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1.
Chin J Traumatol ; 26(1): 33-40, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35868949

RESUMO

Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.


Assuntos
Traumatismo Múltiplo , Traumatismos da Coluna Vertebral , Espondilolistese , Feminino , Humanos , Pessoa de Meia-Idade , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Espondilolistese/complicações , Espondilolistese/cirurgia , Traumatismo Múltiplo/complicações
2.
Chin J Traumatol ; 24(3): 136-139, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33745761

RESUMO

PURPOSE: Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury. CT has been applied for several decades to evaluate blunt pelvic trauma patients. However, it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury (HVI), especially in the early stage after injury. The delayed diagnosis of HVI could result in a high morbidity and mortality. The bowel injury prediction score (BIPS) applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary. We recently found another clinical variable (iliac ecchymosis, IE) which appeared at the early stage of injury, could be predicted for HVI. The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI, and thus reduce complications and mortalities. METHODS: We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital. The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention. The exclusion criteria were abdominal CT insufficiency before operation, abdominal surgery before CT scan, and CT mesenteric injury grade being 5. The MBIPS was defined as BIPS plus IE, which was calculated according to 4 variables: white blood cell counts of 17.0 or greater, abdominal tenderness, CT scan grade for mesenteric injury of 4 or higher, and the location of IE. Each clinical variable counted 1 score, totally 4 scores. The location and severity of IE was also noted. RESULTS: In total, 635 cases were hospitalized and 62 patients were enrolled in this study. Of these included patients, 77.4% (40 males and 8 females) were operated by exploratory laparotomy and 22.6% (8 males and 6 females) were treated conservatively. In the 48 patients underwent surgical intervention, 46 were confirmed with HVI (45 with IE and 1 without IE). In 46 patients confirmed without HVI, only 3 patients had IE and the rest had no IE. The sensitivity and specificity of IE in predicting HVI was calculated as 97.8% (45/46) and 81.3% (13/16), respectively. The median MBIPS score for surgery group was 2, while 0 for the conservative treatment group. The incidence of HVI in patients with MBIPS score ≥ 2 was significantly higher than that in patients with MBIPS score less than ≤ 2 (OR = 17.3, p < 0.001). CONCLUSION: IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity, which is a valuable sign for HVI in blunt pelvic trauma patients. MBIPS can be used to predict HVI in blunt pelvic trauma patients. When the MBIPS score is ≥ 2, HVI is strongly suggested.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Traumatismos Abdominais/diagnóstico por imagem , Equimose/etiologia , Feminino , Humanos , Masculino , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Ferimentos não Penetrantes/diagnóstico por imagem
3.
Chin J Traumatol ; 22(1): 1-11, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30850324

RESUMO

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.


Assuntos
Abdome/cirurgia , Drenagem/métodos , Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Sociedades Médicas/organização & administração , Infecção da Ferida Cirúrgica/prevenção & controle , Traumatologia/organização & administração , Vácuo , China , Humanos
4.
Patient Saf Surg ; 17(1): 28, 2023 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-37968701

RESUMO

BACKGROUND: The percutaneous iliosacral screw technique represents a global standard fixation method for unstable fractures of the posterior pelvic ring. However, the inaccurate positioning of iliosacral screws is associated with a significant risk of severe intra-operative complications. Therefore, this study aimed to investigate the relationship between the skin entry point of the transverse iliosacral screw of the first sacral vertebral body and the anterior superior iliac spine and the greater trochanter of the femur using computed-tomography-guided validation. METHODS: Overall, 91 consecutive patients admitted to a tertiary referral center in China for posterior pelvic ring fixation via the "triangulation method" using computed-tomography-guided validation between January 1, 2020, and December 31, 2020, were included in this retrospective observational cohort study. Modeling and simulated iliosacral screw placement were performed using the Mimics software. The distance between the three points of interest was measured, and their relationship in a rectangular coordinate system was determined. Patients were categorized according to gender, body mass index, and femoral rotation angle to investigate the factors affecting the positional relationship between the three points. RESULTS: An equilateral triangular relationship was observed between the positioning points of the transverse iliosacral screw, anterior iliac spine, and greater trochanter. Additionally, 95% of the entry points were within a circle radius centered 12 mm at the apex of an equilateral triangle comprising the anterior superior iliac spine and the greater trochanter as the base. The entry point in the femoral external rotation was more dorsal than that in the internal femoral rotation. Furthermore, the entry point in females was more rostral than that in males, and the entry point in overweight patients was more dorsal than that in normal-weight patients. CONCLUSIONS: The skin entry point of the percutaneous iliosacral screw can be located by drawing an equilateral triangle from the anterior superior iliac spine and the greater trochanter as the base to the dorsum end of the patient's head. In summary, this retrospective cohort study validated the safety and efficacy of the "triangulation methods" for percutaneous fixation of unstable posterior pelvic ring injuries.

