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1.
Article in Chinese | WPRIM | ID: wpr-910052

ABSTRACT

Objective:To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery (ERAS) for pelvic fractures.Methods:A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020. Of them, 57 were assigned into an intervention group according to a random digits table. They were 42 males and 15 females, aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages. The other random 57 patients were assigned into a control group. They were 40 males and 17 females, aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians. The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2, 6, 12 and 24 weeks, and visual analogue scale (VAS) pain scores and SF36 scores at postoperative 12 and 24 weeks.Results:A total of 105 patients (55 in the intervention group and 50 in the control group) were completely followed up for 151 to 254 d (mean, 177 d). The 2 groups were comparable due to no significant difference between them in the preoperative general data ( P>0.05). The Majeed scores (44±13, 67±16, 86±14 and 98±7) and Barthel indexes (57±13, 79±16, 95±8 and 100±2) at postoperative 2, 6, 12 and 24 weeks in the intervention group were significantly higher than those in the control group [(35±16, 51±16, 73±14 and 91±12) and (45±19, 67±18, 86±12 and 98±4)] (all P<0.05). At postoperative 12 and 24 weeks, the SF-36 scores (129±15 and 141±6) in the intervention group were significantly higher than those in the control group (114±15 and 131±12) ( P<0.05). There was no significant difference in the pain degree between the 2 groups ( P>0.05). Conclusion:In management of pelvic fractures, compared with conventional perioperative rehabilitation approaches, the perioperative ERAS rehabilitation approaches may improve early functional outcomes and thus help the patients restore their activities of daily living earlier.

2.
Article in Chinese | WPRIM | ID: wpr-910013

ABSTRACT

Objective:To explore the epidemiological characteristics of inpatients with tibial pilon fracture in The Third Hospital of Hebei Medical University from 2016 to 2019.Methods:The data of all the patients who had been hospitalized for pilon fracture from January 2016 to December 2019 in The Third Hospital of Hebei Medical University were collected using the medical image computer archiving and transmission system and the medical record query system. The patients' age, gender, occupation, residence, season, cause of injury, Rüedi-Allg?wer classification, and AO classification were analyzed.Results:A total of 234 inpatients with tibial pilon fracture were collected, including 179 males and 55 females, with a ratio of male to female of 3.3∶ 1. The prevalence age ranged from 41 to 50 years in male patients (31.3%, 56/179) and from 51 to 60 years in female patients (25.5%, 14/55). In the 234 patients, farmers (101 cases, 43.2%), rural area (166 cases, 70.9%) and spring season (77 cases, 32.9%) accounted for a higher proportion. The proportions of high-altitude falling (41.0%, 96/234) and high-energy injury (61.5%, 144/234) were the highest. Of the 234 patients by the Rüedi-Allg?wer classification, 23 (9.8%) had type Ⅰ fracture, 90 (38.5%) type Ⅱ fracture, and 121 (51.7%) type Ⅲ fracture, with type Ⅲ fracture prevalent in males (58.1%, 104/179) and type Ⅱ fracture prevalent in females (16.4%, 9/55). Of the 234 patients by the AO classification, 131 (56.0%) had type 43B fracture and 103 (44.0%) type 43C fracture, with a higher proportion of type 43B fractures in women (67.3%, 37/55) than in men (52.5%, 94/179). In type 43B fractures, type 43B3 (43.5%, 57/131) and type 43B3.3 (75.4%, 43/57) were the most common; in type 43C fractures, type 43C3 (74.8%, 77/103) and type 43C3.3 (51.9%, 40/77) were the most common.Conclusions:In the recent 4 years in The Third Hospital of Hebei Medical University, pilon fractures increased year by year and occurred more frequently in spring. They were more common in farmers and in the rural areas. They prevailed in the patients aged from 41 to 50 years. The Rüedi-Allg?wer type Ⅲ fractures and the AO type 43B fractures were the most common.

