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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.
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Since December 2019, corona virus disease 2019 (COVID-19) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of COVID-19. Based on the needs of emergency surgery for orthopedic trauma patients and review of the latest diagnosis and treatment strategy of COVID-19 and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of COVID-19 and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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With the outbreak of corona virus disease 2019 (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) in Wuhan, Hubei Province in December 2019, more and more suspected or confirmed patients have been found in various regions of China. Although China has adopted unprecedented strict quarantine and closed management measures to prevent the spreading of the disease, Department of Traumatic Orthopedics may still have to manage COVID-19 patients with open fractures or severe trauma that require emergency surgery. Therefore, the identification and management of 2019-nCoV infection as soon as possible as well as the protection of all medical staff involved in the emergency treatment of patients are the serious challenges faced by orthopedic traumatologists during the prevention and control of COVID-19. Based on the characteristics of such patients and related diagnosis and treatment experiences during the epidemic of COVID-19, the authors formulate the strategies of surgical management and infection prevention and control for orthopedic trauma patients.
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Objective:To explore the effects of treadmill training during pregnancy on the development of dendritic spines and the expression of brain-derived neurotrophic factor (BDNF) in hippocampal neurons of offspring rats.Methods:According to the random number table, the natural pregnant healthy SPF female rats were divided into control group (CON group) and treadmill training group (TE group), with 6 rats in each group. The pregnant rats in CON group were fed quietly, while those in TE group were given treadmill exercise intervention 60 minutes a day with 5 days a week for 3 weeks. The setting parameters of treadmill training: the slope of electric flat plate was 0°, the track transmission speed was 8 m/min in the first 5 min, 10 m/min in the middle 25 min, and 12 m/min in the last 30 min.The body weight changes of pregnant rats in the two groups were recorded every two days from gestation of 0 day (G0). On day 21 of gestation (G21), the pregnant mice were placed in a quiet environment for labor. The expression of BDNF in hippocampus was detected by Western blot at 0, 7, 14 and 28 days after birth (P0, P7, P14, P28) respectively. The density of dendritic spines in hippocampus was detected by Golgi staining on P28. SPSS 19.0 software was used to analyze the data. Repeated measurement ANOVA was used to analyze the body weight of pregnant rats. t-test was used to analyze the data of neuronal dendritic spines. Results:Golgi staining showed that at P28, the density of dendritic spines in hippocampal CA1 area of TE group(11.330±0.558) was significantly higher than that of CON group (9.667±0.422), and the difference was statistically significant ( t=2.384, P<0.05). Compared with CON group, the relative expression level of BDNF protein in the hippocampus of offspring rats of TE group was significantly higher at P0: ((1.001±0.206), (2.027±0.240), t=3.244, P<0.05), P7: ((1.003±0.152), (2.077±0.172), t=4.669, P<0.05), P14: ((1.005±0.160), (1.562±0.178), t=3.329, P<0.05) and P28: ((1.004±0.196), (1.790±0.191), t=2.875, P<0.05), and the differences were statistically significant. Conclusion:Treadmill training during pregnancy can promote the development of dendritic spines in hippocampal neurons of offspring rats, which may be related to the promotion of BDNF expression in hippocampus.
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With the outbreak of novel coronavirus pneumonia (NCP) induced by 2019 novel coronavirus (2019-nCoV) in Wuhan, Hubei Province in December 2019, more and more suspected or confirmed cases have been found in various regions of China. Although China has adopted unprecedented strict quarantine and closed management measures to prevent the spreading of the disease, Department of Traumatic Orthopedics may still have to manage NCP patients with open fractures or severe trauma that require emergency surgery. Therefore, the identification and management of 2019-nCoV infection as soon as possible as well as the protection of all medical staff involved in the emergency treatment of patients are the severe challenges faced by orthopedic traumatologists during the prevention and control of NCP. Based on the characteristics of such patients and related diagnosis and treatment experiences during the epidemic of NCP, the authors formulate the surgical management strategies for orthopedic trauma patients.
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Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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Most patients with chronic subdural hematoma (CSDH) have a history of craniocerebral trauma. Avulsion of intracranial pontine vein is the main pathogenesis after craniocerebral injury. CSDH drilling and drainage is the most widely used surgical method, with low recurrence and mortality rate. However, the postoperative complication of subdural pyometra is extremely rare, which leads to high mortality and disability rate and thus representing a very challenging disease in trauma surgery. Old age, diabetes mellitus, drainage with foreign body, craniocerebral surgery, open wound, chronic systemic infectious diseases (sinusitis, otitis media, abdominal abscess, lung infection, urinary tract infection), tumor or immune deficiency diseases are all the high risk factors. This paper reviews the pathogenesis, pathogenic bacteria, clinical manifestations, auxiliary examination, treatment and prognosis of subdural empyema after CSDH drilling and drainage in recent years, and provides suggestions for clinical management.