5.
Zhonghua Wai Ke Za Zhi ; 47(24): 1892-5, 2009 Dec 15.
Artigo em Zh | MEDLINE | ID: mdl-20193410

RESUMO

OBJECTIVE: To study the characteristic and surgical treatment of traumatic lumbo-sacro-pelvic injuries. METHODS: A retrospective study was carried out on 8 cases with traumatic lumbo-sacro-pelvic injuries between August 2005 and February 2008, which included 6 male and 2 female, aged from 21 to 52 years with a mean age of 38.4 years. ISS scores were undertaken to evaluate the injury severity of the cases after admission. Measures were taken to treat the emergency that affected the patients' lives. After the patients' conditions were stable, lumbo-iliac fixation was performed to treat traumatic lumbo-sacro-pelvic injuries. Imaging examinations were made to observe the reduction of fracture after operation. Injury of nerve was evaluated with ASIA score, and ASIA scores of preoperation and the last follow-up were analyzed statistically with paired t test. RESULTS: The group was followed up for 9 to 25 months, averaging 16.9 months. Postoperative imaging examinations showed satisfied reduction of fracture. The preoperative ASIA sensory score and motor score were 35.8+/-5.3 and 31.9+/-6.4 respectively, while the sensory score and motor score were 51.8+/-13.8 and 38.2+/-7.5 at the last follow-up respectively. The sensory and motor functions were improved significantly after operation (P<0.01). The functions of urination and defecation of 6 cases were recovered for different degree after operation. In all of the cases, no aggravated injury of nerve occurred. CONCLUSIONS: Traumatic lumbo-sacro-pelvic injuries is a kind of severe injury of lumbo-sacro-pelvic region. It can be treated with lumbo-iliac internal fixation and fine clinical effect can be gained.


Assuntos
Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Região Lombossacral/lesões , Ossos Pélvicos/lesões , Adulto , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/cirurgia , Adulto Jovem
6.
Zhonghua Wai Ke Za Zhi ; 46(11): 801-5, 2008 Jun 01.
Artigo em Zh | MEDLINE | ID: mdl-19035209

RESUMO

OBJECTIVE: To describe the satisfactory intra-iliac paths in Galveston fixation combined with adult human cadaver and radiology study. METHODS: Five adult cadavers with 10 hemisected pelvises were harvested. Parallelly to the Chiotic line, the bone every other 5 mm till the superior rim of the acetabulum (SRA) observing the morphologic characteristics of each cross-sections of the iliac columns was cut. Fifty consecutive and randomly selected patients were measured using three-dimensional computed tomographic reformations. Three paths' valid bony canal lengths (LVBC), contractions' inner widths and positions were evaluated. RESULTS: The Path A with the longest LVBC (137 +/- 8) mm in male, (130 +/- 11) mm in female was the most satisfactory intra-iliac path according to both adult cadaver and radiographic measurement Path A and B allowed placement of 100 mm and 8 mm implants in male, 80 mm and 6 to 7 mm implants in female patients. CONCLUSION: The Path A, passing from the Click point towards the bottom of the anterior inferior iliac spine provides a longer and potentially safer anchor site compared with the traditional path.


