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When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces. 在院前创伤护理中何时选择鞘内通路?以色列国防军的登记研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-10-11 DOI: 10.1016/j.cjtee.2024.08.008
Mor Rittblat, Nir Tsur, Adi Karas, Sami Gendler, Zivan Beer, Irina Radomislensky, Ofer Almog, Avishai M Tsur, Guy Avital, Tomer Talmy

Purpose: Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements.

Methods: A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 - 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05.

Results: Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 - 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 - 23.3).

Conclusion: Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.

目的:在院前环境中,及时进行血管通路对于抢救大出血的创伤伤员至关重要,但在失血性休克期间,由于外周血管塌陷,实现外周静脉(PIV)通路可能具有挑战性。有人建议尽早使用骨内(IO)装置作为替代方案。本研究探讨了与 IO 通道要求相关的损伤特征和因素:方法:一项基于以色列国防军创伤登记处的登记队列研究(2010 - 2023 年)纳入了院前接受 PIV 或 IO 入路的创伤伤员。研究纳入了至少有一次PIV或IO通路尝试记录的伤员,但排除了没有血管通路的伤员。同时需要 PIV 和 IO 的伤员被归入 IO 组。单变量逻辑回归评估了与 IO 入路相关的因素。结果以几率比(OR)和 95% 置信区间(CI)的形式报告,以 p 为显著差异:在 3462 名伤员(86.3% 为男性,中位年龄为 22 岁)中,有 3287 人(94.9%)接受了 PIV 入路,175 人(5.1%)尝试过 IO 入路。在 IO 组中,30.3% 接受了冻干血浆,23.4% 接受了低滴度 O 组全血,明显高于 PIV 组。IO 组的院前死亡率为 35.0%。单变量分析显示,PIV尝试次数增加(OR = 1.69;95% CI:1.34 - 2.13)和深度休克体征(OR = 11.0;95% CI:5.5 - 23.3)与IO接入有明显关联:结论:在院前环境中,严重休克征兆与 IO 接入需求密切相关,每次连续的 PIV 尝试都会增加需要 IO 转换的可能性。在输入低滴度 O 组全血或冻干血浆的同时,院前死亡率也较高,这表明在紧急抢救情况下应使用 IO。对于严重休克的创伤伤员,建议尽早考虑 IO。
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引用次数: 0
A novel arterial coupler with non-return snap-fit connection approach optimized arterial end-to-end anastomotic technique: An experimental study. 新型动脉耦合器与非回流卡入式连接方法优化了动脉端到端吻合技术:实验研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-17 DOI: 10.1016/j.cjtee.2024.09.006
Hong-Bo Guo, Mo-Fei Wang, Ren-Qi Yin, Kang-Kang Zhi
<p><strong>Purpose: </strong>Hand-sewn anastomosis as the gold standard of vascular anastomosis cannot fully meet the requirements of vascular anastomosis in speed and quality. Various vascular couplers have been developed to ameliorate this situation. Most of them are mainly used for venous anastomosis rather than arterial anastomosis, even though it is generally acknowledged that in almost all operations involving vascular reconstruction, it is the arteries that need to be anastomosed faster and more accurately and not the veins. A dedicated device is needed for creating arterial anastomosis in an easy, timesaving, less damaging but reliable procedure. Therefore, we plan to develop a novel arterial coupler device and test pre-clinical safety and effectiveness.</p><p><strong>Methods: </strong>In this cohort study, the rationality of this novel arterial coupler was preliminarily tested by finite element analysis before it was manufactured. Several factors restrict the use of vascular couplers in arterial anastomosis, such as arterial eversion, fixation, etc. The manufactured arterial couplers underwent in vitro and in vivo experiments. In vitro, isolated arteries of beagles were anastomosed with the assistance of an arterial coupler, and the anastomosed arteries were evaluated through anti-traction