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Objective To investigate the safety and effectiveness of vacuum sealing drainage treatment on limb salvage in multiple trauma patients combined with Gustilo type ⅢC fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 102 patients diagnosed with multiple trauma combined with Gustilo type Ⅲ C fracture admitted to Tongji Hospital from October 2005 to October 2015.There were 66 males and 36 temales,aged 17-65 years [(34.2 10.1) years].The injury severity score (ISS) ranged from 18 to 26 points [(19.8 ± 3.2)points].There were 34 patients with femur fracture,66 with tibia/fibula fracture,35 with femur and tibia/fibula fracture.Among the patients,58 were treated with VSD (VSD group) and 44 were treated with routine dressing change after emergency operation (routine group).The two groups were compared for active bleeding,re-vascular exploration,osteofascial compartment syndrome,wound infection and necrosis,gas gangrene,delayed amputation,systemic inflammatory response syndrome (SIRS),sepsis,deep venous thrombosis (DVT)incidence,per capita debridement times,length of stay,skin graft/skin flap rate,fracture fixation rate,incidence of refractory wounds,incidence of nonunion,incidence of complete nerve damage,British medical research council (BMRC) score,and amputation rate/salvage rate.Results All patients were followed up for 6-14 months [(8.4.2.1) months].There was no significant difference in limb salvage rate between the two groups after operation (P ＞ 0.05).Among the indexes of limb salvage treatment after operation,no significant differences were found between the routine group and VSD group in active bleeding,gas gangrene,re-vascular exploration and delayed amputation (P ＞ 0.05);the wound infection and necrosis rates were 32％ and 15％ (P ＜ 0.05);the incidence rates of osteofascial compartment syndrome were 22％ and 7％ (P ＜ 0.05).During the hospital stay,there were no significant differences in DVT incidence and fracture internal fixation rate between the two groups;SIRS incidence rates of routine group and VSD group were 92％ and 73％ (P ＜0.05);the incidence rates of sepsis were 28％ and 10％ (P ＜ 0.05);the per capita debridement times in routine group and VSD group were 4.2 times and 3.2 times,respectively (P ＜ 0.05);hospitalization durations were 42.1 days and 30.2 days (P ＜0.05);skin graft/skin flap rates were 69％ and 46％ (P ＜ 0.05).In the follow-up results,there was no significant difference in the amputation rate/salvage rate between the two groups (P ＜ 0.05).The incidence of refractory wounds was 28％ in routine group and 10％ in VSD group (P ＜ 0.05);the incidence of nonunion was 22％ and 6％ (P ＜ 0.05);the incidence of complete neurological damage was 36％ and 12％ (P ＜ 0.05);the excellent and good rate of BMRC score was 83％ and 96％ (P ＜ 0.05).Conclusions VSD technology can promote wound healing after operation,prevent complications,reduce the number of debridement operations and shorten hospital stay,significantly improving the prognosis and limb function of patients.It is a relatively safe and effective method for the treatment of multiple trauma combined with Gustilo type Ⅲ C fracture.
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Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in 143 multiple trauma patients combined with spine and spinal cord injuries admitted to our department between March 2004 and March 2009.The parameters including injury cause,segment of injuries,associated injuries,complications,treatment methods and outcomes were analyzed.Results Falling and traffic accidents were the main causes for the injuries of spine and spinal cord,accounting for 53.8%(77 cases)and 38.5%(55 cases),respectively.The injured segments involved 101 lumbar vertebrae(50.8%),61 thoracic vertebrae(30.7%),29 cervical spines(14.6%)and 8 sacrococcygeal vertebrae(4.0%).The associated injuries were located at chest(163 regions,38.6%),abdomen(84 regions,19.9%),head and neck(77 regions,18.3%),extremity(65 regions,15.4%),face(17 regions,4.0%)and body surface(16 regions,3.8%).The early complications included electrolyte disturbances in 33 patients (16.8%),respiratory infection in 30(15.3%)and abdominal distention in 19(9.7%).The late complications were malnutrition in 26 patients(13.3%),amyotrophy in 23(11.7%)and deep vein thrombus in 11(5.6%).Treatment methods were operations and expectant treatments in 106 patients (74.1%)and 37(25.9%)respectively.According to American Spinal Injury Association(ASIA)scale,there were 20 patients(14.0%)at grade E before treatment and 53(37.1%)at grade E after treatment.Of all,12 patients were died of mainly multiple organ failure(MOF),cerebral hernia and malnutrition,with mortality rate of 8.39%.There showed an increase of complication and mortality rate with increase of ASIA grade(P ＜ 0.05).Conclusions The spine and spinal cord injuries in patients with multiple trauma are mainly caused by high energy injuries and characterized by high injury severity,complex associated injuries,multiple complications,difficult management and high mortality rate.