Assuntos
Fixação Interna de Fraturas/métodos , Ílio/anatomia & histologia , Adulto , Parafusos Ósseos , Feminino , Humanos , Ílio/diagnóstico por imagem , Ílio/cirurgia , Masculino , Radiografia
7.
Exp Ther Med ; 13(4): 1376-1380, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28413480

RESUMO

The aim of the present study was to analyze the mechanism by which nerve growth factor (NGF) promotes callus formation in mice with tibial fracture. NGF transgenic homozygotic mice and NGF wild homozygotic mice were selected to construct non-stabilized fracture model of tibia. The mice were sacrificed on days 7, 14 and 21, respectively, and each group had a sample with 8 mice at each point in time. X-ray radiography and safranin fast green were used to observe fracture healing and in situ hybridization was used to examine the NGF mRNA expression of tibia at each phase of fracture healing. Tartrate-resistant acid phosphatase (TRAP) staining of callus tissue and the expression level of TRAP mRNA were combined to observe osteoclast formation. COL2A1, a chondrocyte differentiation-related gene in callus, and the mRNA level of SOX9 were combined to observe chondrocyte differentiation. It was found that under X-ray radiography, the fracture of NGF transgenic homozygotic mice healed in advance (P<0.05). Cartilage and bone tissue were identified by safranin and fast green staining. The residual cartilage on the callus tissue of NGF transgenic homozygotic mice had decreased significantly (P<0.05). The NGF mRNA expression level in each phase of callus formation of NGF transgenic homozygotic mice was significantly higher than that of the wild group (P<0.05). The number of positive cells in NGF-TRAP staining at each time point after fracture and the NGF mRNA expression level was markedly higher than that of the wild group, and the expression levels of COL2A1 and SOX9 mRNA were distinctively higher than that of the wild group. In conclusion, NGF potentially improves the healing of tibial fracture by osteoclast formation. Additionally, an increase in the number of osteoblasts in the NGF transgenic homozygotic mice compared with the wild-type mice may be achieved by cartilage differentiation due to NGF increasing the COL2A1 and SOX9 mRNA expression levels.

8.
Injury ; 43(4): 452-7, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21925658

RESUMO

OBJECTIVE: Traumatic lumbosacropelvic fracture-dislocation is a rare but potentially serious injury. Conventional methods like lumbosacral fixation used to treat such injuries often result in suboptimal outcome secondary to complications like pseudoarthroses, sagittal imbalance and hardware failure. In this study, we retrospectively analysed the clinical features and management for this trauma using lumbo-iliac fixation. METHODS: Eight patients (6 male, 2 female; 21-52 years old, mean: 38.4) with traumatic lumbosacropelvic fracture-dislocation were surgically managed by lumbo-iliac internal fixation after lumbosacral decompression. Patients were followed up for 24-40 months (mean: 31.6). American Spine Injury Association (ASIA) scores were measured before surgery and at the last follow-up, and statistically analysed. RESULTS: After surgery, all patients experienced improved sensory and motor performance. Six patients showed recovery of bowel and bladder functions. Immediately after lumbo-iliac fixation, all patients could turn in bed without assistance. Lumbosacral alignment was restored immediately after surgery and no dislocation was observed during follow-up. Radiography indicated excellent integration between the autograft and the vertebrae. After surgery, no patient experienced neurological deterioration. CONCLUSION: Our experience with these cases suggests that early surgical decompression and posterior lumbo-iliac internal fixation can effectively restore spinal alignment, stabilise the spine, and improve neurological symptoms for this complex trauma.


Assuntos
Fixação Interna de Fraturas/métodos , Ílio/cirurgia , Luxações Articulares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Adulto , Descompressão Cirúrgica , Feminino , Humanos , Ílio/lesões , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Pelve/lesões , Pelve/cirurgia , Estudos Retrospectivos , Sacro/lesões , Sacro/cirurgia , Fraturas da Coluna Vertebral/complicações , Adulto Jovem
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