tests. In animal experiments, the bilateral femoral arteries of 5 beagles served as a control group. After dissection, the femoral artery on one side was randomly selected to be anastomosed with a quick arterial coupler (QAC) (QAC group), and the femoral artery on the other side was anastomosed by the same person using an end-to-end suture technique with a 6-0 Prolene suture (suture group). The bilateral femoral arteries of 5 beagles were used for coupler-assisted anastomosis and hand-sewn anastomosis in vivo, respectively. Success rate, blood loss, anastomotic time, clamp time, total operation time, and patency rate were recorded. The patency of anastomosed arteries was assessed using vascular Doppler ultrasound, electromagnetic flowmeter, and pathological examination (6 weeks after surgery).</p><p><strong>Results: </strong>As a novel arterial coupler, QAC was successfully designed and manufactured by using poly lactic-co-glycolic acid raw materials and 3-dimensions printing technology. Its rationality was preliminarily tested through finite element analysis and related mechanical analysis methods. The isolated arteries were successfully anastomosed with the assistance of QAC in vitro testing, which showed good anti-traction properties. In animal studies, QAC-assisted arterial anastomosis has superior profiles compared to hand-sewn anastomosis in anastomotic time (7.80 ± 1.41 vs. 16.38 ± 1.04 min), clamp time (8.80 ± 1.41 vs. 14.14 ± 1.57 min), and total operation time (46.64 ± 2.38 vs. 51.96 ± 3.65 min). The results of electromagnetic flowmeter, vascular Doppler ultrasound, and pathological examination showed that QAC-assisted anastomotic arteries we
目的:手工缝合作为血管吻合的金标准,在速度和质量上无法完全满足血管吻合的要求。为了改善这种情况,人们开发了各种血管耦合器。尽管人们普遍认为,在几乎所有涉及血管重建的手术中,需要更快、更准确吻合的是动脉而不是静脉,但它们大多主要用于静脉吻合而不是动脉吻合。因此,我们需要一种专用设备,以简便、省时、损伤小且可靠的方式进行动脉吻合。因此,我们计划开发一种新型动脉耦合器装置,并对其临床前安全性和有效性进行测试:在这项队列研究中,我们在制造这种新型动脉耦合器之前,通过有限元分析对其合理性进行了初步测试。在动脉吻合术中使用血管耦合器受到多种因素的限制,如动脉外翻、固定等。制造出的动脉耦合器经过了体外和体内实验。在体外实验中,在动脉耦合器的辅助下吻合了小猎犬的离体动脉,并通过抗牵引试验对吻合动脉进行了评估。在动物实验中,5 只猎犬的双侧股动脉作为对照组。解剖后,随机选择一侧股动脉用快速动脉耦合器(QAC)进行吻合(QAC 组),另一侧股动脉由同一人使用 6-0 Prolene 缝线进行端对端缝合(缝合组)。5 只猎犬的双侧股动脉分别用于耦合器辅助吻合和体内手缝吻合。记录了吻合成功率、失血量、吻合时间、钳夹时间、总手术时间和通畅率。使用血管多普勒超声、电磁流量计和病理检查(术后 6 周)评估吻合动脉的通畅情况:结果:采用聚乳酸-共聚乙醇酸原料和三维打印技术,成功设计并制造了新型动脉耦合器 QAC。通过有限元分析和相关力学分析方法对其合理性进行了初步测试。在体外测试中,离体动脉在 QAC 的辅助下成功吻合,显示出良好的抗牵引性。在动物实验中,QAC 辅助动脉吻合术在吻合时间(7.80 ± 1.41 vs. 16.38 ± 1.04 分钟)、夹持时间(8.80 ± 1.41 vs. 14.14 ± 1.57 分钟)和总手术时间(46.64 ± 2.38 vs. 51.96 ± 3.65 分钟)方面均优于手缝吻合术。电磁流量计、血管多普勒超声和病理检查结果表明,QAC辅助吻合动脉的术后血流量(16.86 ± 3.93 vs. 10.36 ± 0.92 mL/min)和术后6周的血管通畅度均优于手缝动脉:结论:QAC 是一种设计精良、易于操作的装置,专门用于端对端动脉吻合术。结论:QAC 是一种设计精良、易于操作的装置,专门用于端对端动脉吻合术,应用该装置可缩短热缺血时间,改善吻合动脉的通畅性,从而改善预后。
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引用次数: 0
Reconstruction of Allen's type IV fingertip amputation via bilateral unequal-sized hallux osteo-onychocutaneous free flaps: A retrospective study with 5-year follow-up. 通过双侧大小不等的同侧骨巩膜游离皮瓣重建艾伦第 IV 型指尖截肢:一项为期五年的回顾性研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-14 DOI: 10.1016/j.cjtee.2024.09.005
Xiu-Zhong Li, Xiu-Yun Wang, Yi-Min Zhou, Da-Zhi Yu, Hua-Gang Zhang, Shu-Jian Hou, Ke-Cheng Lao, Xiao Fan

