ABSTRACT
Objective:To characterize tibial plateau fractures using a computed-tomography-based "four-column and nine-segment" classification.Methods:A retrospective analysis was conducted of the 698 adult patients with tibial plateau fracture (704 knees) who had been admitted to Department of Orthopedics, The Affiliated People's Hospital of Jiangsu University from December 2007 to May 2018. They were 377 males and 321 females with an average age of 51.6 years. The left knee was affected in 371 cases (53.2%), the right knee in 321 cases (46.0%) and bilateral knees in 6 cases (0.9%). According to the differentiated morphological characteristics, the tibial plateau and proximal fibula were divided into 4 columns, which were subdivided into 9 segments. Tibial plateau injury index (TPII) was innovatively introduced to represent the extent of injury. Fracture mapping was retrospectively analyzed according to the "four-column and nine-segment" classification based on the CT imaging.Results:The rates of one-column, two-column, three-column and four-column injuries were 30.5% (215/704), 31.5% (222/704), 28.0% (197/704), and 9.9% (70/704), respectively. On average, 2.2 columns ± 1.0 columns and 3.6 segments ± 2.1 segments were affected in each case. The mean TPII was 5.7±3.0. The rates of mild, moderate and severe comminuted fractures were 50.0% (352/704), 37.5% (264/704), and 12.5% (88/704). The columns most frequently affected were the lateral column (572, 81.3%) and the intermedial column (524, 74.4%) while the less frequently involved ones the medial column (219, 31.1%) and the fibular column (218, 31.0%). The sequence of the segments affected was the posterolateral segment (465, 66.1%), the anterolateral segment (453, 64.3%), the posteromedian segment (379, 53.8%) and the tubercle segment (85, 12.1%).Conclusions:The novel "four-column and nine-segment" classification may be a beneficial system for clinical diagnosis, statistical analysis and prognostic judgment of tibial plateau fractures.
ABSTRACT
Objective To compare the effects of limited fluid resuscitation and aggressive fluid resuscitation in treatment of uncontrolled hemorrhagic traumatic shock,and to improve the cure rate.Methods One hundred and twenty patients with hemorrhagic traumatic shock on the basis of outpatient registration number of single and double were divided into limited fluid resuscitation group(limited group,56 cases) and aggressive fluid resuscitation group (positive group,64 cases),respectively.The preoperative blood lactic acid,base excess,prothrombin time,hemoglobin was compared and the preoperative infusion and the number of patients with death was recorded.Results The preoperative infusion in limited group was significantly less than that in positive group [(1 050 ± 212) ml vs.(2 120 ± 186) ml],the difference was statistically significant (P ＜ 0.01).The mortality rate in limited group was significantly lower than that in positive group [12.50％(7/56) vs.28.12％(18/64)],the difference was statistically significant (P＜ 0.05).The preoperative blood lactic acid,base excess,prothrombin time in limited group were significantly lower than those in positive group [(3.31 ± 0.29) mmol/L vs.(5.78 ± 0.15) mmol/L,(5.42 ± 1.13) mmol/L vs.(9.86 ± 1.21) mmol/L,(11.7 ± 1.9) s vs.(18.1 ± 1.7) s],and the hemoglobin in limited group was significantly higher than that in positive group [(96 ± 18) g/L vs.(83 ± 20) g/L],the differences were statistically significant (P ＜0.01).Conclusions If hemorrhage is not controlled,early limited fluid resuscitation can maintain blood perfusion of vital organs,alleviate acidosis,reduce mortality and creat good conditions for advanced treatment.Limited fluid resuscitation is superior to aggressive fluid resuscitation in operative intervention for patients with uncomtrolled hemorrhagic traumatic shock.