Objective To explore the early diagnostic value of single photon emission computed tomography(SPECT), thoracic computed tomography(CT),and chest X-ray for closed chest trauma. Methods To establish the animal model of unilateral chest impact trauma,to adopt SPECT, thoracic CT, and chest X-ray for early diagnosis of closed chest trauma,and to compare these findings with postmortem examination. Results Thirty minutes after blunt chest trauma, the region of interesting (ROI) between traumatized lung and the heart (ROI2/ROI1) immediately increased to the peak six hours after trauma; on the contralateral lung, the ratio (ROI3/ROI1) increased slowly and reached the peak after six hours, these ratio was still smaller than that of the traumatized lung. These differences were significant (Plt;0.01). Conclusions Chest X-ray is still the most fundamental diagnostic method of chest trauma,but it was thought that the patients of severe chest trauma and multiple injuries should be examined early by thoracic CT. Radionuclide imaging have more diagnostic value than chest X-ray on pulmonary contusion. The diagnostic sensibility to pulmonary contusion of thoracic CT is superior to conventional radiograph,but thoracic CT is inferior to SPECT on exploring exudation and edema of pulmonary contusion. Thoracic CT is superior to conventional radiograph on diagnosis of chest trauma,therefore patients of severe chest trauma and multiple injuries should be adopted to thoracic CT examination at emergency room in order to be diagnosed as soon as possible.
Objective To set up and to evaluate an acute closed brain injury model in rats. Methods The acute closed brain injury was produced in rats by using an impactor consisting of a stand, a guide tube, a weight and a footplate. Ninetysix SD rats were divided into a control group(n＝32, no impact), a mild injury group(n＝32, impact once at force level of 400 g·cm) and a severe injury group(n＝32, impact once at force level of 800 g·cm) to elucidate the physiological responses, the pathophysiological changes and brain edema after brain injury at different injury levels. Results In the mild injury group and the severe injury group, a sudden rise or reduction of blood pressure, deep and fast breath apnea, and pain reflects inhibition were observed. The responses were more obvious in the severe injury group than in the mild injury group. The water content of the brain increased after 6 hours of injury. The pathological contusion and edema of brain were noted or above the impact force level of 800 g·cm. When the impact force rose to or over 1200g·cm, the animals died of persistent apnea mostly. Conclusion Although the established closed brain injury model with different biomechanical mechanisms as the clinical brain injury, it is in conformity with pathological changes and pathophysiological characteristics of acute clinical brain injury, it can be utilized extensively because of its convenient and practice.
Objective To compare the effectiveness of the 3 methods (traditional open Achilles tendon anastomosis, minimally invasive percutaneous Achilles tendon anastomosis, and Achilles tendon anastomosis limited incision) for acuteAchilles tendon rupture so as to provide a reference for the choice of cl inical treatment plans. Methods Between December 2007 and March 2010, 69 cases of acute Achilles tendon rupture were treated by traditional open Achilles tendon anastomosis (traditional group, n=23), by minimally invasive percutaneous Achilles tendon anastomosis (minimally invasive group, n=23), and by Achilles tendon anastomosis l imited incision (l imited incision group,n=23). There was no significant difference in gender, age, mechanism of injury, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 3 groups (P gt; 0.05). Results Minimally invasive group and limited incision group were significantly better than traditional group in hospital ization days and blood loss (P lt; 0.01). Incision infection occurred in 2 cases of traditional group, and healing of incision by first intention was achieved in all patients of the other 2 groups, showing significant difference in the complication rate (P lt; 0.05). Re-rupture of Achilles tendon occurred in 1 case (4.3%) of minimally invasive group and limited incision group respectively; no re-rupture was found in traditional group (0), showing significant difference when compared with the other 2 groups (P lt; 0.05). All cases were followed up 12-18 months with an average of 14.9 months. The function of the joint was restored. The AOFAS score was more than 90 points in 3 groups at 12 months after operation, showing no significant difference among 3 groups (P gt; 0.05). Conclusion The above 3 procedures can be used to treat acute Achilles tendon rupture. However, minimally invasive percutaneous Achilles tendon anastomosis and Achilles tendon anastomosis limited incision have the advantages of less invasion, good heal ing, short hospital ization days, and less postoperative complication, and have the disadvantage of increased risk for re-rupture of Achilles tendon after operations.