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Objective@#To evaluate Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth.@*Methods@#A retrospective analysis was conducted of the 16 patients who had been treated at Department of Orthopaedics, Union Hospital, Tongji Medical College for femoral head fractures of Pipkin type Ⅱ from August 2016 to June 2018. They were 9 men and 7 women, aged from 18 to 45 years (mean, 25.6 years). Of them, 10 cases who had been complicated with posterior dis-location of the hip received emergency hip reduction(<6 h) before surgical fixation. All the patients underwent Herbert screwing directly via the anterior approach. Their incision length, operation time, intraoperative blood loss, hospitalization time, Harris hip scores, therapeutic efficacy and complications were recorded.@*Results@#In this series, the incision length averaged 10.4 cm, operation time 45.6 min, intraoperative blood loss 46.5 mL, and hospitalization time 4.0 d. All the 16 patients were followed up for 11 to 15 months (average, 12.7 months). Their Harris hip scores at preoperation, 3, 6 and 9 months postoperation and at the last follow-up were, respectively, 14.3±2.2, 64.8±2.4, 81.1±4.9, 88.1±4.6 and 91.9±3.4 points, showing a significant difference between any 2 time points (P<0.05). The therapeutic efficacy at the last follow-up by the Thompson-Epstein clinical evaluation was assessed as excellent in 9 cases, as good in 6 and as fair in one. No osteonecrosis of the femoral head or heterotopic ossification was observed by follow-up.@*Conclusion@#For young patients with femoral head fracture of Pipkin type Ⅱ, Herbert screwing directly via the anterior approach provides easy exposure and manipulation, does not aggravate the blood supply to the femoral head, decreases incidence of heterotopic ossification, and leads to shorter operation time and quick functional recovery of the hip.
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Objective To evaluate Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth.Methods A retrospective analysis was conducted of the 16 patients who had been treated at Department of Orthopaedics,Union Hospital,Tongji Medical College for femoral head fractures of Pipkin type Ⅱ from August 2016 to June 2018.They were 9 men and 7 women,aged from 18 to 45 years (mean,25.6 years).Of them,10 cases who had been complicated with posterior dislocation of the hip received emergency hip reduction(＜ 6 h) before surgical fixation.All the patients underwent Herbert screwing directly via the anterior approach.Their incision length,operation time,intraoperative blood loss,hospitalization time,Harris hip scores,therapeutic efficacy and complications were recorded.Results In this series,the incision length averaged 10.4 cm,operation time 45.6 min,intraoperative blood loss 46.5 mL,and hospitalization time 4.0 d.All the 16 patients were followed up for 11 to 15 months (average,12.7 months).Their Harris hip scores at preoperation,3,6 and 9 months postoperation and at the last follow-up were,respectively,14.3 ±2.2,64.8 ±2.4,81.1 ±4.9,88.1 ±4.6 and 91.9 ± 3.4 points,showing a significant difference between any 2 time points (P ＜ 0.05).The therapeutic efficacy at the last follow-up by the Thompson-Epstein clinical evaluation was assessed as excellent in 9 cases,as good in 6 and as fair in one.No osteonecrosis of the femoral head or heterotopic ossification was observed by follow-up.Conclusion For young patients with femoral head fracture of Pipkin type Ⅱ,Herbert screwing directly via the anterior approach provides easy exposure and manipulation,does not aggravate the blood supply to the femoral head,decreases incidence of heterotopic ossification,and leads to shorter operation time and quick functional recovery of the hip.
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Most patients with chronic subdural hematoma (CSDH) have a history of craniocerebral trauma.Avulsion of intracranial pontine vein is the main pathogenesis after craniocerebral injury.CSDH drilling and drainage is the most widely used surgical method,with low recurrence and mortality rate.However,the postoperative complication of subdural pyometra is extremely rare,which leads to high mortality and disability rate and thus representing a very challenging disease in trauma surgery.Old age,diabetes mellitus,drainage with foreign body,craniocerebral surgery,open wound,chronic systemic infectious diseases (sinusitis,otitis media,abdominal abscess,lung infection,urinary tract infection),tumor or immune deficiency diseases are all the high risk factors.This paper reviews the pathogenesis,pathogenic bacteria,clinical manifestations,auxiliary examination,treatment and prognosis of subdural empyema after CSDH drilling and drainage in recent years,and provides suggestions for clinical management.
