Objective To evaluate the clinical importance of doublecontrast CTdiagnosis of traumatic anterior shoulder instability. Methods Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. The patients wereexamined by SOMATOM CR Systematic CT. The results of double contrast CT of the 48 patients were divided into Ⅰ, Ⅱ and Ⅲ degree according to the CT results related to their injury history, clinical symptoms, signs and operation findings. Results The patients had no complaint after the CT examination exceptfor 3 patients, who had slight pain within 2 days after CT examination. The results of double contrast CT were as follow:Ⅰ degree: 9 patients, Ⅱ degree: 22 patients, and Ⅲ degree: 17 patients. All patients with Ⅰ degree injuries were treated with rehabilitation program. The patients with Ⅱ degree injuries were mainly treated withrehabilitation program, but took much longer time. The patients with Ⅲ degreeinjuries were suggested to be treated with surgery. Conclusion To divide the results of double contrast CT into Ⅰ，Ⅱ and Ⅲ degree not only reflects the severity of traumatic anterior shoulder instability but provides information for the treatment of the instability.
In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.
ObjectiveTo investigate the prognostic value of serum procalcitonin (PCT) level and its change for patients with severe trauma and sepsis. MethodsEighty-two patients with severe trauma and sepsis treated between June 2013 and June 2014 were chosen to be our study subjects. According to the clinical outcome at day 28, they were divided into survival group (n=54) and death group (n=28). Serum procalcitonin levels at hour 0, 24, 48, 72, 96, and 120 after admitted to the emergency intensive care unit were detected in all the patients. Then we calculated the rate of procalcitonin change in each time points, injury severity score (ISS) score, acute physiology and chronic health evaluation (APACHE)Ⅱ score and white blood cells (WBC) count. ResultsProcalciton level at hour 24, 48, 72, 96 and 120 of the survival group was significantly lower than the death group (P<0.05); the rate of procalcitonin change at hour 24, 48, 72, 96 and 120 was significantly lower than the death group (P<0.05), and the APACHE Ⅱ score was significantly lower than the death group (P<0.01). There was no significant difference in the ISS score and WBC count between the two groups (P>0.05). ConclusionEarly procalcitonin level and its dynamic change are good indicators in judging the prognosis of patients with severe trauma and sepsis, especially the early dynamic change in the rate of procalcitonin.
ObjectiveTo explore whether positive end-expiratiory pressure (PEEP) guided by the esophageal balloon manometry is better than the ARDS Network standard of care recommendations during treating traumatic acute respiratory distress syndrome (ARDS) patients with mechanical ventilation. MethodsTwelve traumatic ARDS patients selected from September 2013 to March 2015 in ICU of Xiamen No. 3 Hospital were administrated esophageal balloor catheter and underwent mechanical ventilation with PEEP adjusted according to measurements of esophageal pressure and the ARDS Network standard of care recommendations simultaneously. According to the selection method of PEEP, the patients were divided into two groups:the esophageal pressure guided group and the ARDS Network recommendations guided group (the control group). The changes of peak inspiratory pressure, esophageal pressure, transpulmonary end-expiratory pressure, transpulmonary end-inpiratory pressure, lung compliance at 0 h, 24 h, 48 h, 72 h following different PEEP treatments were observed and compared between two groups of patients. ResultsA mean PEEP in the esophageal pressure guided group of (10.98±4.36)cm H2O was significantly higher than the control group of (7.13±2.21)cm H2O (P<0.01). The transpulmonary end-expiratory pressure was significantly higher in the esophageal pressure guided group (0.71±0.62)cm H2O than the control group (-2.29±3.49) cm H2O. And all of the mean transpulmonary end-expiratory pressure remained above zero in the esophageal pressure guided group, whereas in the control group 73% patients remained negative (P<0.01). ConclusionsEsophageal pressure method adjusts PEEP for traumatic ARDS patients with mechanical ventilation through estimating pleural pressure so as to calculate transpulmonary pressure. It can identify traumatic ARDS patients who would benefit from the high PEEP, adjust PEEP individually and meet patients' need more satisfactorily.
Objective To review the current status and advances of the correlation between traumatic brain injury (TBI) and fracture healing. Methods The related domestic and abroad literature about the correlation between TBI and fracture healing was extensively reviewed and analyzed. Results There are a variety of studies on the correlation between TBI and fracture healing, which can be divided into two major aspects: revascularization and osteogenesis; the local and systemic changes of the neuropeptide and hormone after TBI. Conclusion TBI facilitates callus formation, the further research is needed to clarify the exact mechanism.
Form April 1991 to August 1994, ten cases of extensive soft tissue injury of the extremities with bone and tendons exposed were treated by emergency transfer of latissimus dorsi myocutaneous flaps. The types of the myocutaneous flap were as follows: with vascular pedicle in 1 case, free latissimus dorsi myocutaneous flap in 8 cases,and transfer of combined bilateral latissimus dorsi myocutaneous flaps in 1 case. There were 8 males and 2 females with the ages ranging from 7 to 44 years (an average of 24.4 years). The operations were all performed within 6 hours after trauma except in 1 case, due to its delayed arrival to our hospital, the operation was carried out 14 days after trauma. The results were as follows: total survival of the flap in 6 cases, necrosis of the distal portion of the skin of the flap in 3 cases and necrosis of a greater portion of the skin in one case who had been subjected the transfer of combined bilateral latissimus dorsi myocutaneous flap. but the deep muscle layerwas intact. However, the result was encouraging. The operative technique and the advantages of emergency coverage of the wound were discussed.
