Construction and study of nomograph model for prognosis of multiple trauma patients / 中华急诊医学杂志

Objective:To explore the prognostic risk factors of patients with multiple injuries and establish a nomogram prediction model.Methods:The clinical data of 291 patients with multiple injuries admitted to the Emergency Intensive Care Unit (EICU) of General Hospital of Ningxia Medical University were collected, including sex, age, open injury, norepinephrine use, mechanical ventilation, time to hospital after injury, distance to hospital, relative lymphocyte value, platelet count, lactic acid, injury severity score (ISS), acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), Glasgow coma scale (GCS), number of blood transfusions, number of operations, and previous history of diabetes, hypertension and smoking within 24 h after admission. According to whether the condition worsened during the hospitalization of EICU, the patients were divided into the deterioration group and improvement group. SPSS26.0 software was used for statistical analysis of the data, univariate and multivariate analysis were used to screen the factors affecting the prognosis of patients with multiple injuries, receiver operating characteristic (ROC) curve and forest chart were drawn, and the influencing factors in binary Logistic regression model were used to make the nomogram.Results:Mechanical ventilation, norepinephrine use, age, relative lymphocyte value, lactic acid, APACHE-II score, GCS score, and number of operations were significant for predicting the prognosis of patients with multiple injuries ( P<0.05). The independent influencing factors obtained by binary Logistic regression model were age, lactic acid, APACHE-Ⅱ score and number of operations. ROC curve analysis showed that the area under the curve was the largest in multi-factor combined prediction, followed by APACHE-Ⅱ score. The diagnostic cut-off value of each index was as follows: age >58 years old, relative lymphocyte value≤ 8.62%, lactic acid >1.72, APACHE-Ⅱ score >16, GCS score≤ 6, and number of operations≤ 0. The R software was used to establish a nomogram of the influencing factors in the binary Logistic regression model, which had good predictive value. Conclusions:The nomogram constructed by age, relative lymphocyte value, lactic acid, APACHE-Ⅱ score, GCS score, number of operations, mechanical ventilation, and norepinephrine use has a good predictive value for the prognosis of patients with multiple injuries, and is worthy of promotion..

The influence of MDT mode combined with call-out nursing in the perioperative period of multiple injuries on the recovery time and complications of postoperative patients / 中国实用护理杂志

Objective:To explore the effect of multi disciplinary team (MDT) combined with call-out nursing on postoperative recovery time and complications of patients with multiple injuries during perioperative period.Methods:A total of 87 patients with multiple injuries admitted to our hospital from April 2018 to April 2020 were selected as the research objects. The patients were randomly divided into the control group (43 cases) and the observation group (44 cases) using a random number table method. The control group received routine care, and the observation group used MDT mode combined with call-out nursing based on routine care. The surgical awake rate and recovery time of the two groups were compared, and the scores of Glasgow Coma Scale(GCS), Disability Rating Scale(DRS) and the incidence of postoperative complications of the two groups were analyzed.Results:A total of 36 cases (81.82%) in the observation group were awake, which was significantly more than 22 cases (51.16%) in the control group. There was a statistical difference between the two groups ( χ2 value was 9.197, P<0.05). The recovery time of the observation group was (15.52±8.48) days, shorter than (27.13±10.35) days of the control group with significant difference ( t value was 5.729, P<0.01). Seven cases (15.91%) of complications occurred in the observation group after nursing, which was significantly less than 15 cases (34.88%) of the control group. There was a statistical difference between the two groups ( χ2 value was 4.144, P<0.05). After 1, 3, and 6 months of intervention, the GCS and DRS scores of the two groups of patients were lower than the previous point in time, and the observation group was lower than those of the control group, the difference was statistically significant ( t value was 2.003-11.039, P<0.05). Conclusions:The use of MDT combined with call-out nursing for patients with multiple injuries during the perioperative period can increase the postoperative wakefulness rate, reduce the patients' wakefulness time and the probability of complications, and also effectively reduce the patient's coma during nursing and improve their physiological state. It is worthwhile being promoted in related nursing work.