Purpose: The reconstruction of Allen's type IV fingertip amputation is a clinical challenge. Our team designed bilateral unequal-sized hallux osteo-onychocutaneous free flaps for the long-term reconstruction of Allen's type IV fingertip amputation and conducted a retrospective study with a 5-year follow-up aims to evaluate the effects of this technique.

Methods: A retrospective analysis with a 5-year follow-up including 13 patients with Allen's type IV fingertip amputation who were admitted to our hospital from January 2010 to January 2017 was conducted. The patients were treated with bilateral unequal-sized hallux osteo-onychocutaneous free flaps. The operation time, intraoperative blood loss, and complications were recorded, and the survival rate of the transplanted flaps was calculated. During the 5-year follow-up after operation, the nail growth time was recorded and the finger appearance was observed. At the last follow-up appointment, the length, width, and girth of the reconstructed fingertip and contralateral normal fingertip, range of motion of the reconstructed fingertip and contralateral normal fingertip, Semmes-Weinstein test (for the evaluation of tactile sensation), and two-point discrimination testing results were recorded. SPSS 22.0 software was used for the statistical analysis and the data are presented as mean ± SD.

Results: The mean operation time was (5.62 ± 0.51) h, the mean intraoperative blood loss was (34.15 ± 3.13) mL, and the survival rate of the transplanted flaps was 100%. During the 5-year follow-up, the average nail growth time was (10.14 ± 1.98) months and the average bone union time was (3.78 ± 0.91) months. The length, width, and girth of the reconstructed fingertip were (31.52 ± 3.73) mm, (17.82 ± 1.74) mm, and (59.75 ± 3.04) mm, respectively, which did not differ from those of the contralateral normal fingertip. The range of motion of the reconstructed fingertip was (12.15 ± 2.79) degrees which is different from that of the contralateral normal fingertip. The average tactile sensation evaluated via the Semmes-Weinstein test and the average two-point discrimination test of the reconstructed fingertip were (0.39 ± 0.17) g and (7.46 ± 1.14) mm, respectively, which were not different from those of the contralateral normal fingertip. The average Maryland score of feet in the donor area was 87.66 ± 7.39, which was satisfactory.

Conclusion: Bilateral unequal-sized hallux osteo-onychocutaneous free flaps are an effective method to reconstruct Allen's type IV fingertip amputations with a satisfactory appearance and good sensory function.

目的:AllenⅣ型指尖截肢的重建是一项临床挑战。我们的团队设计了双侧不等大的同侧骨-腱-皮游离瓣,用于Allen's IV型指尖截肢的长期重建,并进行了一项为期5年的回顾性研究,旨在评估该技术的效果:方法:对我院2010年1月至2017年1月收治的13例Allen's IV型指尖截肢患者进行了为期5年的回顾性分析。这些患者均接受了双侧不等大的指骨骨膜游离皮瓣治疗。记录了手术时间、术中失血量和并发症,并计算了移植皮瓣的存活率。术后 5 年随访期间,记录指甲生长时间并观察手指外观。最后一次复诊时,记录了再造指尖和对侧正常指尖的长度、宽度和周长,再造指尖和对侧正常指尖的活动范围,Semmes-Weinstein 测试(用于评估触觉)和两点辨别测试结果。统计分析采用 SPSS 22.0 软件,数据以均数±标准差表示:平均手术时间为(5.62±0.51)小时,术中平均失血量为(34.15±3.13)毫升,移植皮瓣的存活率为 100%。5 年随访期间,平均指甲生长时间为(10.14 ± 1.98)个月,平均骨结合时间为(3.78 ± 0.91)个月。再造指尖的长度、宽度和周长分别为(31.52±3.73)毫米、(17.82±1.74)毫米和(59.75±3.04)毫米,与对侧正常指尖相比没有差异。重建指尖的活动范围为(12.15 ± 2.79)度,与对侧正常指尖的活动范围不同。通过 Semmes-Weinstein 测试和两点辨别测试评估的重建指尖的平均触觉分别为(0.39 ± 0.17)克和(7.46 ± 1.14)毫米,与对侧正常指尖相比没有差异。供区足的平均马里兰评分为(87.66±7.39)分,结果令人满意:结论:双侧不等大同侧骨髁皮游离瓣是重建Allen's IV型指尖截肢的有效方法,其外观令人满意,且感觉功能良好。
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引用次数: 0
Morphometric and anatomic characteristics of pronator quadratus muscle. 发音肌的形态和解剖特征。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-10 DOI: 10.1016/j.cjtee.2024.09.004
Nurşen Zeybek, Özcan Gayretli, Yüsra Nur Şanlıtürk, Ayşin Kale

Purpose: In surgical procedures commonly employed for the management of scaphoid and distal radial fractures, the incision and dissection of the pronator quadratus muscle play a pivotal role. Nevertheless, comprehensive investigations into the anatomical intricacies of the pronator quadratus muscle have been relatively scarce within the clinical community. In light of this, our study endeavors to make a substantive contribution to the medical literature by conducting a meticulous examination of the morphology and morphometry of this muscle.

Methods: This study is a cross-sectional observational study conducted on 22 cadaveric upper extremities (44 sides) preserved between January 2005 and December 2018 at Istanbul University. The study included specimens with intact dissection areas and no prior surgical intervention. Observations focused on the morphometry of the pronator quadratus muscle and related anatomical structures. Statistical analysis was performed using SPSS v23.0, employing Student's t-test and paired t-test, with significance set at p < 0.05.