3.
Article in Chinese | WPRIM | ID: wpr-909998

ABSTRACT

Objective:To compare the biomechanical properties between triangular supporting fixation and conventional dynamic hip screw (DHS) fixation in the treatment of femoral intertrochanteric fractures.Methods:Eight pairs of 16 femoral specimens with an average death age of 51.9 years were used in this study. After thawing, they were randomly divided into an experimental group ( n=8) and a control group ( n=8) according to the left or right laterality. They were made models of femoral intertrochanteric fracture of AO 31-A1 type with strain gauges pasted. The experimental group was subjected to fixation with double triangu-lar supporting and the control group conventional DHS fixation to achieve anatomical reduction. The specimens were then mounted onto a biomechanical testing machine and subjected to loading till 400 N at a rate of 10 N/s. The values of overall deformation of the specimens and strain at 16 selected sites were recorded and compared between the 2 model groups. Results:Under the load of 400 N, the overall deformation was (0.31±0.13) mm for the experimental group and (0.49±0.21) mm for the control group, showing a significant difference ( t=-2.456, P=0.023). The strain values in front of femoral neck, upon front fracture line, at inferior-lateral, inferior-median and inferior-interior sites of front fracture line, at the root of anterior fixation screw, below medial femoral neck fracture line, behind femoral neck, at superior-lateral, superior-median and superior-interior sites of posterior fracture line, below posterior fracture line, at superior and inferior roots of posterior fixation screw, at points parallel to the fixation screw in front of and behind femoral shaft were, respectively, -244.90, 13.16, -71.77, -124.38, -366.89,121.62, -10.94, -166.00, -54.93, -367.38, -608.93, -69.09, 326.50, 133.14, 52.97, and -185.82 in the experimental group and -24.62, -40.39, -36.99, -120.97, -486.38, 99.20, 35.36, -205.67, -74.30, -566.01, -1, 085.40, -77.41, 334.34, 114.08, 38.50, and -235.74 in the control group. Internal fixation failure occurred in one specimen in the control group after 1,759 cycles of loading but in none in the experimental group. Conclusion:For femoral intertrochanteric fractures, double triangular supporting fixation may result in less overall deformation and is more consistent with the normal biomechanical conduction of the femur than conventional DHS fixation.

4.
Chinese Journal of Trauma ; (12): 848-854, 2021.
Article in Chinese | WPRIM | ID: wpr-909948

ABSTRACT

The presence of tension blister often predicts severe soft tissue damage,which not only increases the risk of wound complications but also prolongs the surgical treatment time. However,the developed tension blister has been proposed as a potential decompressive approach for it may relieve the pressure of osteofascial compartment and improve the likelihood of relieving clinical symptoms,as well as avoid unnecessary surgery in cases of suspected osteofascial compartment syndrome. Recently,the osteofascial system has been increasingly recognized that associations were found between the tension blister and osteofascial self-release processing. Thus,the timing of blister occurrence and regression substantially influences physicians′ clinical decisions,making blister management as part of the treatment of fractures. In this review,the authors give an overview of the characteristics,mechanism,stress reduction effect,prevention,current treatment status and complications of the fracture-related tension blister,hoping to help orthopedic physicians understand and treat the tensile blister.