Prediction model of perioperative risk of deep venous thrombosis in patients with acute multiple knee joint injuries based on Logistic regression and XGBoost algorithm / 国际外科学杂志

Objective:Based on Logistic regression and XGBoost algorithm, the prediction model of perioperative risk of deep venous thrombosis in patients with acute multiple knee joint injuries was constructed, and the prediction performance was compared.Methods:A total of 120 patients with acute multiple injuries around the knee treated in the Department of Orthopaedic Trauma, Guangzhou Panyu District Central Hospital from January 2017 to June 2020 were retrospectively selected. According to the proportion of 7∶3, the patients were randomly divided into training set ( n=84) and test set ( n=36). The prediction models of Logistic regression and XGBoost algorithm were constructed by training set data, to screen the predictors of perioperative deep venous thrombosis in patients with acute multiple injury around knee joint, and the prediction effect of the model was evaluated by test set data. The measurement data conforming to the normal distribution were expressed as mean±standard deviation ( Mean± SD), and the independent t-test was used for comparison between groups; the measurement data of non-normal distribution were expressed as the median (interquartile range) [ M( P25, P75)], the independent sample Mann-Whitney U test was used for comparison between groups; the Chi-square test was used for comparison of enumeration data between groups. Results:The results of Logistic regression model showed that age, hypertension, coronary heart disease, time from injury to operation, D-dimer at 1 day after operation and multiple injuries were predictive factors for perioperative deep venous thrombosis in patients with acute multiple injuries around the knee joint. The top five important feature scores of XGBoost algorithm model were combined multiple injuries (35 points), time from injury to operation (28 points), age (24 points), coronary heart disease (21 points) and D-dimer 1 day after operation (16 points). In the training set, the area under the curve of the Logistic regression model was 0.805 (95% CI: 0.637-0.912), and χ2=1.436, P=0.329 for Hosmer and Lemeshow test. The area under the curve of the XGBoost algorithm model was 0.847(95% CI: 0.651-0.920), and χ2=1.103, P=0.976 for Hosmer and Lemeshow test. Conclusion:Logistic regression model and XGBoost algorithm model are similar in predicting perioperative deep venous thrombosis in patients with acute multiple injuries around the knee, and multiple injuries, time from injury to operation, age, coronary heart disease and D-dimer 1 day after operation can be used as predictive factors.

Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture. Methods: Between January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC. Results: All incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%. Conclusion: Open reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.

Incidence and risk factors of intraoperative deep venous thrombosis in patients with multiple injuries / 中华创伤骨科杂志

Objective To investigate the incidence and risk factors of intraoperative deep venous thrombosis (DVT) in patients with multiple injuries.Methods A retrospective analysis was conducted of the 183 patients with multiple injuries who had been admitted to the Department of Orthopaedics and Trauma,Xi'an Honghui Hospital from January 2016 to November 2017.They were 117 males and 66 females,aged from 16 to 84 years (average,47.3 years).Craniocerebral injuries occurred in 16 cases,chest injuries in 24 cases,spinal injuries in 9 cases,pelvic acetabular fractures in 64 cases,upper limb fractures in 40 cases,and lower limb fractures in 145 cases.Venous ultrasonography of bilateral lower limbs was performed preoperatively and postoperatively to detect incidence of DVT.The patients were divided into a DVT group and a non-DVT group.The 2 groups were compared in terms of gender,age,interval from injury to surgery,D-dimer levels upon admission and discharge,operation time,intraoperative blood transfusion,injury severity scoring (ISS) and type of injury.After single-factor analysis was used to screen risk factors,multivariate logistic regression analysis was used to determine the main independent risk factors.Results The incidence of lower limb DVT in patients with multiple injuries was 42.08％ (77/183).Of the 77 DVT patients,12 had proximal thrombosis (6.56％) and 65 distal thrombosis (35.52％).Multivariate logistic regression analysis showed that age of ＞ 60 years,operative time for ≥2 hours,and presence of spinal injury were independent risk factors for DVT in patients with multiple injuries (P ＜ 0.05).Conclusions The incidence of lower limb DVT can be high in patients with multiple injuries.An age of ＞ 60 years,operation time for ≥2 hours and presence of spinal injury are independent risk factors for DVT in these patients.

Algunas especificidades concernientes al paciente politraumatizado grave / Some Specifics Concerning About Severe Trauma Patient

El trauma se produce con patrones definidos que permiten identificar factores de riesgo como género (masculino), edad (las extremas de la vida), nivel socioeconómico (bajo), uso de sustancias peligrosas y adictivas, problemas psicológicos y escasa educación relacionada con la seguridad. La mortalidad por lesiones traumáticas graves se mantiene alta. La evaluación precoz de la severidad del trauma permite tratar adecuadamente y con inmediatez a los lesionados, mejorar el pronóstico y lograr que egresen vivos la mayoría de ellos. Por esas razones, constituye un tema de actualidad continuar profundizando sobre sus aspectos cognoscitivos en general, y los relacionados con las principales características de los politraumatizados graves, en particular. Solo contando con equipos multidisciplinarios altamente capacitados y con los recursos necesarios para su atención pre hospitalaria y luego de su hospitalización, puede lograrse la disminución de la mortalidad por esta causa(AU)

