underwent open thyroidectomy from January 2009 to June 2012 were retrospectively analyzed, to explore the relationship between EBSLN injury and the approachs of surgery in open thyroidectomy. Results The overall incidence of EBSLN injury was 2.6% (26/985), and 959 patients (97.4%) didn’t suffered from EBSLN injury. Results of logistic regression showed that the extent of surgery (OR=4.536, P=0.004) and identification of the EBSLN (OR=0.126, P=0.044) were influence factors of EBSLN injury after open thyroidectomy, but age (OR=1.108, P=0.823), gender (OR=0.604, P=0.260), benign or malignant tumor (OR=1.871, P=0.186), anesthesia methods (OR=0.659, P=0.372), and the application of ultrasonic scalpel (OR=0.473, P=0.248) were not associated with EBSLN injury. Conclusion In open thyroidectomy, the extent of surgery and identification of EBSLN are the independent factors of EBSLN injury, which are important to avoid EBSLN injury.
This paper is aimed to assess the effects of red blood cell (RBC) transfusion on clinical outcomes in cardiac surgery. Trials were identified by computer searches of the Pubmed,MEDLINE,Cochrane Library (Issue10,2012),from January 1980 to October 2012. References in identified trials and review articles were checked and experts contacted to identify any additional trials. The homogeneous randomized controlled trials (RCTs) were analyzed with RevMan 5.1 software. Five trials involving a total of 1,203 patients were identified. The results of meta-analyses showed that restrictive transfusion strategies reduced the risk of receiving a RBC transfusion (MD=-1.46,95% CI -1.18--1.1) and the volume of RBCs transfusion (RR=0.69,95% CI 0.53-0.89). No significant difference was noted between the two strategies in terms of mortality,adverse events and hospital or intensive care length of stay. Based on the results mentioned above, one can draw a conclusion that restrictive transfusion strategies reduced the risk of receiving RBC transfusion and the volume of RBCs transfused. Restrictive transfusion strategies did not appear to impact on the rate of adverse events and hospital or intensive care length of stay, compared to liberal transfusion strategies.