5.
Chinese Journal of Anesthesiology ; (12): 1212-1217, 2021.
Article in Chinese | WPRIM | ID: wpr-911344

ABSTRACT

Objective:To evaluate the role of reactive oxygen species (ROS)-mediated mitochondrial pathway of apoptosis in long-term cognitive impairment induced by multiple exposures to sevoflurane in the neonatal rats.Methods:Sixty SPF healthy neonatal Sprague-Dawley rats, weighing 12-20 g, were divided into 3 groups ( n=20 each) using a random number table method: control group (group C), multiple exposures to sevoflurane for anesthesia group (group S) and ROS inhibitor group (group A). Group S and group A inhaled 3% sevoflurane for 2 h starting from 6, 7 and 8 days after birth, while group C inhaled air.In group A, ROS inhibitor N-acetylcysteine (NAC) 150 mg/kg was intraperitoneally injected before each anesthesia with sevoflurane.The spontaneous activity was evaluated by open field test on day 35 after birth.The cognitive function was determined by Morris water maze test on day 36 after birth.The rats were sacrificed after the end of Morris water maze test, and the hippocampal tissues were obtained for determination of the apoptosis rate of hippocampal neurons, reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) (by flow cytometry) and levels of Cyt c and cleaved caspase-9 and caspase-3 (by Western blot). The expression of Bcl-2 and Bax mRNA was detected by real-time polymerase chain reaction.The ultrastructure of mitochondria in hippocampal neurons was observed with a transmission electron microscope. Results:Compared with group C, the escape latency was significantly prolonged, the number of crossing the original platform was reduced, the apoptosis rate of hippocampal neurons and levels of ROS and MMP were increased, the expression of Cyt c, cleaved caspase-9, cleaved caspase-3 and Bax mRNA was up-regulated, the expression of Bcl-2 mRNA was down-regulated, the ratio of Bax/Bcl-2 was increased ( P<0.05), mitochondria were swollen, and mitochondrial cristae structure was broken in group S. Compared with group S, the escape latency was significantly shortened, the number of crossing the original platform was increased, the apoptosis rate of hippocampal neurons and levels of ROS and MMP were decreased, the expression of Cyt c, cleaved caspase-9, cleaved caspase-3 and Bax mRNA was down-regulated, the expression of Bcl-2 mRNA was up-regulated, the ratio of Bax/Bcl-2 was decreased ( P<0.05), and the mitochondrial swelling and rupture of cristae structure were improved in group A. Conclusion:The mechanism by which multiple exposures to sevoflurane induce long-term cognitive impairment may be related to activating the ROS-mediated mitochondrial pathway of apoptosis in neonatal rats.

6.
Chinese Journal of Orthopaedics ; (12): 1412-1418, 2021.
Article in Chinese | WPRIM | ID: wpr-910730

ABSTRACT

Objective:To investigate the effect of the placement of a drainage tube on the prognosis of patients with pelvic fractures treated by modified Stoppa approach.Methods:The medical records of patients with pelvic fractures treated with modified Stoppa approach from August 2012 to August 2017 were retrospectively analyzed. A total of 43 patients including 32 males and 11 females (mean age 47.6 years, range from16 to 69) were included in the study. According to Young-Burgess classification, there were 12 cases of Lateral Compression type LC-I type; 20 cases of Anterior and Posterior Compression type APC-I type and 11 cases of APC-II type. All patients were treated with modified Stoppa approach to reduce the fracture and fix with plate and screw. According to whether a drainage tube was placed during the operation, 22 cases were placed with a drainage tube (drainage group), and 21 cases were not placed with a drainage tube (non-drainage group). The main observation indicators were the intraoperative conditions, antibiotic application, incision suture removal time, postoperative body temperature change, hospital stay and clinical function (Harris score).Results:Wound infection was not observed in two groups. The duration of antibiotic use in the drainage group was 5.0 d (2.0, 8.0) d, and the non-drainage group was 4.0 d (2.0, 5.0) d, the difference was not statistically significant ( Z=1.161, P=0.924). The hospital stays of the two groups were 18.5 d (15.0, 24.3) d and 19.0 d (13.0, 26.0) d, respectively, and the difference was not statistically significant ( Z=0.542, P=0.591). The operation time was 150.2±52.4 min in the drainage group and 138.8±41.2 min in the non-drainage group, and the difference was not statistically significant ( t=0.791, P=0.433). The blood loss in the drainage group was 604.6±387.3 ml, and the non-drainage group was 581.0±275.0 ml. The difference was not statistically significant ( t=0.276, P=0.784). The postoperative body temperature changes of patients in the drainage group and non-drainage group were on day 1 (37.5±0.5 ℃ vs. 37.4±0.4 ℃, t=0.322, P>0.05), day 3 (37.1±0.4 ℃ vs. 37.0±0.4 ℃, t=0.286, P>0.05), day 5 (37.0± 0.3 ℃ vs. 36.8±0.2 ℃, t=2.127, P>0.05), on the 7th day (36.8±0.2 ℃ vs. 36.7±0.4 ℃, t=0.491, P>0.05), the difference was not statistically significant. The time for suture removal of surgical incision was 14.1±0.6 d in the drainage group and 13.9±0.6 d in the non-drainage group, and the difference was not statistically significant ( t=1.072, P=0.329). The Harris scores of the two groups were 96 (91, 100) points for the drainage group and 96 (93, 97) points for the non-drainage group, and the difference was not statistically significant ( Z=0.107, P=0.607). Conclusion:There is no significant influence of the application of drainage on recovery of wound or function for patients with pelvic surgery.