Trauma occurs with defined patterns that identify risk factors as gender (male), age (the end of life), socioeconomic stratus (low), use of dangerous and addictive substances, psychological problems and poor education related to safety. Mortality from severe traumatic injuries remains high. Early assessment of trauma severity allows proper and immediate treatment of the injured patient, as well as improving prognosis and achieving that most of patients are alive at discharge. For these reasons, it is a topical issue continue to deepen on its cognitive aspects in general and those related to the main characteristics of severe trauma patients in particular. Decrease in mortality by this cause can be only achieved with highly trained multidisciplinary teams and resources for pre and post hospital care(AU)

The effects of different pre-hospital intervention of treatment modes on the prognosis of patients with severe multiple trauma / 中华急诊医学杂志

Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma.Methods The general data of 396 patients with severe trauma [injurey severity scores (ISS) ≥25] in our hospital emergency for treatment from January 1,2008 to January 1,2012 was collected.The trauma patients were divided into study group and control group.In the study group,the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1,2010.In the control group,the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1,2010.The injury severity score,medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups.Results The emergency treatment time,length of hospital stays,ICU admission rate,prehospital mortality rate,long-term (6 months) disability rate,and complication rate in the study group were lower than those in the control group,presenting (78.23 ± 21.57) min vs.(96.45 ± 35.14) min,(23.55±12.46) dvs.(28.67±20.72) d,8.1％ (18/222)vs.65.5％ (114/174),13.3％ (34/256) vs.21.6％ (48/222),4.1％ (9/222)vs.9.2％ (16/174),8.1％ (18/222)vs.18.4％ (32/174),in which the differences were statistically significant (P ＜ 0.05).Hospital mortality in the study group was also lower than that in the control group,showing 8.1％ (18/222) vs.12.6％ (22/174),but there was no statistically significant difference (P ＜ 0.05).There was no significant difference in time from occurrence of injury to receiving treatment between the two groups.Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode.It is a good alternative emergency mode.

Analysis of diagnosis and treatment of 226 cases with severe multiple injuries in EICU / 中国基层医药

Objective To explore the strategies of diagnosis and treatment of severe multiple injuries in Emergency Intensive Care Unit (EICU).Methods The clinical data of 226 patients with severe multiple injuries were analyzed retrospectively.188 patients were treated by surgical operation,and 38 patients were not treated by surgical operation.Results Among these patients,46 patients (accounted for 20.3%)were with pulmonary infection and atelectasis,41 patients (accounting for 18.1%)were with multiple -organ dysfunction syndrome (MODS), 35 patients (accounted for 15.5%)were with acute respiratory distress syndrome (ARDS),and 19 patients (accounted for 8.4%)were with stress ulceration and bleeding.198 patients (accounted for 87.6%)were successfully rescued, and 28 patients (accounted for 12.3%)died.The main cause of death in the early stage was the serious craniocerebral injury,and the main cause of death in the later stage was the multiple -organ dysfunction.Conclusion EICU plays a very important role in comprehensive treatment of severe multiple injuries,and can obviously increase the success rate of treatment and cure of severe multiple injuries.

Clinical application of the blood transfusion with equal ratio component in severe multiple injuries with acute traumatic coagulopathy / 重庆医学

Objective To investigate the clinical effect of the blood transfusion with equal ratio component in severe multiple in‐juries with acute traumatic coagulopathy(ATC) .Methods Thirty‐eight patients who had severe multiple injuries with ATC were divided randomly into control group and treatment group .Control group was treated with the different ratio packed red blood cells (PRBC)and fresh frozen plasma(FFP) ,while treatment group received the equal ratio PRBC and FFP .Hemoglobin(HB) ,pro‐thrombin time(PT) ,international normalized ratio(INR) ,fibrinogen(FIB)were measured on the 1st ,2nd ,3rd day after admission . The total amount of PRBC during these 3 days ,the days of hospitalization in ICU ,the corrected rate of shock ,the 28‐day mortality were compared between groups .Results Compared with the control group ,the levels of PT ,INR and FIB of treatment group on the 2nd ,3rd day after admission were better(P<0 .05) .The total amount of PRBC[(18 .5 ± 6 .3)U]during these 3 days ,the days of hospitalization in ICU [(5 .9 ± 4 .3)d] in treatment group were less than those in the control group [(25 .9 ± 7 .8)U ,(10 .5 ± 7 .6)d] (P<0 .05) ,while the corrected rate of shock(85 .0% )in treatment group was higher than that of the control group(44 .4% ) .The 28‐day mortality(10 .0% )in treatment group was lower than that of the control group(27 .8% )(P<0 .05) .Conclusion The blood transfusion with equal ratio component in severe multiple injuries with ATC could not only improve blood clotting index ,reduce the total amount of PRBC and the time in ICU ,but also increase the corrected rate of shock and decrease the 28‐day mortality .

