Chinese expert consensus on emergency surgery for severe trauma and infection prevention during corona virus disease 2019 epidemic (version 2023) / 中华创伤杂志

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Research progress in pain control and respiratory management in patients with flail chest / 中华创伤杂志

Flail chest is a severe chest trauma that is commonly associated with lung contusion, resulting in acute respiratory distress syndrome and respiratory failure, which brings challenges in clinical management. It has become a clinical consensus that surgical treatment of flail chest can rapidly restore thoracic stability, eliminate paradoxical breathing, and maintain stability of respiratory and circulatory functions. However, non-surgical interventions continue to be crucial in further improving the prognosis of patients with flail chest, such as pain management and respiratory management. In this study, the authors review the research progress in pain control and respiratory management during comprehensive treatment of patients with flail chest for better understanding of pain management and lung injury care, which may provide references for clinical treatment and further improvement of clinical prognosis and quality of life for patients with flail chest.

Chinese consensus on surgical treatment of traumatic rib fractures (2021) / 中华创伤杂志

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Trauma center model in general hospitals for patients with severe trauma: a multicenter study / 中华创伤骨科杂志

Objective:To evaluate the trauma center model in general hospitals for patients with severe trauma.Methods:The data of 1,248 patients with severe trauma (ISS≥16) were retrospectively analyzed who had been admitted to the trauma centers in 6 Chinese general hospitals from January 2019 through June 2020. They were 987 males and 261 females with an age of 50.4 years ± 15.4 years. Their injuries were caused by a traffic accident in 622 cases, falling from a height in 357 cases, a knife in 62 cases, and others (like a heavy object and fall) in 207 cases. Upon admission, their injury severity scores (ISS) were 24.9±8.5 and their Glasgow coma scores (GCS) 12.6±3.6. They were all treated in a scientific and standard manner by a multidisciplinary team at the trauma center of their specific general hospital. Recorded were deaths within 30 days after admission, 30-day mortality and causes of death.Results:All the patients were treated effectively. 101 deaths occurred within 30 days after admission, yielding a 30-day mortality of 8.1%. The main causes of death were severe craniocerebral injury in 56 cases, hemorrhagic shock in 26 cases, multi-organ failure in 11 cases and others in 8 cases.Conclusions:Establishment of trauma centers in China can make up for the disadvantage of over-division of clinical specialties in large general hospitals which has led to insufficient care for patients with severe trauma and multiple injuries. The trauma centers in general hospitals may be a feasible model to be popularized in treatment of patients with severe trauma and multiple injuries.

Treatment efficacy of damage control strategy in elderly patients with multiple injuries combined with thoracic trauma / 中华创伤杂志

Objective To investigate the efficacy of damage control strategy in treating elderly patients with multiple injuries combined with thoracic trauma and evaluate its efficacy.Methods A retrospective case-control study was performed to analyze the data of 877 elderly patients with multiple injuries combined with thoracic trauma admitted from January 2005 to December 2016.There were 574 males and 303 females,aged 65-94 years (mean,70.8 years).The patients were divided into damage control group (n =406) and non-damage control group (n =471),according to the application of damage control strategy.The injury severity score (ISS) of the damage control group and the non-damage control group were (14.4 ± 8.5) points and (13.7 ± 9.4) points,respectively.The emergency operation rate within 24 hours,the blood loss during emergency operation,the thoracic and abdominal surgery,vascular interventional embolization,thoracic fracture and limb pelvic fracture operation within 72 hours,as well as ICU treatment rate,treatment time,complications,and prognosis were compared between the two groups.Results Fifty-one cases (12.6％) in the damage control group and 93 cases (19.7％) in the non-damage control group underwent emergency operation within 24 hours (P ＜ 0.01).The blood loss during emergency operation were (465.2 ± 329.6) ml in the damage control group and (574.4 ± 437.3) ml in the non-damage control group (P ＜ 0.01).Operation time of the two groups were (108.7 ± 57.1)minutes and(123.5 ± 86.4) minutes,respectively(P ＜ 0.01).In the damage control group and the nondamage control group respectively,there were 25 cases (6.2％) and 48 cases (10.2％) of laparotomy (P ＜ 0.05),23 cases (5.7％) and six cases (1.3％) of vascular interventional embolization (P ＜0.01),41 cases (10.1％) and 29 cases (6.2％) of internal fixation for thoracic fracture (P ＜ 0.05),zero and 232 cases (49.3％) of internal fixation for fracture of limbs and pelvis (P ＜0.01),92 cases (22.7％) and 53 cases (11.3 ％) of external fixation for extremity and pelvic fractures (P ＜ 0.01).A total of 271 cases (66.7％)in the damage control group and 256 cases (54.4％)in the non damage control group were admitted to ICU (P ＜ 0.01),and the ICU treatment time was (8.1 ± 6.5) days and (10.5 ±7.4)days,respectively (P ＜ 0.01).The top three complications for the two groups were atelectasis and pulmonary infection,arrhythmia and heart failure,respiratory failure and acute respiratory distress syndrome (ARDS).In the damage control group and the non-damage control group respectively,the incidence of atelectasis and pulmonary infection were 65％ and 64.5％ (P ＞ 0.05),the incidence of arrhythmia and heart failure were 53.4％ and 60.5％ (P ＜ 0.05),and the incidence of respiratory failure and ARDS were 17.7％ and 23.8％ (P ＜ 0.05).A total of 29 cases died in the damage control group (7.1％) and 53 cases died in the non damage control group (11.3 ％) (P ＜ 0.05).Conclusions Damage control strategy should be applied to treating elderly patients with multiple injuries combined with chest injury.By simplifying or reducing emergency surgery,active ICU treatment,and focusing on the fixation of chest fractures,damage control strategy can effectively reduce complications and improve survival rate.

