Tratamiento conservador no invasivo del traumatismo esplénico / Non-invasive conservative treatment of splenic trauma

RESUMEN Antecedentes: el tratamiento conservador no invasivo del traumatismo esplénico disminuye intervenciones quirúrgicas innecesarias y depende centro asistencial donde es aplicado. Objetivo: describir los resultados del tratamiento conservador no invasivo de pacientes con traumatismo abdominal cerrado con lesión esplénica y correlacionarlos con variables preoperatorias. Material y métodos: trabajo observacional descriptivo de pacientes con traumatismo abdominal cerrado con lesión esplénica ingresados entre 2012-2022. Se analizaron cinemática del traumatismo, lesiones asociadas, grado de lesión tomográfica y de hemoperitoneo, lugar de internación y resultado del tratamiento conservador no invasivo. Resultados: en 102 pacientes la cinemática del traumatismo de mayor frecuencia fue moto/auto (47,1%); el porcentaje de éxito del tratamiento conservador no invasivo fue 66,6%, y se relacionó con el grado de lesión tomográfica (p <0,001), grado de hemoperitoneo (p <0,001), presencia de otras lesiones (p <0,001), traumatismo encéfalo craneano grave (p <0,009), y lugar de internación (p <0,002). Conclusión: a pesar de no contar con todos los recursos humanos y tecnológicos recomendados, el tratamiento conservador no invasivo en esta serie tuvo resultados comparables con centros de mayor complejidad.

ABSTRACT Background: Non-invasive conservative treatment of splenic trauma reduces the rate of unnecessary surgical interventions and depends on the type of healthcare center involved. Objective: The aim of this study is to describe the outcomes of non-invasive conservative treatment in patients with blunt abdominal trauma and splenic injury and their correlation with the preoperative variables. Material and methods: We conducted a retrospective and observational study of patients admitted with blunt abdominal trauma and splenic injury between 2012 and 2022. The variables analyzed were kinematics of trauma, lesion severity on computed tomography images, amount of hemoperitoneum, type of unit of hospitalization and results of non-invasive conservative treatment. Results: Among 102 patients, the most common kinematics of trauma was motorcycle-to-car collisions (47.1%); the success rate of non-invasive conservative treatment was 66.6%, and was associated with lesion severity on computed tomography images (p < 0.001), amount of hemoperitoneum (p < 0.001), presence of other injuries (p < 0.001), severe trauma brain injury (p < 0.009), and type of unit of hospitalization (p < 0.002). Conclusion: Despite the absence of recommended human and technological resources, the results of non-invasive conservative treatment in this series were comparable to those obtained in high complexity centers.

Laparoscopia con preservación de órgano en lesión esplénica en dos tiempos por traumatismo cerrado de abdomen / Laparoscopy with spleen preservation for delayed splenic rupture due to blunt abdominal trauma

RESUMEN El tratamiento no operatorio (TNO) de lesiones abdominales en traumatismo cerrado de abdomen (TCA) se basa en pilares clínicos y radiológicos. Presentamos el de caso de paciente masculino de 16 años que ingresa en el Servicio de Emergencias por dolor abdominal en hipocondrio izquierdo y antecedente de traumatismo cerrado de abdomen reciente. Se establece protocolo de TNO basado en cuadro clínico e imágenes pero, en forma posterior, ante la evolución desfavorable, se cambia la conducta y se realiza tratamiento laparoscópico conservador de órgano.

ABSTRACT Nonoperative management (NOM) of organ injuries in abdominal blunt trauma (ABT) is based on clinical and imaging test findings. We herein present a 16-year-old male patient with a history of recent blunt abdominal trauma was admitted to the emergency department for abdominal pain in the left hypochondrium. A protocol for NOM was established based on the clinical picture and imaging findings, but afterwards, in view of the unfavorable progression, the approach was modified to laparoscopic organ-preserving surgery.

STEPPING TOWARDS NON-SURGICAL MANAGEMENT: STUDY IN A TERTIARY CARE CENTRE IN A DEVELOPING NATION

Objective: To assess the emerging trend of Non-operative Management and image guided interventions over surgery in a tertiary care hospital in a developing nation. Data regarding patients who underwe Methods: nt Non-Operative Interventions (NOI) or Non-Operative Management (NOM) in VMMC and Safdarjung hospital, New Delhi, India over past 3 years was collected retrospectively from hospital database. Max diameter of liver abscess mana Results: ged nonoperatively ranged from 3.5 to 14 cm. Mean diameter was 7.15 +/- 3.20 cm. Mean volume of the abscess was 538 ml. 43.33% of the abscesses were ruptured. 73.33% of the patients underwent pigtail insertion and the rest underwent ultrasound guided aspiration. 12 patients underwent PTBD in the center over past 3 years. All the patients had malignant etiology of some sort. 75% patients had carcinoma of Gall bladder, and the rest had biliary stricture of malignant nature. Conclusion: NOIs have revolutionized management of several entities for which surgery was sole resort until few decades back. However, these facilities come with their own set of limitations. There is a paucity in literature in the developing world regarding outcome of NOI

Do We Ever Need to Fix Clavicle Fractures in Adolescents?