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Objective To study the alteration of microbial population distribution and resistance of clinical bacterial isolates in patients with severity muhiple injuries. Methods The distributed Features of 432 strains of infection germs detected among the patients with severe muhiple iniuries admitted into hospital from January 2004 to December 2006 were statistically analyzed during. Results In the total 432 strains,the G accounted for 62.9%(272/432),dominated mainly by pathogens including Pseudomonas aeruginosa,Acinetobacter baumanni I and Escherichia Coli.The G+accounted for 37%(160/432),mainly including Staphylococcus anreus,enterococci and coagulase negative staphylococcus (CNS).Mixed infection rate was 41.1%.The isolating rate of enterococci.CNS and Sten Matophilia was obviously upgraded. Conclusions The source of infection in patients with severity multiple injuries is Gram-negative bacterium,suggesting that surveillance of bacterial resistance and rational use of antimicrobial agents should be emphasized during clinical therapy.
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BACKGROUND: Caspase family is viewed as the executive factor of cell apoptosis. Neuronal apoptosis happens probably after spinal cord injury.OBJECTIVE: To observe the changes in caspase-3 expression after spinal cord injury in rats so as to probe into the relationship between it and neuronal apoptosis and provide the evidence on the prop e r time window of intervention on alleviating secondary spinal cord injury.DESIGN: Self-control and mutual-control were designed in animal experiment.SETTING: Department of Traumatic Surgery and Department of Orthopedics of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.MATERIALS: The experiment was performed in Experiment Room of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January to December 2001, in which, 54SD rats were employed, of either sex, mass weighted varied from 220 to 250 g and provided from Animal Experimental Center of Tongji Medical College of Huazhong University of Science and Technology.rats were divided into the control and injury group. Laminectomy was only done on Ts and T9 in the control and the injury group was subdivided into 9 subgroups, in which, the materials were collected on the 4th and 8th hours and on the 1st, 2rd, 3rd, 7th 14th and 21st days successively, 6 rats in each one. After abdominal anesthesia with 30 g/L pentobarbitol sodium,sternal cord on T8 andT9 segments were exposed with Nystrom method and 50 g weight compressed the front middle region of the spinal cord of such segments with arch smooth metal pad 2.2 mn×5.0 mm for 5 minutes. After injury, artificial bladder urination was done 3 times at 10:00, 16:00and 22:00 successively everyday till the bladder reflex was established.cord was collected at various time spots after spinal cord injury. 4 pieces of spinal cord tissue masses from each group, about 8mm in length, were embedded with paraffin and sectioned continuously. Afterwards, HE staining, immunohistocheistry and TUNEL (TdT-mediated dUTP-biotin nick end labeling) were performed successively. Two rats were sacrificed on ice in each group and central tissue of injured spinal cord was placed in expression was assayed with immunohistochemistry method, neuronal apoptosis was assayed with TUNEL method and linear correlation was used to analyze the correlativity between caspase-3 expression and neuronal apoptosis.pase-3 expression after spinal cord injury in rats of each group.RESULTS: Six rats were maintained in each group and included in result optic microscope: Extensive hemorrhage appeared in 1 hour in injured segment. In 4 to 8 hours, spinal structure began destructive and a large amount of neuronal death appeared. In 24 hours, the destruction of spinal cord became severe and in 7 to 21days, the range of injury was defined with immunohistochemistry in rats of each group: Very few caspase-3 expressions (2.1±0.5) presented in neurons of spinal cord in normal rat. In 8hoursafter spinal cord injury, caspase-3 expression of positive neurons was increased remarkably (89.2±10.5) and up to the peak (189.6±12.7) in 3 days. Caspase-3 expression of positive cell and apoptotic cell appeared alexpression assayed with transcription-polymerase chain reaction (RT-PCR)in rats of each group: Caspese-3 mRNA (0.442±0.024) began increased in 4h, was up to the peak (0.634±0.028) in 48 hours and was restored to be normal (0.351±0.013) in 7 days, which appeared early than apoptosis, indicating positive correlation with the level of neuronal apoptosis (r=0.622).In the control and 4 hours group, stained cell was seen occasionally and positive cell appeared 8 hours later, mainly localized in gray matter. Afterwards, positive cell was increased and up to the peak in 3 days. In 7 days,positive cell of apoptosis and staining was decreased gradually in gray matter, mainly around the white matter. Little amount positive cells appeared on the 14th day and 21st day.CONCLUSION: In normal spinal cord tissue, caspase-3 existed in form of zymogen with very low activity. Caspase-3 is enhanced in expression after spinal cord injury in rats, expresses in large amount in 8 hours and is up to the peak in 24 to 48 hours, which is overlapped in time with positive apoptotic cell assayed with TUNEL and concerning to the localization, it is in conformity with positive apoptotic cell of spinal cord injury compared with positive cell of caspase-3. It is indicated that caspase-3 is involved in regulation of cell apoptosis after spinal cord injury. It is seen in this experiment that the time from spinal cord injury to the activation of caspase-3 is the time window of treatment for cell apoptosis intervened by spinal cord and alleviating secondary spinal cord injury. It is suggested that genetic intervention or specific caspase-3 inhibitor should be applied in 48 hours.
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Objective To study relationship between blood-glucose change and prognosis of the patients after severe traumatism.Methods 70 cases severe traumatic emergency patients selected tested the level of blood-glucose instantly when they presented themselves to the clinic after injury,used saccharimether and blood-glucose test paper provided by the Johnson Limited Corporation,and 30 slight traumatic emergency patients at the same time were selected as contrel.Result The blood-glucose after severe traumatic were markedly higher than that of slight traumatic group,which have significance(P