Results: Significant differences were found in the morphometric measurements of the pronator quadratus muscle between the right and left upper extremities, particularly in the vertical distance between the proximal and distal attachment points of the pronator quadratus to the radius (p = 0.008). Additionally, significant differences were observed between male and female samples for radius length (p < 0.001), ulna length (p < 0.001), pronator quadratus width (p < 0.001), and the vertical distance between pronator quadratus attachment points on both the radius (p = 0.001) and ulna (p = 0.001). Furthermore, significant correlations were identified between radius length and parameters such as the vertical distance between pronator quadratus attachment points on both the radius (p = 0.002) and pronator quadratus width (p = 0.03), and between ulna length and parameters including the vertical distances on the radius (p = 0.001) and ulna (p = 0.024).

Conclusion: In light of our comprehensive analysis, which encompasses not only the anatomical features of the pronator quadratus muscle but also its vascular supply and the organization of its neurovascular structures, we posit that our study holds significant implications for the field of orthopedic surgery. We anticipate that this research will furnish valuable insights that can inform and enhance orthopedic procedures.

目的:在治疗肩胛骨和桡骨远端骨折的常用外科手术中,切开和剥离前庭大肌起着关键作用。然而,在临床上,对握前肌复杂解剖结构的全面研究相对较少。有鉴于此,我们的研究通过对这块肌肉的形态学和形态计量学进行细致研究,努力为医学文献做出实质性贡献:本研究是一项横断面观察性研究,对象是伊斯坦布尔大学 2005 年 1 月至 2018 年 12 月期间保存的 22 具尸体上肢(44 侧)。研究对象包括解剖区域完整且之前未进行过手术干预的标本。观察的重点是发音肌和相关解剖结构的形态测量。统计分析使用 SPSS v23.0,采用学生 t 检验和配对 t 检验,显著性以 p 为标准:左、右上肢之间的旋前肌形态测量结果存在显著差异,尤其是旋前肌与桡骨近端和远端附着点之间的垂直距离(p = 0.008)。此外,男性和女性样本在桡骨长度上也存在明显差异(p 结论:男性和女性样本在桡骨长度上存在明显差异:我们的综合分析不仅涵盖了旋前肌的解剖特征,还包括其血管供应及其神经血管结构的组织,因此我们认为我们的研究对矫形外科领域具有重要意义。我们预计,这项研究将为矫形外科手术提供有价值的见解。
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引用次数: 0
Prevalence and risk factors of training-related abdominal injuries: A multicenter survey study. 与训练有关的腹部损伤的发生率和风险因素:一项多中心调查研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-10 DOI: 10.1016/j.cjtee.2024.09.003
Chuan Pang, Wen-Quan Liang, Gan Zhang, Ting-Ting Lu, Yun-He Gao, Xin Miao, Zhi-Da Chen, Yi Liu, Wen-Tong Xu, Hong-Qing Xi

Purpose: This study aims to identify the prevalence and risk factors of military training-related abdominal injuries and help plan and conduct training properly.

Methods: This questionnaire survey study was conducted from October 2021 to May 2022 among military personnel from 6 military units and 8 military medical centers and participants' medical records were consulted to identify the training-related abdominal injuries. All the military personnel who ever participated in military training were included. Those who refused to participate in this study or provided an incomplete questionnaire were excluded. The questionnaire collected demographic information, type of abdominal injury, frequency, training subjects, triggers, treatment, and training disturbance. Chi-square test and t-test were used to compare baseline information. Univariate and multivariate regression analyses were used to explore the risk factors associated with military training-related abdominal injuries.

Results: A total of 3058 participants were involved in this study, among which 1797 (58.8%) had suffered training-related abdominal injuries (the mean age was 24.3 years and the service time was 5.6 years), while 1261 (41.2%) had no training-related abdominal injuries (the mean age was 23.1 years and the service time was 4.3 years). There were 546 injured patients (30.4%) suspended the training and 84 (4.6%) needed to be referred to higher-level hospitals. The most common triggers included inadequate warm-up, fatigue, and intense training. The training subjects with the most abdominal injuries were long-distance running (589, 32.8%). Civil servants had the highest rate of abdominal trauma (17.1%). Age ≥ 25 years, military service ≥ 3 years, poor sleep status, and previous abdominal history were independent risk factors for training-related abdominal injury.

Conclusion: More than half of the military personnel have suffered military training-related abdominal injuries. Inadequate warm-up, fatigue, and high training intensity are the most common inducing factors. Scientific and proper training should be conducted according to the factors causing abdominal injuries.