ObjectiveTo compare the effectiveness between open reduction and closed reduction of pediatric subtrochanteric fractures using elastic stable intramedullary nailing (ESIN). MethodsBetween January 2010 and January 2014, 22 children with subtrochanteric fractures were treated by ESIN internal fixation combined with hip cast fixation, and the clinical data were retrospectively reviewed. Closed reduction was used in 12 cases (group A) and miniopen reduction in 10 cases (group B). There was no significant difference in gender, age, sides, fracture causes, type of fracture, complications, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, the limb function was evaluated according to the Flynn et al. outcome score. ResultsThe intraoperative blood loss of group A was significantly less than that of group B, but the operation time of group A was significantly longer than that of group B (P<0.05). All the patients were followed up 12-36 months (mean, 14.9 months). There was no major complications in the other patients of both groups except 1 patient having delayed wound healing in group B. There was no significant difference in fracture healing time between 2 groups (t=-1.006, P=0.327). Inverted angle of 10° and shortened limb of 1.8 cm were observed in 1 case of group A, and sagittal plane angle of 15° and shortened limb of 2 cm in 1 case of group B. There was no abnormal walking and function of hip and knee activity at last follow-up. According to the Flynn et al. outcome score, the results were excellent in 8 cases and good in 4 cases in group A, and were excellent in 6 cases and good in 4 cases in group B, showing no significant difference between 2 groups (χ2=0.041, P=0.956). ConclusionBoth closed and open fracture reduction using ESIN have satisfactory outcomes for treating pediatric subtrochanteric fractures. A mini-open reduction should be selected intraoperatively if closed reduction proves to be difficult.
Objective To determine the effect of closed tracheal suction system versus open tracheal suction system on the rate of ventilator-associated pneumonia in adults. Methods We searched The Cochrane Library (Issue 1, 2007), PubMed (1966 to 2006) and CBM (1980 to 2007), and also hand searched relevant journals. Randomized controlled trials involving closed tracheal suction system versus open tracheal suction system for ventilator-associated pneumonia in adults were included. Data were extracted and the quality of trials was critical assessed by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2.8 software was used for data analyses. Result Five randomized controlled trials involving 739 patients were included. Results of meta-analyses showed that compared to open tracheal suction system, closed tracheal suction system did not increase the rate of ventilator-associated pneumonia (RR 0.83, 95%CI 0.50 to 1.37) or case fatality (RR 1.05, 95%CI 0.85 to 1.31). No significant differences were observed between open tracheal suction system and closed tracheal suction system in the total number of bacteria (RR 0.83, 95%CI 0.50 to 1.37), the number of SPP colony (RR 2.87, 95%CI 0.94 to 8.74) and the number of PSE colony (RR 1.46, 95%CI 0.76 to 2.77). There was no significant difference between the two groups in the duration of ventilation and length of hospital stay. Conclusion Open or closed tracheal suction systems have similar effects on the rate of ventilator-associated pneumonia, case fatality, the number of SPP and PSE colonies, duration of ventilation and length of hospital stay. However, due to the differences in interventions and statistical power among studies included in this systematic review, further studies are needed to determine the effect of closed or open tracheal suction systems on these outcomes.
Objective To introduce a new surgical approach to rectify the shortened lower limbs. Methods From March 1985 to October 2000,288 cases of shortened lower limbs were treated and reviewed. Closed fracture at the metaphysis was made by a self-made “needle saw”, and then the “multiple-plane and double-track elongation instrument” was adopted to elongate the fractured bone. There were totally 161 cases of male and 127 cases of female included, with average age 21.3 years old, ranging from 12 to 29 years old, among which there were 268 cases elongated at the proximal metaphysis of the tibia, 16 cases at the distal femur and 4 cases at the distal tibia. All of the cases were followed up for 6 to 8 months before clinical evaluation. Results The lower limbs in 288 cases were elongated for 3.0 to 11.5 cm in 24 to 96 days, averaging 47 days, which fulfilled pre-operative plan. In the second week after the operation, new calculus and periosteum formed obviously in the gap between the fractured parts, and in 6 to 8 months bone union was observed at the fractured site in all cases. There was no nerve or blood vessel injury, or non-union of the metaphysis fracture. The functionof the manipulated knee joints and ankle joints recovered well. Conclusion It is a practical and safe surgical option to rectify the shortened lower limbs by closed fracture at the metaphysis, followed by elongation of the fractured bone,without any complication such as non-union or atrophy of manipulated bone, andwith no need of internal fixation or bone grafting.