Nueva clasificación para la rodilla flotante en adultos / A new classification for Floating knee in adults

La clasificación de Fraser para la rodilla flotante, ha sido desde su publicación, la más difundida y utilizada a nivel mundial para estadificar esta lesión. En la rodilla flotante, el compromiso intraarticular se ha relacionado con mayor tasa de complicaciones y con los resultados funcionales más pobres. Sin embargo, la clasificación de Fraser, no toma en cuenta el compromiso de los tejidos blandos, lo cual también es importante para determinar el tratamiento, complicaciones y pronóstico. Otra lesión asociada a la rodilla flotante y que ha sido ampliamente documentada, es el compromiso de los ligamentos de la rodilla y las fracturas de rótula. Otros sistemas de clasificación propuestos posteriormente a la clasificación de Fraser, no toman en cuenta estos y otros elementos. Consideramos que una clasificación para la rodilla flotante, debe tomar en cuenta cuatro aspectos fundamentales para su diagnótico, tratamiento y pronóstico: morfología de la lesión, compromiso articular, compromiso de las partes blandas y compromiso de los ligamentos de la rodilla y afectación de la rótula. Con esta investigación proponemos un nuevo sistema de clasificación para la rodilla flotante que toma en cuenta estas variables, y que además, es simple y proporciona importante información para su diagnóstico, tratamiento y pronóstico(AU)

The Fraser classification for floating knee has been since its publication, the most widespread and worldwide used to stage this injury. In the floating knee, intra-articular commitment has been linked to higher rates of complications and poorer functional outcomes. However, the classification of Fraser, does not take into account the commitment of the soft tissues, which is also important in determining treatment, complications and prognosis. Another lesion associated with floating knee and has been widely documented, is the commitment of the ligaments of the knee and patella fractures. Other classification systems subsequently proposed to Fraser classification, do not take into account these and other elements. We think that a classification for floating knee should include four key factor for diagnosis, treatment and prognosis: lesion morphology, joint involvement, commitment soft tissue and commitment of knee ligament and patellar involvement. With this research we propose a new classification system for floating knee that takes into account these variables, and furthermore, is simple and provides important information for diagnosis, treatment and prognosis(AU)

Analysis of risk factors to acute lung injury based on multiple trauma * / 重庆医学

Objective To investigate the risk factors to acute lung injury based on multiple trauma to provide a theoretical basis for early intervention .Methods The emergency surgical patients with multiple trauma in our hospital from March 2006 to March 2011 were selected .The patients meeting the diagnostic criteria for acute lung injury were taken as the study group and the others as the control group .All patients were enrolled for evaluating the injury severity score (ISS) ,acute physiology and chronic health Ⅱ(APACHE Ⅱ) score and recording smoking ,alcohol abuse ,diabetes mellitus ,number of organ damage ,gastrointestinal bleeding , pulmonary contusion ,diffuse intravascular coagulation (DIC ) ,vomiting ,traumatic shock ,time to correct shock ,blood transfusion . The polymorphism of rs3788853 ,rs13306087 ,rs12709426 of angiotensin-converting enzyme(ACE) gene were analyzed .Results In the study group and the control group ,there were statistical differences in 6 influencing factors of the ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,time to correct shock>6 h(P0 .05);the 6 kinds of influencing factors were risk to acute lung injury based on multi-ple trauma by Logistic regression analysis .Conclusion The ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,long time to correct shock are the risk factors to acute lung injury based on multiple trauma .