目的:本研究旨在确定与军事训练相关的腹部损伤的发生率和风险因素,从而帮助正确规划和开展训练:本研究于 2021 年 10 月至 2022 年 5 月对来自 6 个军事单位和 8 个军事医疗中心的军人进行了问卷调查,并查阅了参与者的病历,以确定与训练相关的腹部损伤。所有参加过军事训练的军人都被包括在内。拒绝参加本研究或提供的问卷不完整的人员被排除在外。问卷收集了人口统计学信息、腹部损伤类型、频率、训练科目、诱因、治疗和训练干扰。基线信息的比较采用卡方检验和 t 检验。采用单变量和多变量回归分析探讨与军事训练相关的腹部损伤的相关风险因素:本研究共有 3058 名参与者,其中 1797 人(58.8%)曾在训练中腹部受伤(平均年龄为 24.3 岁,服役时间为 5.6 年),1261 人(41.2%)未在训练中腹部受伤(平均年龄为 23.1 岁,服役时间为 4.3 年)。有 546 名受伤患者(30.4%)中止了培训,84 名(4.6%)需要转诊到上级医院。最常见的诱因包括热身不足、疲劳和高强度训练。腹部受伤最多的训练科目是长跑(589 人,32.8%)。公务员的腹部外伤率最高(17.1%)。年龄≥25岁、军龄≥3年、睡眠状况不佳和既往腹部病史是训练相关腹部损伤的独立危险因素:结论:半数以上的军人曾遭受过与军事训练相关的腹部损伤。结论:半数以上的军人曾遭受过与军事训练有关的腹部损伤,热身不足、疲劳和高强度训练是最常见的诱发因素。应根据导致腹部损伤的因素进行科学、正确的训练。
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引用次数: 0
The surveillance and assessment of acute injuries in different age categories in national wrestling championships. 监测和评估全国摔跤锦标赛中不同年龄组别的急性损伤情况。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-06 DOI: 10.1016/j.cjtee.2024.09.001
Sema Can, Erkan Demirkan, Mustafa Arıcı, Mehmet İsmail Tosun, Halil İbrahim Cicioğlu

Purpose: The purpose of this study is to surveil the injuries in wrestling according to the different age categories and wrestling styles throughout the competition season.

Methods: The study was designed as a descriptive study. The study was conducted during the wrestling competition season in 2023 (from January 2023 to July 2023), which includes 5 different age categories: U-15, U-17, U-20, U-23, and seniors, along with the Turkey National Wrestling Championships. The data of injuries was recorded immediately after the acute injury was treated by the medical expert during the competitions and evaluated according to the parameters that were obtained. In the statistical analysis, the frequency and percentage values were presented as descriptive statistics and the Chi-square test was used.

Results: The study incorporated a total of 6214 wrestlers and a total of 7151 wrestling bouts were performed during these competitions. The analyses indicated that the rate of injury incidence was 42.65‰ in all wrestling styles. When taking account of the injured body parts in all wrestlers' exposures, the occurrence of injuries to the head-face, neck, trunk, upper extremity, and lower extremity, rates of 17.6‰, 1.3‰, 3.6‰, 13.5‰, and 6.6‰, respectively, were observed. According to the pre-diagnosis based on freestyle, Greco-Roman, and female wrestling styles, injuries with bleeding (39.6%, 46.3%, and 14.6%, respectively) and muscle strain (37.9%, 28.7 %, and 52.6%, respectively) most often occurred.

Conclusion: The study findings indicate that most cases of injury appeared to occur in bleeding and muscle strain in all wrestling styles. We suggest that medical experts should set up their health equipment with consideration to the injuries that occur most frequently.

目的:本研究的目的是根据不同年龄组别和摔跤风格,调查整个比赛季节摔跤运动中的受伤情况:本研究为描述性研究。研究在 2023 年摔跤比赛季节(2023 年 1 月至 2023 年 7 月)进行,包括 5 个不同年龄组别:包括 5 个不同年龄组:U-15、U-17、U-20、U-23 和老年组,以及土耳其全国摔跤锦标赛。受伤数据是在比赛期间由医疗专家对急性损伤进行治疗后立即记录的,并根据获得的参数进行评估。在统计分析中,以频率和百分比值作为描述性统计,并使用卡方检验:研究共涉及 6214 名摔跤运动员,在这些比赛中共进行了 7151 次摔跤比赛。分析表明,所有摔跤项目的受伤率均为 42.65‰。考虑到所有摔跤运动员受伤的身体部位,头面部、颈部、躯干、上肢和下肢的受伤发生率分别为 17.6‰、1.3‰、3.6‰、13.5‰和 6.6‰。根据自由式摔跤、希腊罗马式摔跤和女子摔跤的前期诊断,出血(分别为 39.6%、46.3% 和 14.6%)和肌肉拉伤(分别为 37.9%、28.7% 和 52.6%)是最常发生的损伤:研究结果表明,在所有摔跤类型中,大多数损伤似乎都发生在出血和肌肉拉伤上。我们建议医疗专家在设置医疗设备时应考虑到最常发生的损伤。
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引用次数: 0
A new approach for percutaneous ilio-sacral screw fixation: CT-based pre-operative planning with conventional fluoroscopy to reduce malposition rate and operating time. 经皮髂骶螺钉固定术的新方法:基于 CT 的术前规划与传统透视相结合,降低错位率并缩短手术时间。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-06 DOI: 10.1016/j.cjtee.2024.09.002
Xinyou Han, Qingsong Fu, Xinhua Yuan, Weibin Wang

