Polytrauma with thoracic and/or abdominal injuries: experience in 1 540 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries.</p><p><b>METHODS</b>The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively.</p><p><b>RESULTS</b>In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% (181/1 206) and 79.9% (612/766) in patients with thoracic and abdominal injury (P<0.01), 5.2% (39/758) and 31.7% (142/448) in patients with blunt and penetrating chest trauma (P<0.01), and 72.45% (359/496) and 93.7% (253/270) in patients with blunt and penetrating abdominal injuries (P<0.01), respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9% (75/950) and 3.6% (21/590), respectively (P<0.01). Most patients died from exsanguination.</p><p><b>CONCLUSIONS</b>The first "golden hour" after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.</p>

Management of severe pelvic fracture associated with injuries of adjacent viscera / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.</p><p><b>METHODS</b>The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.</p><p><b>RESULTS</b>To cease massive bleeding due to pelvic fracture, ligation of internal iliac arteries was performed on 33 cases, and angioembolization on 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 8.86% (7/79); the main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4 cases, thrombosis of right common iliac artery in 1, ARDS following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.</p><p><b>CONCLUSIONS</b>Prompt diagnosis and proper treatment are the key to success. Devascularization of internal iliac arteries with external fixation cage of the pelvis, cystostomy and proximal sigmoidostomy are effective procedures in emergency treatment of the critical patients.</p>

Management of severe pelvic fracture associated with injuries of viscera / 中华外科杂志

<p><b>OBJECTIVE</b>To probe the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.</p><p><b>METHODS</b>The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.</p><p><b>RESULTS</b>Ligation of internal iliac arteries was performed in 33 cases for ceasing massive bleeding due to pelvic fracture, and angioembolization in 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 9% (7/79); The main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4, thrombosis of right common iliac artery in 1, acute respiratory distress syndrome (ARDS) following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.</p><p><b>CONCLUSIONS</b>Prompt diagnosis and proper treatment were the key of the success. Devascularization of internal iliac arteries with external fixation cage of pelvis, cystostomy and proximal sigmoidostomy were effective procedures frequently used in the emergency treatment of the severe pelvic fracture patients.</p>