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.
Fifteen rabbits were given a second degree scald on the back, then a large amount of fluid were given rapidly. In this way an acute diluted hyponatremia and a brain edema model were produced. In one group, the magnetotherapy was instituted immediately following the acut injury, while in the other group, it was started after the brain edema being developed. After giving a large quantity of fluid, the Na~+, CI~-, and K~+ concentrations in the blood were decreased and the quantity of water in the brain tissue was increased evidentely. The phenomena of neuron edema and widening of the perivascular space were also found. It was proved that the model of experimental brain edema could be produced on animals and the treatment and the prevention for brain edema could be obtained to advantage to certaiin degree. Also,it was better to use the magnetotherapy in brain edema as early as possidle.
Objective To investigate the short-term effectiveness of Swanson artificial joint replacement in treating post-traumatic metacarpophalangeal joint stiffness. Methods Between August 2007 and May 2010, 11 cases (13 fingers) of metacarpophalangeal joint stiffness with soft tissue defects underwent Swanson artificial joint replacement. There were 7 males (9 fingers) and 4 females (4 fingers), aged 43 to 65 years with an average of 49 years. The involved fingers included 4 thumbs, 4 index fingers, 3 middle fingers, and 2 ring fingers. The types of injury included open and crush injury in 8 fingers, fracture of the metacarpophalangeal joint in 3 fingers, metacarpophalangeal joint severing in 2 fingers. The time from joint stiffness to hospitalization was 12 to 48 weeks (mean, 24 weeks). The joint activity was (136.82 ± 28.96)°. According to total active motion (TAM) assessment, included good in 1 finger, fair in 6 fingers, and poor in 6 fingers before operation. The activities of daily living were assessed by Sollerman score, which was 45.64 ± 11.04. The X-ray films and CT scan showed traumatic arthritis of the metacarpophalangeal joint. Results The incision healed by first intention. All patients were followed up 12 to 34 months (mean, 24.1 months). At last follow-up, the joint activity was (194.64 ± 28.86)°, showing significant difference when compared with preoperative value (t=25.214, P=0.000). According to TAM assessment, including excellent in 1 finger, good in 4 fingers, fair in 7 fingers, and poor in 1 finger. The Sollerman score was 67.45 ± 8.20 postoperatively, showing significant difference when compared with the preoperative score (t=10.470, P=0.000). X-ray examination showed no prosthesis fracture, periprosthetic fracture, or joint dislocation occurred at last follow-up. Conclusion Swanson artificial joint replacement can be appl ied to treat posttraumatic metacarpophalangeal joint stiffness, which can improve the joint activity and has satisfactory short-term effectiveness.
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 evaluate the effects of in situ subtalar arthrodesis with bone graft for subtalar traumatic arthritis, and to analyse the plantar pressure distribution so as to provide the evidence for effectiveness evaluation. Methods Between March 2004 and December 2008, 26 patients with unilateral subtalar arthrodesis undergoing bone graft fusion wereenrolled (test group). After operation, the imageology diversity and the effect of subtalar arthrodesis on adjacent joint wereobserved. American Orthopaedic Foot and Ankel Society (AOFAS) ankle and hindfoot score and radiographs were used to assess the foot function before and after operation. Twenty-six normal subjects served as controls. Footscan system was used to test the distribution of maximum plantar pressure and the change of gravity center curve. No significant difference was found in gender, age, height, and weight between 2 groups (P gt; 0.05). Results All patients were followed up 18.2 months on average (range, 14-71 months). The mean subtalar arthrodesis time was 5.6 months (range, 4 months and 15 days to 11 months). The mean AOFAS ankle and hindfoot score improved from 35.18 ± 8.16 preoperatively to 76.36 ± 6.90 postoperatively (t=13.910, P=0.000). Nine (34.6%) patients had satisfactory functional effects, and 13 (50.0%) patients basically satisfactory. The talocalcaneal height, talocalcaneal angle, talar decl ination angle, and calcaneus patch angle were 87.04% ± 6.17%, 76.73% ± 5.13%, 65.86% ± 7.01%, and 70.19% ± 8.33% of the contralateral side, respectively. Osteoarthritis of the adjacent joints occurred in 7 cases. The maximum plantar pressure increased in the third to fifth metatarsal bones and decreased in the first to second metatarsal bones, showing significant differences when compared with normal controls (P lt; 0.05). No significant difference was found in the plantar pressure between arthrodesis foot and contralateral foot of the test group (P gt; 0.05). The plantar pressure was well distributed in patient who was satisfied with the effect, but it was still different from normal controls. In patients who had high plantar pressure n middle foot, mild heel inversion occurred. The gravity center curve of the contralateral foot in the test group was almost the same as that of normal controls; curve medially shifted when forefoot touched down. The curve irregularly and laterally shifted in the subtalar arthrodesis foot; the curve did not medially shift when forefoot touched down. Conclusion In situ subtalar arthrodesis with bone graft has good cl inical results for subtalar traumatic arthritis. Gait analysis can be appl ied to assess the therapeutic effectiveness, and contribute to make a surgical plan. For the adaptive alteration of contralateral side after subtalar arthrodesis, a cohort of normal subjects should be used for comparison in gait analysis.