@#Introduction: Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents. Materials and methods: This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 1997- 2015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening. Results: A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of nonunion. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain. Conclusion: Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Lesión quirúrgica de vía biliar compleja. Manejo conservador / Complex bile duct injury. Conservative management

RESUMEN La colecistectomía laparoscópica es el tratamiento de elección para la litiasis vesicular sintomática. Aunque la tasa de complicaciones es baja, las lesiones de la vía biliar representan un grave problema. La asociación con una lesión vascular (lesión compleja) genera un impacto adicional, disminuyendo la calidad de vida y la sobrevida a largo plazo. Presentamos el caso de una paciente con lesión compleja por compromiso vascular del pedículo hepático derecho que desarrolló una atrofia del parénquima correspondiente. Ante la ausencia de complicaciones sépticas, el tratamiento no operatorio pudo realizarse en forma exitosa.

ABSTRACT Laparoscopic cholecystectomy is considered the standard of care for symptomatic cholelithiasis. Although the rate of complications is low, bile duct injuries represent a serious problem. The association with vascular injury (complex injury) poses an additional impact by reducing the quality of life and long-term survival. We report the case of a female patient with complex injury due to vascular involvement of the right hepatic pedicle who developed right liver atrophy. Non-operative management was successful due to the absence of septic complications.

Semi-occlusive dressing as non-operative treatment vs. operative treatment for fingertip amputations: A retrospective cohort study

INTRODUCTION@#Treatment of fingertip amputations have demonstrated good outcomes with both surgical and nonsurgical management.@*OBJECTIVE@#The objective of this study was to compare non-operative treatment with semi-occlusive dressing with any surgical treatment for fingertip amputations in adult fingers, Allen types I-III in a retrospective cohort review.@*METHODS@#A retrospective chart review was done on adult patients with fingertip amputations Allen types I-III from January 1, 2018 to December 31, 2020. Patients included in the studies were distributed into two treatment groups: non-operative and operative groups. Outcomes to be measured were time to full healing, range of motion, nail deformities, Tinel’s sign, and discoloration of the reconstructed fingertip.@*RESULTS@#A total of 38 patients with 40 digits were included (19 patients with 20 digits for each treatment group). The results showed a larger defect for the operative group (3 cm2 vs 2.1 cm2), with shorter time to healing (1.4 months vs 2.2 months). There were more complications in the operative group like the Tinel’s sign, nail deformity and discoloration, as well as joint contractures. Range of motion was better for patients treated non-operatively.@*CONCLUSION@#Treatment with semi-occlusive dressing showed similar results in terms of wound healing but takes a longer time and less complications compared to operative treatment.

Advances in non-operative treatment of advanced hypopharyngeal squamous cell carcinoma / 国际肿瘤学杂志

Hypopharyngeal squamous cell carcinoma has a high degree of malignancy, hidden location, atypical early symptoms, most patients have reached advanced stage at the time of treatment. Surgical treatment will cause patients to lose laryngeal function and poor postoperative quality of life. The combined application of non-operative therapies such as radiotherapy and chemotherapy can improve the larynx preservation rate of patients and obtain a survival rate similar to that of surgical treatment. Targeted therapy has achieved better results in the treatment of hypopharyngeal squamous cell carcinoma, and immunotherapy has also made great progress in the treatment of head and neck squamous cell carcinoma, which brings new hope for patients with hypopharyngeal squamous cell carcinoma.

