2018年 · 第21卷第05期

Purpose: Trauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran.　 Methods: This prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance system criteria were applied to define 5 types of nosocomial infections. The variables analyzed as the risk factors of infection and mortality included sex, age, mechanism of injury, site of injury, injury severity score (ISS), surgical intervention, length of hospitalization, intensive care unit (ICU) admission, and type of pathogen. Then, the incidence of nosocomial infection and also risk factors of mortality in traumatic patients were evaluated. All data analyses were performed using the statistical package for social sciences, version 15 (SPSS Inc., Chicago) and p ≤ 0.05 is considered to be statistically significant.　 Results: The incidence of nosocomial infection was 7.2% (p < 0.001). Pneumonia was the most common type of infection detected in our study. Infection led to a 7.8-fold increase in mortality of the traumatic patients (p < 0.001). Admission in intensive care units and old age were the main risk factors of mortality in infected traumatic patients. Old age, gunshot and motor vehicle accidents, trauma to extremities and abdomen, higher injury severity score, and prolonged hospitalization, made the traumatic patients more susceptible to infection.　 Conclusion: The really high incidence of nosocomial infection in traumatic patients in Iran depends on some risk factors that should be considered. Also infection increases the mortality rate in the traumatic patients, which could be reduced by eliminating its risk factors.

Fifty percent of the deaths caused by severe trauma occur within 1 h after injury. With the concepts of "golden 1 h" and "platinum 10 min" , the professionals in the field of emergency trauma treatment have agreed on the necessity of establishing a rapid and efficient trauma rescue system. However, due to the size of the hospital, the population in the neighborhood, the local economic conditions and geographical features, how to establish an optimal trauma rescue system remains an issue. In this paper, we introduced our experiences in a county-level hospital located in middle-and high-income areas.

Severe trauma has the characteristics of complicated condition, multiple organs involved, limited auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to primary hospitals to receive treatments. But the traditional mode of separate discipline management can easily lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mortality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospitals (usually the top general hospital within the administrative region of a county), can establish a scientific and comprehensive trauma care system, the success rate of trauma rescue in this region can be greatly improved. On March 1st, 2013, Tiantai People's Hospital of Zhejiang Province, China set up a trauma care center, which integrated the pre-hospital and in-hospital trauma treatment procedures, and has achieved good economic and social benefits. Till March 1st, 2017, 1265 severe trauma patients (injury severity score >16) have been treated in this trauma center. The rescue success rate reached 95% and the delayed and/or missed diagnosis rate was less than 5%. Totally 86 severe cases of pelvic fractures with unstable hemodynamics were treated, and the success rate was 92%. The in-hospital emergency rescue response time is less than 3 min, and the time from definite diagnosis to surgery is within 35 min.

Military Brain Science is a cutting-edge innovative science that uses potential military application as the guidance. It was preliminarily divided into 9 aspects by authors: understanding the brain, protecting the brain, monitoring the brain, injuring the brain, interfering with the brain, repairing the brain, enhancing the brain, simulating the brain and arming the brain. In this review, we attempt to propose the concept, content and meaning of the Military Brain Science, with the hope to provide some enlightenment and understanding of the research area.

Patients suffering from zygomatic complex fractures always present facial deformity and dysfunctions, and thereafter develop psychological and physiological problems. It is really hard to get an ideal prognosis for the zygomatic complex fractures because of the complicated anatomical structures. Computer-assisted surgery techniques, as the new emerging auxiliary methods, can optimize the surgical protocol, predict operation outcomes, and improve the accuracy and quality of the operation. Meanwhile the postoperative complications can be reduced effectively. This review aims to provide a comprehensive overview of the application of computer-assisted surgery techniques in the management of zygomatic complex fractures.

Purpose: To evaluate massive transfusion protocol practices by trauma type at a level I trauma center.　 Methods: A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained.　 Results: Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients. Overall, the mortality rate was 38.16%. The most common injury sustained among blunt trauma patients was head injury (36.21%), whereas the majority of the penetrating trauma patients sustained abdominal injuries (55.56%). Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients (p < 0.01).　 Conclusion: Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients.

Purpose: Investigation of injury patterns epidemiology among car occupants may help to develop different therapeutic approach according to the seat position. The aim of the study was to evaluate and compare differences in the incidence of serious injuries, between occupants in different locations in private cars.　 Methods: A retrospective study including trauma patients who were involved in motor vehicle accidents and admitted alive to 20 hospitals (6 level Ⅰ trauma centers and 14 level Ⅱ trauma centers). We examined the incidence of injures with abbreviated injury score 3 and more, and compared their occurrence between seat locations.　 Results: The study included 28,653 trauma patients, drivers account for 60.8% (17,417). Front passenger mortality was 0.47% higher than in drivers. Rear seat passengers were at greater risk (10.26%) for traumatic brain injuries than front seat passengers (7.48%) and drivers (7.01%). Drivers are less likely to suffer from serious abdominal injuries (3.84%) compared to the passengers (front passengers - 5.91%, rear passengers — 5.46%).　 Conclusion: Out of victims who arrived alive to the hospital, highest mortality was found in front seat passengers. The rate of serious chest injuries was higher as well. Rear seat passengers are at greater risk for serious traumatic brain injuries. All passengers have a greater incidence of abdominal injuries. These findings need to be addressed in order to develop "customized" therapeutic policy in trauma victims.