Purpose: Percutaneous ilio-sacral screw (ISS) insertion using conventional C-arm fluoroscopy has been a widely employed technique for pelvic posterior ring fixation, particularly in developing regions. However, this approach presents technical challenges, leading to a high malposition rate. We introduced a new method for ISS insertion without additional equipment or software and suggested whether it could reduce the malposition rate and operating time.

Methods: This is a retrospective cohort study. The study included all patients who underwent percutaneous ISS fixation between January 2020 and December 2022. Patients treated with open reduction or other types of implants were excluded. The patients were divided into 2 groups based on the screw insertion method: Group A utilized the traditional dual-plane adjustment method, while Group B received the newly introduced method. In all cases, conventional C-arm fluoroscopy was the sole guidance during the surgical procedure. Malposition rate, radiation exposure, and operating time were compared between groups. Post-operative CT scans were used to assess screw accuracy using the Smith grading method. The Student's t-test or the Mann-Whitney U test was chosen for comparing the quantitative variables based on the normality test results. The Chi-squared test was utilized for comparing qualitative variables.

Results: A total of 72 patients with pelvic posterior ring disruption treated with percutaneous ISS under conventional fluoroscopy guidance were included in this study. Among them, 32 patients were in Group A and 40 patients were in Group B. In Group B, the average operation duration per screw was 33 min with 29 fluoroscopy applications, which was significantly lower than that in Group A (44 min, p < 0.001, 38 times, p < 0.001, respectively). Furthermore, the post-operative CT scan revealed that only 10.7% (6/56) of screws in Group B were inappropriately positioned according to the Smith criteria.

Conclusion: The novel method introduced in this study demonstrated a reduction in both malposition rates and operating time compared to the traditional dual-plane adjustment method. Precise pre-operative CT planning in conjunction with conventional fluoroscopy could establish this method as a widely applicable technique for percutaneous ISS fixation.