In recent years, although the mortality rate caused by traumatic brain injury has declined, the disability rate has remained high, which has a serious impact on patients and their families. Therefore, solving the complications and sequelae caused by traumatic brain injury is the focus and difficulty of current clinical research. Integration of traditional and western medicine rehabilitation is an effective method for the treatment of the central nervous system at home and abroad, and it also fully reflects its therapeutic advantages in the application of traumatic brain injury. Based on this, this paper will mainly introduce the clinical characteristics of patients with traumatic brain injury, and systematically expound the commonly used clinical rehabilitation treatment methods of integration of traditional and western medicine, aiming to provide a certain guidance for the rehabilitation treatment of traumatic brain injury.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.
Taking Wistar rats and pigs as models, the basic fibroblast growth factor (bFGF) was studied on wound healing. Five rats and five pigs were used in the experiment. Each rat had 2 roundshapedwound (1.8cm in diameter) and each pig had 4 wounds of the same size as that ofthe rat. One wound of each rat and 2 wound of each pig were dressed with bFGF saline (60U/cm2). While the other wounds of the rats and pigs were dressed with normal saline as control. The wounds treated with bFGF were completely covered with granulation tissue on the 7th day after injury, and in 14 days the wounds were almost completely covered by epithelium. The bFGF would enhance the growth of theepithelial cells, reepithelization of the wound and the tensile strength of thetissue. It was concluded that the bFGF could promote skin regeneration, whichmight be the direct action of bFGF on the bFGF receptors in the basic cells of skin.
Objective?To investigate the surgical method and effectiveness of repairing traumatic metacarpophalangeal joint defect by the composite tissue flap autograft of the second metatarsophalangeal joint.?Methods?Between June 2005 and December 2009, 6 cases (6 fingers) of traumatic metacarpophalangeal joint defect were treated with the composite tissue flap autograft of second metatarsophalangeal joint (containing extensor tendon, flexor tendon, proper digital nerve, planta or dorsal flap). All patients were males, aged 18-48 years, including 3 cases of mechanical injury, 2 cases of crush injury, and 1 case of penetrating trauma. The 2nd, 3rd, and 4th metacarpophalangeal joints were involved in defects in 2 cases, repectively, and defects ranged from 1.5 cm × 1.5 cm to 3.0 cm × 2.5 cm in size. All patients had skin and soft tissue defects, and defects ranged from 4 cm × 2 cm to 5 cm × 4 cm in size; and 5 cases complicated by extensor tendon defect (2.5-5.0 cm in length), 3 cases by flexor tendon rupture, and 3 cases by common palmar digital nerve injury. The time from injury to admission was 2-6 hours.?Results?The composite tissue flaps and skin grafts survived in all cases. All incisions healed by first intention. All patients were followed up 1-5 years. The X-ray films showed good healing between the transplanted metatarsophalangeal joint and metacarpals and phalanges at 9-14 weeks postoperatively. The appearance, colour, and texture of the skin flap were satisfactory, and the senses of pain and touch were recovered. The palmar flexion range of transplanted metacarpophalangeal joints was 50-70°, and the dorsal extension range was 5-10° at last follow-up. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 4 cases, good in 1 case, and fair in 1 case, and the excellent and good rate of 83.3%. No dysfunction of the donor foot was observed.?Conclusion?The metatarsophalangeal joint composite tissue flap can provide bone, nerve, skin, muscles, and tendons, so it is an effective approach to repair the metacarpophalangeal joint defect and to recover the function of the injured joints in one operation.
A model of infection following trarma was established by introducing B.staphyloecus aureus into the wound.In the exporimental anlmals,the intraoporative high regional concentration of antibiotics was adopted to prevent infection of the distal part of the limb of the rabbits,and those trcated with the conventional method were served as the control.The results showed that in the exporimental animals,not a single limb had developed infection,while in the control group,The tissue culture s...