Rodilla flotante en adultos: 30 años de revisión / Floating knee in adults: a 30 years review

La rodilla flotante es la asociación simultánea de fracturas ipsilaterales del fémur y la tibia que incluye una combinación de fracturas diafisiarias, metafisiarias e intraarticulares. Su tratamiento representa un reto terapéutico. Se realizó un estudio retrospectivo, analítico, observacional de cohorte hospitalaria conducido en un centro de IV nivel. Se incluyeron todos los pacientes de ambos sexos con edad igual o mayor a 16 años, que ingresaron con diagnóstico de rodilla flotante, desde enero 1980 a diciembre 2010. Se incluyeron 314 pacientes. 71 % de sexo masculino y edad promedio de 28,22 años. El grupo etario de 16-25 años fue el más afectado. 66% fueron abiertas. Los accidents automovilísticos fueron la causa en 92% de los casos. 58% fueron tipo I de Fraser. La técnica quirúrgica que se relacionó con los mejores resultados clínicos y radiológicos al término del seguimiento fue el enclavado endomedular bloqueado tanto para el fémur como para la tibia. La tasa de infección fue 14% y mortalidad del 6%(AU)

A floating knee is the simultaneous ipsilateral association fractures of the femur and tibia which includes a combination of diaphyseal, metaphyseal and intraarticular fractures. lts an high-energy injury caused trauma and is associated with high risk of morbidity and mortality. Treatment of floating knee representa a therapeutic challenge. We performed a prospective, analytic cohort observational hospital conducted a level IV center. We included all patients of both sexes, aged greater than or equal to 16 years, admitted with the diagnosis of knee Floating Hospital Universitario de Los Andes, from January 1980 to December 2010. 314 patients were found. 71 % were male and mean age 28.22 years. The age group 16-25 years was the most affected. 66% were open. The cause was motor vehicle accidents in 92% of cases. 58% were type I Fraser. The surgical technique was associated with better clinical and radiological follow-up was at the end of the locked intramedullary nailing both the femur and tibia for. The infection rate was 14% and mortality of 6%(AU)

The effection of Shenfu Injection (Ginseng-radix aconitum Injection) to the coagulation in the patient of multiple trauma complicated with shock / 中华急诊医学杂志

Objective To investigate the effection of Shenfu Injection (Ginseng-radix aconitum Injection)to the blood coagulation system and its prognosis in the patient of multiple trauma complicated with shock.Methods We prospectively studied 90 patients of multiple trauma complicated with shock,who came from the emergency center of the Second Affiliated Hospital of Medicine' s college of Zhe-Jiang University and emergency department of Lishui People' s Hospital from February 2007 to December 2011,and excluded those suffered with the dysfunction of coagulation system and uncontrolled ongoing bleeding before trauma.And then these eligible patients were randomly divided into two groups:treatment group ( 45 cases ) and control group (45 cases),the control group were received the routine treatment,the treatment group were received Shenfu Injection in early stage based on the routine treatment.The two groups were measured the platelet count (PLT),prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB) before treatment and 3,7 days after treatment.Results The differences of the PLT,PT,APTT,TT,FIB between the treatment group and control group at 3,7 d after the treatment was statistically significant (P ＜ 0.05 ). Conclusions Shenfu Injection has positive regulation to the coagulation system in the patient of multiple trauma complicated with shock.

Correlation Between Pulmonary Contusion and Myocardial Contusion in Patients with Multiple Injuries

PURPOSE: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. METHODS: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). RESULTS: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with PaO2/FiO2. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. CONCLUSION: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation.

Experience on rescue of patients with severe multiple injuries after sudden disaster under field condition / 第二军医大学学报

Objective: To study the rescue strategy for patients with severe multiple injuries after sudden disaster under field condition. Methods and results: A 53-year-old female patient was referred to us after hit on the pelvis in the China Wenchuan earthquake. Her symptoms included large volume of hematuria, difficult breath, tenderness of the whole abdomen, and bedsore. Portable B ultrasound revealed effusion of abdomen and left chest cavity, and bladder rupture. Portable blood-gas analyzer indicated severe anemia + hypoxemia + hypokalemia + acidosis. Drainage was done through left chest cavity aspiration and bladder aspiration. Abdominal examination found rectal rupture (perforation), which was managed by Harttman + cystostomy followed by anti-infection treatment. The patient recovered 18 days after operation. Conclusion: The rich experience and skillful surgical management, the full play of portable equipment, the help from the local hospital, together with timely anti-infection management, are the keys to successful rescue of patients with severe multiple injuries under field condition.