目的:使用传统 C 型臂透视经皮髂骶螺钉(ISS)插入一直是骨盆后环固定术广泛采用的技术,尤其是在发展中地区。然而,这种方法存在技术难题,导致了较高的错位率。我们引入了一种无需额外设备或软件即可插入 ISS 的新方法,并提出该方法是否能降低错位率和缩短手术时间:这是一项回顾性队列研究。研究对象包括 2020 年 1 月至 2022 年 12 月期间接受经皮 ISS 固定术的所有患者。不包括接受开放复位或其他类型植入物治疗的患者。根据螺钉植入方法将患者分为两组:A 组采用传统的双平面调整方法,而 B 组则采用新引入的方法。在所有病例中,传统的 C 型臂透视是手术过程中唯一的引导方式。比较了各组的错位率、辐射量和手术时间。术后 CT 扫描采用 Smith 分级法评估螺钉的准确性。根据正态性检验结果,采用学生 t 检验或 Mann-Whitney U 检验来比较定量变量。定性变量的比较采用卡方检验:本研究共纳入 72 例在常规透视引导下经皮 ISS 治疗的骨盆后环中断患者。其中,A 组 32 例,B 组 40 例。在 B 组中,每枚螺钉的平均手术时间为 33 分钟,透视次数为 29 次,明显低于 A 组(44 分钟,P 结论:该研究采用的新方法证明了在传统透视引导下经皮 ISS 治疗骨盆后环中断的效果:与传统的双平面调整法相比,本研究中引入的新方法可减少错位率和手术时间。精确的术前 CT 规划与传统透视技术相结合,可使该方法成为一种广泛适用的经皮 ISS 固定技术。
{"title":"A new approach for percutaneous ilio-sacral screw fixation: CT-based pre-operative planning with conventional fluoroscopy to reduce malposition rate and operating time.","authors":"Xinyou Han, Qingsong Fu, Xinhua Yuan, Weibin Wang","doi":"10.1016/j.cjtee.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.09.002","url":null,"abstract":"<p><strong>Purpose: </strong>Percutaneous ilio-sacral screw (ISS) insertion using conventional C-arm fluoroscopy has been a widely employed technique for pelvic posterior ring fixation, particularly in developing regions. However, this approach presents technical challenges, leading to a high malposition rate. We introduced a new method for ISS insertion without additional equipment or software and suggested whether it could reduce the malposition rate and operating time.</p><p><strong>Methods: </strong>This is a retrospective cohort study. The study included all patients who underwent percutaneous ISS fixation between January 2020 and December 2022. Patients treated with open reduction or other types of implants were excluded. The patients were divided into 2 groups based on the screw insertion method: Group A utilized the traditional dual-plane adjustment method, while Group B received the newly introduced method. In all cases, conventional C-arm fluoroscopy was the sole guidance during the surgical procedure. Malposition rate, radiation exposure, and operating time were compared between groups. Post-operative CT scans were used to assess screw accuracy using the Smith grading method. The Student's t-test or the Mann-Whitney U test was chosen for comparing the quantitative variables based on the normality test results. The Chi-squared test was utilized for comparing qualitative variables.</p><p><strong>Results: </strong>A total of 72 patients with pelvic posterior ring disruption treated with percutaneous ISS under conventional fluoroscopy guidance were included in this study. Among them, 32 patients were in Group A and 40 patients were in Group B. In Group B, the average operation duration per screw was 33 min with 29 fluoroscopy applications, which was significantly lower than that in Group A (44 min, p < 0.001, 38 times, p < 0.001, respectively). Furthermore, the post-operative CT scan revealed that only 10.7% (6/56) of screws in Group B were inappropriately positioned according to the Smith criteria.</p><p><strong>Conclusion: </strong>The novel method introduced in this study demonstrated a reduction in both malposition rates and operating time compared to the traditional dual-plane adjustment method. Precise pre-operative CT planning in conjunction with conventional fluoroscopy could establish this method as a widely applicable technique for percutaneous ISS fixation.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Autologous osteoperiosteal transplantation for cystic osteochondral lesions of the talus: Bone reconstruction is essential. 自体骨骨膜移植治疗距骨囊状骨软骨损伤:骨重建至关重要。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-08-28 DOI: 10.1016/j.cjtee.2024.08.006
Yuxuan Wei, Zhuhong Chen, Nian Sun, Zhu Tang, Hao Guo, Canjun Zeng

Purpose: Autologous osteoperiosteal transplantation (AOPT) is one of the most feasible and effective techniques for cystic osteochondral lesions of the talus (OLT). However, few reports have been reported about the process of graft-host bone healing and bone articular surface reconstruction, which help us to further understand the actual situation of bone healing and modify surgical methods.

Methods: We retrospectively evaluated 33 osteochondral lesions in 30 patients undertaking AOPT for OLT with subchondral cysts from December 2016 to October 2021. According to CT observation, we used 4 variables to describe the bony articular repair, including the integration of the articular surface, the height of the bone filling, the status of bone union, and the appearance of bone resorption or cystic change. We also analyzed the demographic data and clinical function. Descriptive statistics were used for demographic and clinical variables. Normally distributed data were presented as mean ± SD, and non-normally distributed data were presented as median (Q1, Q3). Associations between these variables and the primary clinical outcomes were examined using t-test or one-way ANOVA test for continuous variables.

Results: The patients' mean age was (41.7 ± 14.0) years old and the mean follow-up time was (29.6 ± 17.8) months. The chondral lesion size was (14.3 ± 4.1) mm. The cyst depth was (10.9 ± 3.7) mm. Significant improvements were observed in functional outcomes (according to the numeric rating scale for pain when walking and the American orthopedic foot and ankle society score) between the preoperative and latest follow-up evaluations, from 4.2 ± 2.1 to 2.2 ± 2.0 (p < 0.001), and from 66.8 ± 12.9 to 83.2 ± 10.4, respectively (p < 0.001). The overall satisfaction reached 8.3 of 10 points. All patients returned to sports and their median daily steps reached 8000 steps with 27 (81.8%) patients walking over 6000 steps daily. According to CT observation, "discontinuous bony articular surface and gap > 1 mm" was found in 27 grafts (81.8%), and "below the level of the adjacent articular surface, ≤ 1 mm" in a third of the grafts. Abnormal height of bone filling affected numeric rating scale score (p = 0.049) and American Orthopedic Foot and Ankle Society score (p = 0.027). Of note, bone resorption or cystic changes appeared in up to 13 autografts (39.4%).

Conclusions: AOPT is an effective and acceptable technique for cystic OLT. Bone reconstruction is essential for large cystic OLT. How to get better bony articular reconstruction and avoid cyst recurrence should still be paid more attention.