Value of AIS-ISS for evaluation of trauma in the elderly / 中华创伤杂志

Objective To investigate the effect and significance of AIS-ISS in assessing injury severity and prognosis of aged trauma patients.Methods A retrospective study was done on data of 2 599 patients hospitalized over 24 hours from October 2009 to September 2012.There were 597 patients aged 60 years or over (aged group) and 2 002 patients aged below 60 years (non-aged group).Injury causes,ISS,complication incidence,emergency operation rate,and ICU treatment were compared between the two groups.Results Similar in causes of injury,the two groups were mainly injured from traffic accidents and falls on the ground or from height.ISS was (10.7 ± 7.8) points in aged group and (10.4 ± 8.3) points in non-aged group,with no significant difference (t =0.653,P ＞ 0.05).Incidence of major complications was higher in aged group than in non-aged group (P ＜ 0.01).Top three complications were pulmonary infection or atelectasis (4.36％),shock (4.19％),and urinary infection (3.52％).Lower emergency operation rate (21.44％ vs 30.57％,P ＜ 0.01),higher ICU treatment (75.71％ vs 36.26％,P ＜ 0.05),and higher mortality (3.85 ％ vs 2.25％,P ＜ 0.05) were observed in aged group when compared to non-aged group.Conclusions AIS-ISS should be carefully selected to evaluate injury severity and prognosis of the aged trauma patients.Early total care should be performed for the aged trauma patients even if AIS-ISS is relatively low.

Recombinant activated factor Ⅶ for coagulopathy in patients with severe multiple injuries / 中华创伤杂志

Objective To evaluate the effect of recombinant activated factor Ⅶ (rⅦa) in treatment of hemorrhagic shock after severe multiple injuries with coagulopathy.Methods Sixteen cases of coagulopathy after severe multiple injuries administered with rⅦa between July 2011 and June 2012 were reviewed.The requirements of blood product and coagulogram variation were comparatively studied before and after rⅦa therapy.Results After rⅦa therapy,bleeding was brought to a halt in 24 hours for nine cases and in 72 hours for seven cases.In the end,13 out of the 16 cases survived in the absence of myocardial infarct,cerebrovascular accident or deep vein thrombosis.Requirements of red blood cells,fresh frozen plasma,cryoprecipitate and platelet (PLT) were decreased at 48 hours after the final therapy as compared with those at 48 hours prior to the primary therapy,but statistical significance only existed in the reduction of fresh frozen plasma and cryoprecipitate (P ＜ 0.05).The coagulogram indices including prothrombin time (PT) and activated partial thromboplastin time (APTT) at 4 hours after the final therapy presented statistical differences from those prior to the primary therapy (P ＜ 0.05).Conclusion rⅦa is an important,effective and safe auxiliary means for surgical hemostasis of coagulopathy after severe multiple injuries.

Relationship Between Nuclear Factor-Kappa B and Restenosis after Angioplasty / 中国普外基础与临床杂志

Objective To discuss the role of nuclear factor kappa B in restenosis after angioplasty.Methods Related literatures of recent 5 years were reviewed.Results Nuclear factor kappa B could lead to hyperplasia of vascular intima which resulted from proliferation and decrease of apoptosis of vascular smooth muscle cells.Conclusion Nuclear factor kappa B plays an important role in restenosis after angioplasty.