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Objective To investigate the analgesic efficacy of ultrasound guided transversus abdominis plane block and to compare the efficacy of posterior approach and medial approach of ultrasound guided transversus abdominis plane block (TAPB) in providing postoperative analgesia after children laparoscopic groin surgery.Methods Eligible children 2 ～ 4 years old (n =60),American society of anesthesiologists (ASA) I,undergoing elective laparoscopic unilateral groin surgery were randomly assigned into posterior approach group (Group P),medial approach group (Group M) and control group (Group C).Many parameters were measured and recorded during the study,including funk sedation scores,intraoperative circulation monitoring at time points of T1 (before induction),T2 (skin incision) and T3 (skin closure),length of surgery,the time from post anesthesia care unit (PACU) arrival to the first obtainable pain score,length of PACU stay,modified-children's hospital of eastern ontario pain scale(m-CHEOPS),pediatric anesthesia emergence delirium (PAED) scores,number of children with sufentanil administered in PACU,number of people occurred nausea and vomiting,and satisfaction of parents.Results There were no statistically significant difference in general characteristics,basic emotion score,duration of surgery,the time from PACU arrival to first obtainable score,haemodynamic parameter at T1 and satisfaction of parents among groups P,M,and C.However,the m-CHEOPS scores at the time points of first obtainable,10 min,the number of children received sufentanil administration,PAED scores and haemodynamic parameter at T2 and T3 were significantly lower in groups P and M than in group C.There were no significant difference in parameters mentioned above between groups P and M.Conclusions Ultrasound guided transversus abdominis plane block could provide efficient and secure postoperative analgesia for children undergoing laparoscopic groin surgery.Both posterior approach and medial approach are ideal options.
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Objective To evaluate the effect of hypoxic-ischemic time on reduction of hypoxic-ischemic brain injury by sevoflurane postconditioning in neonatal rats.Methods Two hundred and ten 7-day-old Sprague-Dawley rats (105 male,105 female),weighing 13-17 g,were randomly divided into 7groups (n=30 each) using a random number table:sham operation group (group Sham),hypoxia-ischemia group (group HI),and sevoflurane postconditioning at different hypoxic-ischemic time point groups (P0,P3,P6,P 12 and P24 groups).Immediately after ligation of the left common carotid artery,and at 3,6,12 and 24 h after ligation,the rats inhaled the mixed gas containing 2％ sevoflurane for 30 min in P0,P3,P6,P13 and P24 groups,respectively.The fatality was recorded within 7 days after establishment of the model.At 7 days after establishment of the model,the rats were sacrificed,the brains were removed,and the right and left cerebral hemispheres were weighed separately,and the left/right cerebral hemisphere weight ratio was calculated.The hippocampal CA1 region and posterior cingulate gyrus were isolated,and the ratio of density of normal neurons in the left to the right was calculated.Results Compared with group Sham,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal neurons were significantly decreased,and the fatality rate was increased in the other six groups (P＜0.05).Compared with group HI,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal ncurons were significantly increased in P0,P3 and P6 groups (P＜0.05),and no significant change was found in the parameters mentioned above in P12 and P24 groups (P＞0.05).Compared with group P6,the left cerebral hemisphere weight,left/right cerebral hemisphere weight ratio,and ratio of density of normal neurons were significantly increased in P0 and P3 groups (P＜ 0.05).There was no significant difference in the parameters mentioned above between group P0 and group P3 (P＞0.05).Conclusion Sevoflurane postconditioning performed within 6 h of hypoxia-ischemia can reduce hypoxic-ischemic brain injury,and it provides no cerebral protection if exceeding 12 h.
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Ultrasound guided regional nerve blockade in children is a kind of safe,visualized and efficient regional nerve blockade which can be supervised,probe-controlled synchronously and share a brand future compared with traditional land-mark based technique and the intravenous opiates.The aim of this review is to give an overview of the research and application development of ultrasound guided nerve blockade in children undergoing groin surgery.