7.
Chinese Journal of Orthopaedics ; (12): 1373-1379, 2021.
Article in Chinese | WPRIM | ID: wpr-910725

ABSTRACT

Pelvic fractures usually are high-energy injuries, which often involve high incidence of nerve injury, including lumbosacral plexus injuries and cauda equina injuries. Duo to 50% of neurological improvement has been reported regardless of the type of operative or nonoperative management after pelvic fractures complicated with nerve injuries, it still remains controversial whether surgical exploration is effective in such cases at an early stage and there is also some disagreement between anterior exploration or posterior exploration. We should find out the mechanism of pelvic fractures and the nature of nerve injuries. What's more, we must have a clear understanding of the location and qualitative diagnosis of the nerve injuries. After admission of patients, a detailed physical examination, combined with pelvic X-ray, CT, magnetic resonance neurography (MRN) and other imaging findings, which are conducive to make accurate diagnosis of the nature of nerve injuries, are carried out to make a targeted treatment plan. Generally speaking, cauda equina injuries are more common injuries in U-shaped sacral fractures, which cause the compression and space-occupying lesions of the sacral canal, so the posterior approach is a major approach to achieve the reduction and fixation of the sacral fractures and the decompression of sacral canal. While the lumbosacral plexus injuries are caused by the anterior compression, it is better to perform anterior approach to achieve the desired effect.

8.
Chinese Journal of Orthopaedics ; (12): 1361-1366, 2021.
Article in Chinese | WPRIM | ID: wpr-910723

ABSTRACT

Objective:To compare the biomechanical properties of triangular supporting fixation and Gamma nail fixation for intertrochanteric fractures of the femur.Methods:The femoral CT imaging data provided by a healthy adult male volunteer aged 40 years, height 172 cm, and weight 75 kg were used to reconstruct the femur model using Mimics 21.0 software and Geomagics 2013 software. Evans type I intertrochanteric fracture models were established using UG12.0 software, and Gamma nail and triangular supporting intramedullary nail models were reconstructed to simulate intertrochanteric fracture internal fixation, respectively. In Abaqus software, two internal fixation models of Gamma nail and triangular supporting intramedullary nail in standing state are simulated, and the stress peaks of the main nail, fixation screw and bone substance were collected, also the stress peak of supporting screw of the triangular supporting intramedullary nail is obtained. Additionally, the maximum displacement of the fracture model fixed by Gamma nail and triangular supporting intramedullary nail is measured.Results:Under the load of 1 200 N, the peak stress of the two fracture internal fixation models was located in the main nail, in which the peak stress of the triangular supporting intramedullary nail was 233.73 MPa, which was 11.9% lower than that of the Gamma nail (265.21 MPa); the peak stress of the fixation screw was located in the contact area between the pressure screw and the main nail, which was 23.2% lower in triangular supporting intramedullary nail than that of the Gamma nail (138.86 MPa vs. 180.75 MPa); the peak stress of the bone model was located in the medial cortex of the femur, which was 61.67 MPa and 32.38 MPa, respectively, 47.5% lower in the triangular supporting intramedullary nail than that of the Gamma nail; the peak stress of the supporting screw in the triangular supporting intramedullary nail was 92.04 MPa. The maximum displacement of the fracture model fixed with triangular supporting intramedullary nail was 17.34 mm, which was 10.5% less than the maximum displacement of the fracture model fixed with Gamma nail (19.37 mm). Conclusion:Compared with Gamma nail, triangular supporting intramedullary nail fixation can significantly improve the stability of intertrochanteric fractures and stress distribution as well as reduce stress peak and stress concentration area, which is helpful to improve the efficacy of intertrochanteric fractures.