Analysis of risk factors related to death within 1 year after non-operative treatment of hip fractures in the elderly / 中华老年医学杂志

Objective:To analyze the risk factors for death within one year after non-operative treatment of hip fractures in the elderly.Methods:Clinical data of 83 elderly patients with hip fractures treated non-operatively from March 2012 to March 2017 who had met the criteria of inclusion and exclusion were included.They were divided into the death group and the survival group according to whether they had died within one year after non-operative treatment.Univariate and multivariate regression analysis were used to screen risk factors for death within one year after non-operative treatment.Results:Of the 83 patients, 26(31.3%)died within one year, including 10(38.5%)from pulmonary infections and 6(23.1%)from acute myocardial infarction.Univariate analysis showed that age, gender, walking ability before a fracture, number of comorbidities, coronary heart disease and COPD each had a significant impact on the death of patients within one year after receiving non-operative treatment( P<0.05). Multivariate Logistic regression analysis showed that age(≥76 years old)( OR=12.704, P=0.001), COPD( OR=5.870, P=0.042)and coronary heart disease( OR=7.451, P=0.007)were independent risk factors for death within one year after non-operative treatment. Conclusions:The mortality is as high as 31.3% in elderly patients with hip fractures within one year after non-operative treatment.The main cause of death is pulmonary infections.Age(≥76 years old), COPD and coronary heart disease are independent risk factors for death within one year after non-operative treatment.

Achados tomográficos nos traumas abdominais contusos e perfil dos pacientes / Tomographic findings in contune abdominal trauma and patient profile

O trauma é a 5ª. causa de morte no mundo e, na população com menos de 40 anos, é a maior causa de óbitos. O abdome é região frequentemente lesada e requer tratamento cirúrgico com frequência. Em se tratando de trauma contuso, exames de imagem oferecem diagnóstico mais acurado conduzindo tratamento mais adequado. O objetivo deste estudo foi avaliar a relação dos achados tomográficos, do exame físico e a prevalência das lesões. Foram selecionados 39 politraumatizados e vítimas de trauma abdominal contuso, através de um estudo prospectivo. Foram comparados exame físico e o achado tomográfico. Em conclusão, mostrou-se que a avaliação clínica isoladamente pode fazer com que lesões passem desapercebidas; a tomografia computadorizada teve boa sensibilidade e especificidade devendo ser realizada para diagnosticar e melhor guiar a terapêutica.

Trauma is the 5th cause of death in the world and, in the population under 40 years old, it is the biggest cause of death. The abdomen is a frequently injured region and often requires surgical treatment. In the case of blunt trauma, imaging tests offer a more accurate diagnosis leading to more appropriate treatment. The aim of this study was to evaluate the relationship between tomographic and physical examination findings and the prevalence of lesions. Thirty-nine polytraumatized and victims of blunt abdominal trauma were selected through a prospective study. Physical examination and tomographic findings were compared. In conclusion, it has been shown that clinical assessment alone can make lesions go unnoticed; computed tomography had good sensitivity and specificity and should be performed to diagnose and better guide therapy.

Impacto de la infección por SARS-CoV-2 (COVID-19) en el tratamiento de una lesión duodenal por arma de fuego / Impact of SARS-CoV-2 infection (COVID-19) in the treatment of duodenal gunshot injury

RESUMEN Se presenta el caso clínico de un paciente con traumatismo abdominal por herida de arma de fuego (HAF). En otra institución se realizó cirugía de exclusión pilórica y hepatorrafia por lesión hepatoduo denal. Fue derivado a nuestra institución a las 12 horas posoperatorias. Intercurre en el posoperatorio con neumonía grave por COVID-19 y complicaciones de su cirugía ini cial. La presentación severa de la enfermedad nos inclina por el manejo no operatorio. La utilización de drenajes percutáneos permitió el manejo de colecciones evitando una cirugía mayor inicial. La recuperación pulmonar facilitó la cirugía definitiva. La neumonía severa por COVID-19 en un paciente con lesión duodenal grave por HAF condiciona la toma de decisiones.

ABSTRACT We report the case of a patient with an abdominal gunshot trauma with liver and duodenal injury who underwent pyloric exclusion and liver repair in another institution. The patient was transferred to our institution 12 hours after surgery. During hospitalization, severe pneumonia due to COVID-19 and complications of the initial surgery developed. Non-surgical management was decided due to the severity of the disease. Percutaneous drainage allowed for the management of the collections avoiding a major initial surgery. Once he recovered from the pneumonia, the definite surgery was performed. Severe COVID-19 pneumonia in a patient with serious duodenal shotgun injury is a determining factor for decision-making of treatment options.

Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this reviewis to discuss the AOSTSIC systemand its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperativemanagement,with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

A prospective study of injury pattern and outcome of blunt trauma abdomen patients in a tertiary care hospital in eastern part of India

Background: Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. The evaluation and treatment of abdominal injuries are critical components in the management of severely injured trauma patients. The study was done to study pattern and outcome of BTA patients in a tertiary care hospital in eastern part of India as few studies exist in this part of the country.Methods: Prospective descriptive study conducted in in SRN Hospital, Prayagraj over a period of one year with all cases of blunt injury abdomen included with respect to inclusion criteria.Results: In our study mean age was 23.2±17.6 years. 92% were male and 8% were female RTA are responsible for most number of cases (78%). Conservative management done in 34 (68.0%) and Operative Intervention done in 16 (32.0%) cases. In our study, X-ray erect had 75% accuracy total subsets of 336 organ scans were performed on ultrasound specific injury was seen in total 50 cases and total 210 CT scans performed was able to pick up 59 injuries (p=0.0002). CECT forms the core investigation of choice in dealing with blunt injury abdomen cases. In our present study, paralytic ileus (prolonged) (31%) and pelvic intraabdominal abscess (31%) as postoperative complications.Conclusions: CECT abdomen is the investigation of the choice with RTA being the most common mode of BTA. So effort should be made to implement traffic rules. Hemodynamic instability with radiological findings useful in deciding operative versus conservative management of blunt trauma patients.

Quality of life of carpal tunnel syndrome with non operative treatment: cohort study

Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy entrapment and it interferes with the quality of life. Treatment for CTS can be divided into operative and non-operative treatment. Our objective was to compare the quality of life and pain intensity in a patient with CTS after oral treatment and local corticosteroid injection (LCI).Methods: A prospective cohort study was conducted in 18-65 years patients with CTS. Primary outcome was to compare the quality of life post oral treatment (NSAIDs, oral steroids, gabapentin) and LCI using the Short Form-36 questionnaire. Secondary output was to compare pain intensity using Numeric Rating Scale (NRS). Mann-Whitney and independent t-test were used to assess the comparison between the treatment.Results: Sixty CTS patients were included in this study, with 32 patients (53.33%) assigned to LCI. After observation one month, statistical analysis showed that LCI improved the quality of life better than oral in physical function and bodily pain components (p = 0.036 and p = 0.047). Injection treatment decreased pain intensity more than oral not statistically significant after 14 days (p=0.087), but was significant after one month (p=0.002).Conclusions: Local corticosteroid injection improved quality of life and decreased pain intensity better than oral treatment after one month.

Role of Conservative Management in High Grade Renal Injuries: Our Experience at a Tertiary Care Centre

Introduction: Renal injuries account for up to 1–5% of alltrauma related injuries. Over the years there has been a shifttowards non-operative treatment for blunt renal trauma. Theaim of our study was to assess outcomes of patients managedconservatively (non-operatively) for high grade blunt renalinjury at our centre.Material and methods: The study was conducted in aretrospective manner using hospital records of last 5 years. Allpatients with blunt renal injuries were included. These patientswere categorized based on AAST(1989) injury gradingand further subdivided into operative and non-operativemanagement groups. These management strategies wereanalyzed in terms of ‘failure of non- operative management’,complications and need for adjunctive procedures. Descriptiveanalysis was done using Microsoft Excel(2010, ver14)software.Results: Forty three patients were included in the study witha mean age of 44.6 years. Out of the total, 28 had grade I– III injuries, 11 had grade IV and 4 had grade V injuries.All the grade I-III patients were managed conservatively andrequired no adjunctive procedures. One (9%) of grade IV and2(50%) of grade V injuries underwent immediate exploration.Out of 10 cases of grade IV injuries which underwent nonoperative management, 3(30%) required delayed explorationand none of the grade V injuries required delayed exploration.Complications included urinary tract infection (UTI) (6 cases),persistent hematuria (3 cases), hypertension(2 cases), urinoma(2 cases) and ileus(2 cases) .All complications were Claviengrade 1-2 with no mortalities overall.Conclusion: If the patient is hemodynamically stable,even grade IV and V blunt renal injuries can be managedconservatively, as is seen in our study where failure of nonoperative management occured in only 30% of grade IV andnone of the Grade V injuries.

Current status regarding selective non-operative management of abdominal gunshot wounds / 解放军医学杂志

Laparotomy should be routinely performed in the cases of abdominal gunshot wounds. However, recent studies found that 20%-30% abdominal gunshot wounds were non therapeutic or negective, and some complications secondary to laparotomy, such as local infection, often developed. Selective non-operative management (SNOM) can reduce the incidence of operative complications, length of hospitalization, and medical cost, thus has been recommended for the patients with abdominal blunt and stabbing wounds. However, it remains obscure whether SNOM is suitable for patients with abdominal gunshot wounds and which patients should be suitable for SNOM. This paper aims to review the important findings from questionnaire survey, clinical practice studies, and large-scale systematic reviews, and then propose how to identify the candidates for SNOM, hoping to be helpful for improving our management strategy of abdominal gunshot wounds.