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Objective To evaluate the effects of isoflurane postconditioning on long-term cognitive function of neonatal rats with hypoxic-ischemic brain injury (HIBI).Methods Sixty 7-day-old Sprague-Dawley rats,weighing 12-16 g,were randomly divided into 4 groups (n =15 each) using a random number table:sham operation group (group Ⅰ),isoflurane postconditioning group (group Ⅱ),cerebral hypoxia-ischemia group (group Ⅲ),and isoflurane postconditioning after cerebral hypoxia-ischemia group (group Ⅳ).Brain ischemia was induced by permanent ligation of the left common carotid artery followed by inhalation of 8 ％ O2-92 ％ N2 for 2 h at 37 ℃ in Ⅲ and Ⅳ groups.In Ⅰ and Ⅱ groups,the left common carotid artery was only isolated but not ligated.The rats inhaled 1.5％ isoflurane in 30％ O2-70％ N2 for 30 min starting from 2 h of hypoxia in Ⅱ and Ⅳ groups.The rats were exposed to 30％ O2-70％ N2 for 30 min in Ⅰ and Ⅲ groups.Morris water maze test was carried out at 30-35 days after HIBI.The escape latency,swimming speed,swimming distance,the number of times the animals crossing the platform quadrant,the percentage of time spent in the platform quadrant and the percentage of swimming distance in the platform quadrant were recorded.The animals were sacrificed after Morris water maze test.The density of normal neurons in ventral posterior inferior thalamic nucleus and hippocampal CA3 region in left and right cerebral hemisphere was measured and the ratio of the density of normal neurons in the left to right cerebral hemisphere was calculated.Results Compared with group Ⅰ,the escape latency was significantly prolonged at 30-34 days after HIBI in group Ⅲ and at 31 and 34 days after HIBI in Ⅳ group,the number of times the animals crossing the platform quadrant,percentage of time spent in the platform quadrant,percentage of swimming distance in the platform quadrant,and ratio of the density of normal neurons in the left to right cerebral hemisphere were decreased at day 35 after HIBI in group Ⅲ,no significant changes were found in the number of times the animals crossing the platform quadrant,percentage of time spent in the platform quadrant,and percentage of swimming distance in the platform quadrant,and the ratio of the density of normal neurons in the left to right cerebral hemisphere was decreased at day 35 after HIBI in group Ⅳ,and no significant changes were found in the parameters mentioned above in group Ⅱ.Compared with group Ⅲ,the escape latency was significantly shortened at 31-34 days after HIBI,and the number of times the animals crossing the platform quadrant,percentage of time spent in the platform quadrant,percentage of swimming distance in the platform quadrant,and ratio of the density of normal neurons in the left to right cerebral hemisphere were increased at day 35 after HIBI in group Ⅳ.There was no significant difference in the swimming speed and swimming distance at day 35 after HIBI between groups.Conclusion Isoflurane postconditioning can improve long-term cognitive function of neonatal rats with HIBI.
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Objective To evaluate the effects of isoflurane postconditioning on mitochondrial permeability transition pore (mPTP) in brain tissues of neonatal rats with hypoxic-ischemic brain injury.Methods One hundred and twenty 7-day-old Sprague-Dawley rats,weighing 12-16 g,were randomly divided into 4 groups (n =30 each) using a random number table:sham operation group (group S),isoflurane group (group I),hypoxicischemic brain injury group (group HIBI),and hypoxic-ischemic brain injury + isoflurane postconditioning group (group HI).To establish hypoxic-ischemic brain injury model in the neonatal rats,the left common carotid artery ligation was carried out,and then the rats were exposed to 8％ O2 + 92％ N2 at 37 ℃ for 2 h in HIBI and HI groups.The rats inhaled 1.5 ％ isoflurane for 30 min after the model was established in group HI.The rats only inhaled 1.5％ isoflurane for 30 min in group I.At 24 h after the model was established,10 rats taken out randomly in each group were sacrificed and brains were removed to detect mPTP opening.At 7 days after the model was established,the survival rate was recorded in the rest rats.The rats were then sacrificed and brains were removed and the right and left cerebral hemispheres were weighed separately,and the ratio between left/right cerebral hemispheres was calculated.The density of normal neurons in ventral posterior inferior thalamic nucleus and hippocampal CA3 region in the left and right cerebral hemispheres were measured and the ratios of the density of normal neurons in the left to right cerebral hemisphere were calculated.Results There was no significant difference in the survival rate between the four groups (P ＞ 0.05).Compared with group S,the ratios of the density of normal neurons in the left to right cerebral hemisphere,weight of left cerebral hemisphere,and ratio between left/right cerebral hemispheres were significantly decreased,and mPTP opening was increased in group HIBI (P ＜ 0.05),and no significant changes were found in the parameters mentioned above in group I (P ＞ 0.05).Compared with group HIBI,the ratios of the density of normal neurons in the left to right cerebral hemisphere,weight of left cerebral hemisphere,and ratio between left/right cerebral hemispheres were significantly increased,and mPTP opening was decreased in group HI (P ＜ 0.05).Conclusion The mechanism by which isoflurane postconditioning reduces hypoxic-ischemic brain injury may be related to inhibition of mPTP opening in brain tissues of neonatal rats.