9.
Article in Chinese | WPRIM | ID: wpr-885039

ABSTRACT

Objective:To evaluate the effect of sevoflurane on necroptosis in isolated hippocampal neurons and the relationship with ryanodine receptor.Methods:Primarily cultured hippocampal neurons of fetal rats of Sprague-Dawley rats were inoculated in culture wells (100 μl/well) or culture flasks (3 ml/bottle) at a density of 5×10 5 cells/ml at 7 days of culture and divided into 3 groups ( n=24 each) using a random number table method: control group (group C), sevoflurane group (group S) and ryanodine receptor antagonist group (group R). Group C received routine culture.Ryanodine receptor antagonist Dantrolene at a final concentration of 3 μmol/L was added in group R. Thirty minutes later, the cells were placed in the incubator containing 2% sevoflurane and cultured for 5 h at 37 ℃ in S and R groups.Then cells were collected, the morphology of neurons was observed with an inverted microscope, the concentrations of free calcium ion ([Ca 2+ ] i) in cytoplasm were determined by flow cytometry, the expression of ryanodine receptor and phosphorylated MLKL protein (p-MLKL) was detected by Western blot, the expression of RIP3 was measured by immunofluorescence, and necroptosis rate was calculated. Results:Compared with group C, the [Ca 2+ ] i were significantly increased, the expression of ryanodine receptor and p-MLKL was up-regulated, and the necroptosis rate was increased in S and R groups ( P<0.05). Compared with group S, the expression of ryanodine receptor and p-MLKL was significantly down-regulated, and the [Ca 2+ ] i and necroptosis rate were decreased in group R ( P<0.05). There was no obvious abnormality in the morphology of neurons in group C. The cell body of neurons were shrunk, the processes were broken, and the network between processes was sparse in group S. The cell body was round, and the morphology was close to normal in group R. Conclusion:Sevoflurane can cause necroptosis in isolated hippocampal neurons of rats, and the mechanism is related to up-regulating the expression of ryanodine receptors and leading to calcium overload.

10.
Chinese Journal of Orthopaedics ; (12): 137-140, 2021.
Article in Chinese | WPRIM | ID: wpr-884697

ABSTRACT

Tibial plateau fracture is a common acute trauma of the knee joint. At present, there are many studies on its classification and treatment, and minimally invasive treatment has become a research hotspot and mainstream direction of tibial plateau fracture. We summarized the clinical results of minimally invasive treatment of more than 300 cases of tibial plateau fractures, and proposed the concept of core weight-bearing area on tibial plateau, that is, the core weight-bearing area of the tibial plateau of the knee joint under normal motion statuswhile walking and moderate-intensity running. We performed thinsection CT scanning of the knee joint in a male volunteer for three-dimension finite element modeling.The results showed that during the walking state (the load was twice that of gravity), the core weight-bearing area of the medial and lateral plateaus was 389 mm 2 and 363 mm 2, accounting for 33.2% and 42.9% of tibial plateau, respectively;during the moderate-intensity running state (the load was four times that of gravity), the core weight-bearing area of the medial and lateral plateaus was 418 mm 2 and 406 mm 2, accounting for 35.6% and 48.0%of tibial plateau, respectively. Accordingly, tibial plateau fractures are supposed to be divided into core weight-bearing fracture and non-core weight-bearing fracture, and there are significant differences in the treatment ofthese twokinds of fractures: reduction is more demanding for core weight-bearing fracture,and the fracture involves the core area closely, the anatomical reduction is sought; for non-core weight-bearing area, the reduction requirements can be appropriately low demanded, and even in some cases , for example simple avulsion fracture, marginal fracture, some tibial plateau Hoffa fractures,can be treated conservatively. In summary, during clinical diagnosis and treatmentpractice, orthopedic surgeons should take the core weight-bearing area fracture as the core of diagnosis and treatment, strictly evaluate the extent of fracture involvement, select targeted internal fixation materials, and target to promote more accurate, minimally invasive, and individualized treatment of tibial plateau fractures.