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
Objective To investigate the cl inical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3females and aging 35-68 years (48.5 years on average). The disease duration varied from 7 days to 183 days (56 days on average). The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 (2 cases), and L3, 4, L4, 5 (2 cases), and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months (34.7 months on average). The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation (P lt; 0.05). No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference (P lt; 0.05) when compared with that (10 ± 2) before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.
ObjectiveTo systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.MethodsThe Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=−0.85, 95%CI −1.66 to −0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI −0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=−2.24, 95%CI −4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).ConclusionsCurrent evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To compare the cl inical results of two plating osteosynthesis techniques, open reduction and plating ostosynthesis (ORPO) and minimal invasive plating osteosynthesis (MIPO), in surgical treatment of mid-distal humeralshaft fractures. Methods From March 2004 to October 2006, 40 cases of closed unilateral mid-distal humeral shaft fractures were surgically treated with MIPO or ORPO. In the MIPO treated group (n=19), there were 14 males and 5 females, with a mean age of 39.05 years. Fractures involved in middle humeral shaft in 10 cases and distal fragment in 9 cases. According to OTA classification, there were 3 cases of type A, 13 cases of type B and 3 cases of type C. Four cases compl icated by radial nerve palsies. In the ORPO treated group (n=21), there were 13 males and 8 females with a mean age of 39.05 years, including 14 cases of type A and 7 cases of type B fractures according to OTA classification. The fractures involved in middle humeral shaft in 13 cases and distal fragment in 8 cases. Five cases compl icated by radial nerve palsies. The time from injury to operation in both groups were 2 to 14 days. For patients in the MIPO group, fractures were closely reduced and fixated with an anterior placed plate inserted through two small incisions made at the anterior side of arm, away from fracture sites. The radial nerves were not exposed. For patients in the ORPO group, fractures were exposed, reduced, and fixated with an anterolateral or a posterior positioned plate after careful dissection and protection of radial nerve through an anterolateral or a posterior approach. The operation time, the occurrence of iatrogenic radial nerve palsy and the bone heal ing time were recorded. The functions of the affected shouldersand elbows were evaluated with UCLA end-result score and Mayo elbow perform index (MEPI), respectively. Results All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in the MIPO group after surgery; however, 5 cases of transient iatrogenic radial nerve palsies were identified in the ORPO group after surgery, and the function of radial nerve recovered in these cases at the last follow-up. Eighteen cases were followed up 14-44 months (mean 25.44 months) in MIPO group, and 19 cases were followed up 13-48 months (mean 32.11 months) in ORPO group. The mean bone heal ing time was 17.06 (12-32) weeks in MIPO group and 16.11 (8-58) weeks in ORPO group, showing no significant difference between two groups (P gt; 0.05). There was no nonunion and hardware failure in both groups. The mean forward flexion of the shoulder was 166.94° (150-170°) in MIPO group and 164.74° (130-170°) in ORPO group. The mean UCLA shoulder score was 34.78 (33-35) points in MIPO group and 34.42 (30-35) points in ORPO group. The mean range of motion of the elbow in MIPO and ORPO groups was 133.33° (120-140°) and 136.7° (120-140°), respectively. The MEPI in these two groups was 99.44 (90-100) and 99.74 (95-100) points, respectively. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion The good results could be obtained when ORPO and MIPO technique are appl ied to treat mid-distal humeral shaft fractures. MIPO technique has advantages to not expose the radial nerve and to decrease the occurrence of iatrogenic radial nerve palsies.