Purpose: Maxillofacial injuries are commonly encountered in the practice of emergency medicine. More than 50% of patients with these injuries have multisystem trauma that requires coordinated management between emergency physicians and surgical specialists in oral and maxillofacial surgery, otolaryngology, plastic surgery, ophthalmology, and trauma surgery. The aim of this study is to identify the patterns of brain injuries associated with maxillofacial trauma and its outcome.　 Methods: This descriptive study (cross-sectional) was carried out among 90 polytrauma patients with maxillofacial fractures attending the Emergency Department at Suez Canal university Hospital and fulfilling our inclusion and exclusion criteria.　 Results: This study demonstrates the relation between type of maxillofacial fracture and type of traumatic brain injuries in which the majority of patients with epidural hemorrhage presented with mid face fractures (60%), while the minority of them presented with upper and lower face fractures (20% for each of them). The majority of patients with subdural hemorrhage were associated with mid face fractures (75%), the majority of patients with brain contusions associated with mid face fractures (75%), and all of the patients presented by pneumocephalus were associated with mid face fractures (100%).　 Conclusion: The results of this study confirm the value of quick diagnosis and early intervention, which is fundamental to prevent morbidity as well as mortality especially with regards to prevention of traumatic brain injury as even a short duration of hypoxia and edema will lead to significant permanent neurological deficits.

Purpose: Renal denervation (RD) has been demonstrated to be an effective approach to reduce blood pressure for those with resistant hypertension. Yet, we aimed to explore the effect and possible mechanism of RD on blood-pressure response to hemorrhagic shock in spontaneously hypertensive rats.　 Methods: A total of 48 male spontaneously hypertensive rats were randomized to three groups: study group, sham-operation group and control group. RD was achieved by cutting off renal nerves and swabbing phenol on it. Ten weeks after RD, 8 rats in each group were sacrificed to collect the kidney and heart tissues. The remaining rats were subjected to an operation to induce hemorrhagic shock which would lead to 40% loss of total blood volume, and observed for 120 min. The serum concentration of norepinephrine was measured before and three weeks after RD.　 Results: The blood-pressure and norepinephrine levels were reduced significantly after RD (p < 0.05). Systolic blood pressure and diastolic blood pressure of the surgery group were higher than those in the sham and control groups at 15, 30 and 45 min after hemorrhagic shock (p < 0.05), while no significant difference was observed at 60, 90 and 120 min (p > 0.05). Additionally, the beta-1 adrenergic receptor (β1-AR) in the study group was significantly higher than those in the other two groups (p < 0.05) after hemorrhagic shock.　 Conclusion: This study demonstrated that RD could to some extent improve blood-pressure response to hemorrhagic shock in an established model of severe hemorrhagic shock in spontaneously hypertensive rats. The mechanism might be associated with up-regulation of β1-AR.

Purpose: To explore the advantages of palmar approach with Kirschner-wire (K-wire) fixation in the treatment of children's distal radius extension type fracture.　 Methods: Thirty patients, average age of 8.5 years ranging from 5 to 13 years, with distal radius extension type fracture and undergoing a failed manual reposition in our hospital were included, and treated by palmar approach with K-wire fixation between May 2014 and December 2017. Among these patients (21 male and 9 female), 5 patients had chronic injuries over 10 days, and 6 patients had fracture of the distal radius epiphysis. The time between injury and treatment ranged from 1 to 30 days. Among them, 11 patients with right-sided fractures and 19 patients with left-sided fractures were operated via the palmar longitudinal incision approach.　 Results: The results were evaluated after an average of 18 months ranging from 5 to 36 months after operation. The recovery time of fracture was from 4 to 8 weeks and all incisions were primary healing with an average of 6 weeks. Nonunion, delayed union, early closure of distal radial epiphysis, and wrist varus/valgus deformity were not found in all the cases. Based on Gartland and Wereley wrist score assessment undertaken three months after operation, excellent scores were achieved in 24 cases, good scores in 3 cases, acceptable scores in 3 cases.　 Conclusion: The palmar approach with K-wire fixation via a front longitudinal incision in the treatment of children's distal radius extension type fracture has following advantages: (1) easy to reposition for both fresh and old fractures; (2) less damage to surrounding tissues and epiphysis; (3) quick recovery. It is suitable to treat children's distal radius extension type fracture.

Die-punch fractures or impaction fractures of distal radius articular surface are difficult to treat and hard to achieve satisfactory reduction. We present a unique, percutaneous and minimally invasive technique to elevate the depressed lunate fossa and maintain the reduction of the elevated fragment with no need of grafting in such fractures. This technique is simple, reproducible and can be executed with simple instrumentations. We think it deserves a variety of implications in the treatment of distal radius fractures.

We treated a 15-year-old female patient with fracture of the post-lateral femoral condyle and the bone shifted in front of the knee. Considering that the traditional surgical approach has the shortcomings of significant trauma and poor prognosis, we designed an arthroscopic procedure, which achieved satisfactory short-term efficacy, effectively reduced and fixed the fractures, avoided damage to vascular nerves, and maximally reduced the trauma caused by surgery itself.