11.
Article in Chinese | WPRIM | ID: wpr-884231

ABSTRACT

Objective:To explore the factors related to functional recovery of the knee in patients with tibial plateau fracture complicated with intercondylar ridge fracture.Methods:Included in this retrospective study were 63 patients who had been treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University from January to June 2019 for tibial plateau fracture complicated with intercondylar ridge fracture. They were 43 males and 20 females, aged from 18 to 66 years (average, 43.9 years). According to our comprehensive classification of tibial plateau fractures, there were 27 simple ones (20 cases of type Ⅰ and 7 cases of type Ⅱ) and 36 complicated ones (16 cases of type Ⅲ, 17 cases of type Ⅳ, one of type Ⅴ and 2 cases of type Ⅵ). To screen out major influencing factors, a multiple linear regression model was used to analyze the 12 factors that might affect functional recovery of the knee by the Hospital for Special Surgery (HSS) scoring: age, gender, occupation, fracture type, way of medical payment, cause of injury, operation method, starting time for rehabilitation, postoperative brace installation, time from injury to operation, length of hospital stay, and presence or absence of a free intercondylar ridge fracture fragment.Results:The 63 patients were followed up for 6.0 to 7.1 months (average, 6.1 months). The HSS knee scores ranged from 45 to 100 points (average, 92.4 points). The HSS knee scores were significantly different between different fracture types ( P<0.05). The HSS scores were significantly higher for the patients without a free intercondylar ridge fracture fragment than for those with ( P<0.05). Multiple linear regression model analysis of the 5 variables with P<0.02 in the single factor analysis (age, fracture type, way of medical payment, hospital stay and presence or absence of a free intercondylar ridge fracture fragment) and HSS scores showed that only fracture type and presence or absence of a free intercondylar ridge fracture fragment had a significant impact on the knee function. Their regression equation was Y=125.591-7.790a-17.277b (Y indicates HSS score, a indicates fracture type and b indicates presence or absence of a free intercondylar ridge fracture fragment). Conclusions:The short-term prognosis for tibial plateau fractures of comprehensive types Ⅰ&Ⅱ (simple ones) may be better than that for tibial plateau fractures of comprehensive types Ⅲ, Ⅳ, Ⅴ&Ⅵ (complicated ones). For patients with a free intercondylar ridge fracture fragment on their lateral knee X-ray film, effective reduction and fixation is indicated but is not for those without.

12.
Article in Chinese | WPRIM | ID: wpr-884221

ABSTRACT

Objective:To evaluate the anterior expansion of sacral foramen and decompression of sacral plexus via the lateral-rectus approach (LRA) in the surgical treatment of sacral fractures complicated with sacral plexus injury.Methods:From January 2013 to June 2018, 11 patients were treated at Department of Orthopaedics, The Third Hospital Affiliated to Southern Medical University for obsolete sacral fractures complicated with sacral plexus injury. They were 8 males and 3 females, aged from 17 to 54 years (average, 38 years). According to the Denis classification, all the sacral fractures belonged to Denis Zone Ⅱ. According to British Medical Research Council (BMRC) grading system, the nerve injury was complete damage in 2 cases and partial damage in 9. The mean time from injury to surgery was 6 months (range, from 0.7 to 12.0 months). After the sacroiliac joint was exposed via the LRA, the lumbosacral trunk was exposed and released between iliac vessels and the iliopsoas. Next, the S1 foramen was expanded and the S1 nerve root was released after separation of the median sacral artery and the internal iliac artery. Reduction and fixation of the sacroiliac joint was carried out for patients with unstable sacral fracture. X-ray and CT examinations of the pelvis were performed to evaluate fracture healing and neurological function recovery postoperatively.Results:Of this cohort of 11 cases, operation succeeded in 10 but failed in one whose sacral fracture was found to have completely healed with the S1 foramina totally occluded. The surgical time averaged 110 min (range, from 70 to 220 min) and the blood loss 1, 100 mL (range, from 450 to 2, 800 mL). Postoperative X-ray and CT examinations showed that the sacral foramens were expanded significantly without any complications. The follow-up time averaged 18 months (range, from 12 months to 4 years). By the BMRC grading system at the last follow-up, the neural function was completely recovered in 5 cases, partially recovered in 4 cases and not recovered in one.Conclusion:Significant anterior expansion of sacral foramen and decompression of sacral plexus via the LRA is a viable and effective alternative for treatment of sacral fractures complicated with sacral plexus injury.

13.
Article in Chinese | WPRIM | ID: wpr-811521

ABSTRACT

Although the epidemic outbreak of Corona Virus Disease 2019 (COVID-19) restricted freecoming and going of people, it was inevitable that fracture patients, elderly ones with low-energy fracture in part ICU lar, sought medical attention. In this special situation, itwas crucial for trauma orthopaedists to do well in prevention and control of COVID-19 infection and in perioperative management of their patients as well while they went on with routine diagnosis and treatment. It was also of great significance for prognosis of the patients and prevention and control of the epidemic that orthopaedic surgeons chose proper surgical and anesthesia methods. In the process of diagnosis, treatment, nursing and rehabilitation, medical staff too was challenged by how to prevent themselves from infection and how to eliminate cluster COVID-19 transmission. This paper, from the perspectives of orthopedic surgeons, nurses and patients, expounds briefly on the management of patients with orthopedic trauma during the epidemic period of COVID-19 in a mode of multidisciplinary comprehensive interventions.