目的:自体骨骨膜移植(AOPT)是治疗距骨囊状骨软骨病(OLT)最可行、最有效的技术之一。然而,关于移植物-宿主骨愈合和骨关节面重建过程的报道却很少,这有助于我们进一步了解骨愈合的实际情况并修正手术方法:我们回顾性评估了2016年12月至2021年10月接受AOPT治疗OLT伴软骨下囊肿的30例患者的33处骨软骨病变。根据CT观察结果,我们用4个变量来描述骨关节修复情况,包括关节面的整合情况、骨填充高度、骨结合状况以及骨吸收或囊变的出现。我们还分析了人口统计学数据和临床功能。人口统计学和临床变量采用描述性统计。正态分布数据以均数 ± SD 表示,非正态分布数据以中位数(Q1、Q3)表示。对于连续变量,采用 t 检验或单向方差分析检验这些变量与主要临床结果之间的关系:患者的平均年龄为(41.7±14.0)岁,平均随访时间为(29.6±17.8)个月。软骨病变大小为(14.3 ± 4.1)毫米。囊肿深度为(10.9 ± 3.7)毫米。在术前评估和最近一次随访评估之间,功能结果(根据行走时疼痛的数字评分量表和美国矫形足踝协会评分)有明显改善,27 例移植物(81.8%)的功能结果从(4.2 ± 2.1)降低到(2.2 ± 2.0)(p 1 mm),三分之一的移植物的功能结果为 "低于邻近关节面水平,≤ 1 mm"。骨填充高度异常会影响数字评分量表评分(p = 0.049)和美国矫形足踝协会评分(p = 0.027)。值得注意的是,多达 13 例自体移植物(39.4%)出现骨吸收或囊变:结论:AOPT 是一种有效且可接受的囊性 OLT 技术。结论:AOPT是治疗囊性OLT的有效且可接受的技术,骨重建对大囊性OLT至关重要。如何更好地进行骨关节重建,避免囊肿复发,仍需进一步关注。
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引用次数: 0
FM1-Editorial board FM1-编辑部
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-08-27 DOI: 10.1016/S1008-1275(24)00087-7
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引用次数: 0
Recurrent spinal subdural hematoma following percutaneous kyphoplasty: A unique case report. 经皮椎体后凸成形术后复发性脊柱硬膜下血肿:一份独特的病例报告。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-08-17 DOI: 10.1016/j.cjtee.2024.08.005
Wen-Hui Liu, Xin-Min Lin, Xin-Yu Lu, Hai Han, Liang-Zhi Zhang, Hai-Xian Lin, Zi-Wen Liu

Spinal intradural (subdural and subarachnoid) hematoma following percutaneous kyphoplasty is an extremely rare complication. In this report, we described a case of 2 episodes of subarachnoid hemorrhage with delayed paralysis after kyphoplasty. A 73-year-old man underwent percutaneous kyphoplasty in our hospital an osteoporotic vertebral fracture at the T12 level. On the 55 h after kyphoplasty for T12 osteoporotic vertebral fracture, he developed paralysis of the lower limbs. An emergency posterior decompression from T8 to L2 was performed. And the subarachnoid hematomas were removed. Postoperatively, the neurological symptoms improved rapidly. However, 2 weeks after the operation, the patient experienced a setback with severe neurological decline (paraplegia with sensory and autonomic dysfunction). An emergency posterior decompression from T5 to L2 was performed. The subarachnoid hematomas were removed. This case reflects the cause and progression of spinal subdural hematoma. Previous literature has debated the best treatment approach for spinal subarachnoid hemorrhage, but the prognosis of patients is heavily dependent on precise symptom evaluation and localization.

经皮椎体后凸成形术后出现脊髓硬膜内(硬膜下和蛛网膜下腔)血肿是一种极为罕见的并发症。在本报告中,我们描述了一例椎体后凸成形术后发生两次蛛网膜下腔出血并伴有延迟性瘫痪的病例。一名 73 岁的男性因 T12 水平骨质疏松性脊椎骨折在我院接受了经皮椎体后凸成形术。在接受椎体后凸成形术治疗 T12 骨质疏松性脊椎骨折 55 小时后,他出现了下肢瘫痪。医生紧急为他进行了从 T8 到 L2 的后路减压术。并清除了蛛网膜下血肿。术后,神经症状迅速好转。然而,术后两周,患者出现了严重的神经功能衰退(截瘫,伴有感觉和自主神经功能障碍)。医生紧急实施了从 T5 到 L2 的后路减压术。蛛网膜下血肿被清除。该病例反映了脊髓硬膜下血肿的病因和进展。以往的文献对脊髓蛛网膜下腔出血的最佳治疗方法存在争议,但患者的预后在很大程度上取决于精确的症状评估和定位。
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引用次数: 0
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Chinese Journal of Traumatology
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