Role of preoperative C-reactive protein and erythrocyte sedimentation rate in predicting postoper-ative infections following multiple fractures / 中华创伤杂志

Objective To discuss the value of preoperative C-reactive protein (CRP) and eryth-rocyte sedimentation rate (ESR) in predicting postoperative infections following multiple fractures. Methods A study was conducted in 78 patients with multiple fractures (complicated with pelvic frac-ture, ISS > 18) treated in our department from December 2006 to March 2009. CRP and ESR levels be-fore second damage control operation as well as postoperative infections were recorded. Meanwhile, the optimal cut-off value was determined by receiver operating characteristic curve and analyzed. Results There were 11 patients with postoperative infection. The preoperative optimal cut-off value of CRP was 50 mg/L, with a sensitivity of 0.909 and a specificity of 0.821. The preoperative optimal cut-off value of ESR was 27.5 mm/h, with a sensitivity of 0.818 and a specificity of 0.791. The combination tests showed the sensitivity and specificity of 0.875 and 0.900 respectively. Conclusion CRP (50 mg/L) can be a sensitive predictive index for postoperative infection in the multiple fractures (complicated with pelvic fractures). Combination test of CRP and ESR can benefit diagnosis of postoperative infection.

Damage control of severe limb(finger) with multiple injuries / 中华显微外科杂志

Objective To explore the strategy of damage control in clinic treatment of severe limb (finger) with multiple injuries.Methods Severe multiple injuries patients with ISS evaluation more than 16 points were chosen for this study.Simple replatations of severed limb(finger) were perfored in 40 patients while their multiple injuries were actively treated.Results Among the 40 cases, all cases survived.1-3 years follow-up showed that the results were excellet in 8, good in 21, middle in 7, and poor in 4, with an excellent or good rate of 72.5 percent.Conclusion Multiple specialties cooperation, early treatment of multiple injuries and experienced microsurgery operation are the keys to improve success rate of replantation of severed limb(linger) with multiple injuries.

Diagnosis and Treatment of 42 Cases of Multiple Injuries with Pancreatic Injury / 华中科技大学学报（医学）（英德文版）

In order to summarize the clinical diagnosis and treatment methods for 42 cases of mul- tiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carded out in our hospital. Most cases were associated with hemopneumothorax and rib fractures (52.3%), shock (50%), multiple fractures (47.6%), and severe brain injury (26.1%). In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases (97.6%) were cured (including 40 cases receiving surgical operation and one case receiving the conservative treatment). Postoperative complications occurred in 16 cases (21 cases/times): pancreatic fistula (5 cases/times) and incisional wound infection (5 cases/times), in- tra-abdominal infection (3 cases/times), stress ulcer (3 cases/times), pleural effusion (3 cases/times), pulmonary infection (one case) and wound dehiscence (1 case). The principle therapy of multiple in- juries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.

Experience about treatment of segmental and comminuted femoral fractures in multiple injuries / 中国矫形外科杂志

[Objective]To summarize the experience about treatment of segmental and comminuted femoral fractures with intramedullary nail in multiple injuries.[Method]From March 2002 to July 2006,28 patients with segmental and comminuted femoral fractures were treated surgically,13 with AO type C1,9 with C2 and 6 with C3.All of the fractures were treated with close reduction static intramedullary nail fixation.[Result]The postoperative follow-up ranged from 11 to 34 months with an average of 21 months.All of the fractures were healed.Limit load was required for 5 patients who had delayed union without special treatment.After 18-30 months the patients healed up.There were no fat embolisms.No complications such as infection,intramedullary bending or break occurred.[Conclusion]Treatment of femoral fractures with intramedullary nail is a standard method.However,to achieve satisfactory results,comprehensive treatment,careful planning and procedure should be taken for segmental and comminuted femoral fractures in multiple injuries.

Early Intramedullary Nailing Fixation for Treating Tibia and Fibula fractures in Patients with Multiple Injuries / 医学研究杂志

Objective To explore the clinic effect of earlier AO solid bone nail fixation for treating tibia and fibula fractures in patients with multiple injuries.Methods Twenty-four patients with multiple injuries combined tibia and fibula fractures were selected between January 2004 and June 2007,including 13 close fractures and 11 open fractures,8 cases of Gustilo gradeⅠ,2 casesof Gustilo grade Ⅱ,1 case of Gustilo grade Ⅲa..All patients underwent closed reduction fixation with AO solid bone nail.Of all the patients,19 had emergency operation,5 had selective operation.Results During 8～29 months following up Among 24 patients,1 case was found with deep infection,1 case complained knee pain,another cases gained excellent clinic results.Conclusion Earlier Intramedullary Nailing fixation for tibia and fibula fractures in patients with multiple injuries can not only easy for early functional exercise,but also easy for nursing care.