Prospective Study of Management of Solid Organ Injury in Blunt Trauma Abdomen

Blunt injury to abdomen is one of the most common injury caused by road traffic accidents. The advent of newer imaging techniques with high resolution computed tomography scanners (CT scan) has enabled the clinicians to exactly diagnose the extent of the intra abdominal injuries. High grade injuries are commonly managed by surgery but the shift to selective non operative management (NOM) of blunt injuries to abdominal solid organs are one of the most notable trends in the case of trauma. Methods: This study was conducted on 50 patients of blunt abdominal trauma admitted in Guru Nanak Dev Hospital, attached to Govt. Medical College, Amritsar. Patients of all age groups with blunt trauma abdomen were admitted in hospital. Results: In the present study, most common age group affected was 21-40 years (70%); out of which males were more commonly affected (90%); most common mode of injury was road traffic accident accounting for 76% of patients of all age groups. In this study, 2 out of 13 patients expired who were kept on NOM due to liver injuries. Failure to resuscitate these patients was the main cause of mortality. 4 out of 12 operative cases expired. Most common organ injured was liver (50%) followed by spleen (36%). Other organs injured were pancreas and kidney, 6% each. Mortality rate in patients who were receiving NOM was 5.26% while patients who received operative management had mortality rate of 33.3%. Conclusion: Morbidity and mortality can be prevented by timely initial resuscitation and correct diagnosis as well as management (non operative or operative) which depends on patient’s hemodynamic stability and findings of imaging studies.

Association between the time of neutrophils to the lowest and prognosis of patients with esophageal squamous cell carcinoma treated with non-operative therapy / 中华肿瘤杂志

Objective@#To investigate the association between the time of neutrophils to the lowest and prognosis of patients with esophageal squamous cell carcinoma (ESCC) treated with non-operative therapy.@*Methods@#The clinical data of 325 non-operative treated ESCC patients were collected in this study. The X-title software was applied to establish optimal threshold of neutrophil reduction to the lowest value. According to the optimal threshold, the patients were divided into early group (115 cases) and late group (210 cases). The clinical features and survival time of the two groups were compared, and the factors of prognosis were analyzed by Cox regression model with univariate and multivariate analysis.@*Results@#The X-title software demonstrated the optimal cutoff values for the time of neutrophils to the lowest was 39 days. The median overall survival time was 21.0 months in the early group which was significantly higher than that in the late group (16.0 months). Multivariate Cox regression analysis showed that the treatment methods and the time of neutrophils to the lowest were independent factors for overall survival of patients with ESCC treated by non-surgical therapy. Compared with radiotherapy alone, concurrent chemoradiation could benefit the survival (HR=0.64, P=0.026). The prognosis of patients in the late group of neutrophils to the lowest (HR=1.38, P=0.038) was poor compared with the early group. Furthermore, stratified by treatment methods, the overall survival of two groups showed statistically significant difference only in patients received concurrent chemoradiation. The mortality risk in the late group was higher than that in the early group (HR=3.53, P=0.010).@*Conclusion@#The time of neutrophils to the lowest is an independent prognosis factor for non-operative treated ESCC patients. The prognosis of patients in the early group is better than that in the late group.

Application of multi-mode combined analgesia in the early stage of non-operative treatment of traumatic rib fractures in adults / 中华胸心血管外科杂志

Objective@#To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-operative treatment of adult traumatic rib fractures.@*Methods@#A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females totally with a median age of(47.3±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Traditional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment(T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after injury. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared.@*Results@#The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0.05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0.05), the combined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0.05). The incidence of pneumonia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group.@*Conclusion@#In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adverse reactions.

Advance in Dynamic Functional Rehabilitation after Non-operative Treatment of Acute Achilles Tendon Rupture (review) / 中国康复理论与实践

There is no consensus on the best treatment for acute Achilles tendon rupture. Functional rehabilitation after surgical treatment has been widely recognized, but the functional rehabilitation of non-surgical treatment has not been specifically studied. Based on the clinical practice of all kinds of Achilles tendon rupture, the best dynamic functional rehabilitation scheme and evaluation method were discussed. In order to bring more effective rehabilitation strategies for patients with Achilles tendon rupture, and reduce the rate of re-rupture and complications.

Application of multi-mode combined analgesia in the early stage of non-operative treatment of traumatic rib fractures in adults / 中华胸心血管外科杂志

Objective To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-opera-tive treatment of adult traumatic rib fractures. Methods A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females total-ly with a median age of(47.3 ±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Tradi-tional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment (T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after inju-ry. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared. Results The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0. 05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0. 05),the com-bined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0. 05). The incidence of pneumo-nia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group. Conclusion In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adverse reactions.