Objective To investigate the causes of death and evaluation of injury severity in patients with thoracic trauma so as to enhance the diagnosis and treatment of thoracic trauma. Methods A retrospective study was carried out in 687 patients with thoracic trauma, which were divided into different groups according to their condition of injury (chest injury group and multiple injuries group) and outcome (survival group and death group) and penetrating into pleural cavity (penetrating injury group and blunt trauma group), then trauma scores(revised trauma score,abbreviated injury scale,injury severity score,probability of survival)were compared respectively. In addition, the highrisk causes of trauma death were analyzed. Results Among 687 cases, there are 488 cases with blunt trauma and 199 cases with penetrating injury. The causes of trauma death in blunt trauma group were brain injury (10 cases) and acute respiratory failure (6 cases) and multiple organ dysfunction syndrome (4 cases) and hypovolemic shock (1 case). The causes of trauma death in penetrating trauma group were hypovolemic shock (9 cases). There were statistically difference of trauma score in the death group and the survival group（GCS：t=4.648,P=0.000; RTS:t=4.382,P=0.000;thoracic AIS：t=2.296,P=0.027;ISS：t=4.871，P=0.000; Ps：t=4.254,P=0.000）. There was no statistically difference of thoracic AIS in the chest injury group and the multiple injuries group (t=0.723, P=34.567), and there were statistical significances in RTS（t=2.553,P=0.032）, ISS（t=10.776,P=0.000）, Ps（t=3.868,P=0.007）. There were statistically difference of RTS（t=3.161,P=0.007）and ISS （t=4.118,P=0.005） in the blunt trauma survival group and penetrating injury survival group, and there was no statistical significance in Ps（t=0.857,P=97.453）. The blunt trauma death group had statistical difference compared with penetrating injury death group in trauma score（GCS：t=4.016,P=0.001，RTS:t=3.168,P=0.006;thoracic AIS：t=2.303, P=0.043;ISS：t=4.218,P=0.002;Ps：t=4.624,P=0.001）. The mortality of trauma was gradually increased with the trauma scores. The mortality was 10.7% when whole ISS was 20.25. The mortality in penetrating injury group was higher than that in blunt trauma group with the same ISS between two groups. Conclusion Applying trauma score is conducive to the judgement of trauma severity and optimizing clinical treatment. The death causes in blunt trauma group were more complex than in penetrating injury group. Severe trauma and multiple injuries are the main death causes of thoracic trauma.
ObjectiveTo explore the diagnostic and therapeutic value of laparoscopy in acute abdomen. MethodsRelated literatures were collected to analyze the advantages, the scope of application, and the effect on the body of laparo-scopy, and to clearly defined the indications of laparoscopy in acute abdomen and related taboos. ResultsMost people could be tolerated for CO2 pneumoperitoneum. Laparoscopic surgery had a certain advantages compared with open surgery in the diagnosis and treatment. It was widely used in the diagnosis and treatment of acute abdomen. ConclusionLaparo-scopic surgery is recommended for acute appendicitis, acute cholecystitis, peptic ulcer perforation, and so on, but it is still controversial in intestinal obstruction, intestinal diverticulum perforation, and the application of abdominal trauma, which need more randomized controlled studies comparing with open operation.
Objective To investigate the methods of establishing 3-dimensional skull model using electron beam CT(EBCT) data rapid prototyping technique, andto discuss its application in repairing crainomaxillofacial trauma. Methods The data were obtained by EBCTcontinuous volumetric scanning with 1.0 mm slice at thickness. The data were transferred to workstation for 3-dimensional surface reconstruction by computeraided design software and the images were saved as STL file. The data can be usedto control a laser rapid-prototyping device(AFS-320QZ) to construct geometricmodel. The material for the model construction is a kind of laser-sensitive resinpower, which will become a mass when scanned by laser beam .The design and simulation of operation can be done on the model. The image data were transferred to the device slice by slice. Thus a geometric model is constructed according to the image data by repeating this process. Preoperative analysis, surgery simulation and implant of bone defect could be done on this computer-aided manufacture d3D model. One case of craniomaxillofacial bone defect resulting from trauma wasreconstructed with this method. The EBCT scanning showed that the defect area was 4 cm×6 cm. The nose was flat and deviated to left. Results The -3dimensional -skull was reconstructed with EBCT data and rapid prototyping technique. The model can display the structure of 3-dimenstional anatomyand their relationship.The prefabricated implant by 3-dimensional model was well-matched with defect .The deformities of flat and deviated nose were corrected. The clinical result wassatisfactory after a follow-up of 17 months. Conclusion The 3-dimensional model of skull can replicate the prototype of disease and play an important role in the diagnosis and simulation of operation for repairing craniomaxillofacial trauma.