14.
Chinese Journal of Trauma ; (12): 124-128, 2020.
Article in Chinese | WPRIM | ID: wpr-811518

ABSTRACT

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.

15.
Chinese Journal of Trauma ; (12): 111-116, 2020.
Article in Chinese | WPRIM | ID: wpr-811516

ABSTRACT

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.

16.
Chinese Journal of Trauma ; (12): 104-110, 2020.
Article in Chinese | WPRIM | ID: wpr-811515

ABSTRACT

With the spread of novel coronavirus pneumonia (NCP) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus so as to make better decision against this epidemic and protect patients' families and medical staff. This consensus elaborates not only epidemic condition of NCP, but also general principles of medical admission, treatment and protection for both medical staff and patients, in order to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of NCP.

17.
Article in Chinese | WPRIM | ID: wpr-867833

ABSTRACT

Although the epidemic outbreak of Corona Virus Disease 2019(COVID-19) restricted free coming and going of people, it was inevitable that fracture patients, elderly ones with low-energy fracture in particular, sought medical attention. In this special situation, it was crucial for trauma orthopaedists to do well in prevention and control of COVID-19 infection and in perioperative management of their patients as well while they went on with routine diagnosis and treatment. It was also of great significance for prognosis of the patients and prevention and control of the epidemic that orthopaedic surgeons chose proper surgical and anesthesia methods. In the process of diagnosis, treatment, nursing and rehabilitation, medical staff too was challenged by how to prevent themselves from infection and how to eliminate cluster COVID-19 transmission. This paper, from the perspectives of orthopedic surgeons, nurses and patients, expounds briefly on the management of patients with orthopedic trauma during the epidemic period of COVID-19 in a mode of multidisciplinary comprehensive interventions.

18.
Chinese Journal of Trauma ; (12): 827-830, 2020.
Article in Chinese | WPRIM | ID: wpr-867783

ABSTRACT

Hoffa fracture of tibial plateau is a special type of coronal fracture of tibial plateau, among which occult fracture accounts for a large proportion, resulting in missing diagnosis and delayed treatment. The current studies are all case reports, and the incidence, diagnostic protocol, injury characteristics and injury mechanism of Hoffa fracture have not been systematically studied. The commonly used classifications such as AO type, Schatzker type, three-column classification and comprehensive classification of tibial plateau cannot cover this type. In this study, a retrospective case series study was performed for the clinical data of 3 086 patients with tibial plateau fractures. There were 13 patients with Hoffa fracture of tibial plateau, and 23% of them were occult ones. The injury mechanism of this fracture was as follows: under the state of knee joint flexion, axial violence through femur concentrated on the posterior half of tibial plateau, with the knee joint in transient varus and pronation position, leading to the posteromedial coronal splitting fracture. According to the position and degree of fracture displacement involving the joint, the fracture was divided into three type: type I involving the articular surface of tibial plateau fracture less than 1/4, type II involving the articular surface of tibial plateau equal to or more than 1/4 and less than 1/2, type III involving the joint face equal to or more than 1/2. Each fracture type was divided into three subtypes, of which subtype A was non-displaced fracture, subtype B had articular surface displacement<2 mm, and subtype C had articular surface displacement≥2 mm. According to the classification characteristics, the treatment principles were proposed. The authors systematically summarized the Hoffa fracture of tibial plateau for the first time in aspects of the incidence, injury characteristics, injury mechanism, fracture classification and treatment principles, which is helpful to avoid missed diagnosis and improve treatment efficacy.

19.
Chinese Journal of Trauma ; (12): 385-392, 2020.
Article in Chinese | WPRIM | ID: wpr-867725

ABSTRACT

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

20.
Chinese Journal of Trauma ; (12): 111-116, 2020.
Article in Chinese | WPRIM | ID: wpr-867685

ABSTRACT

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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