Chinese Journal of Traumatology最新文献

Rhabdomyolysis (RM) is a multifactorial clinical syndrome characterized by the disintegration and necrosis of muscle tissue, leading to the release of cellular contents into the circulation. One of the most severe complications of RM is acute kidney injury, with a mortality rate of 20%-50%. Early and timely diagnosis is the key to improving the prognosis of patients with RM. The etiology of RM is complex and associated with various traumas, drugs, medications, and hereditary diseases, and the clinical symptoms are nonspecific. Therefore, its diagnosis highly relies on the doctor's experience and the level of medical equipment. However, RM often occurs in situations with limited medical resources, such as natural disasters, battlefields, and large-scale traffic accidents. In these scenarios, the varying levels of expertise among rescue personnel can lead to delays in diagnosis and treatment, thereby increasing the risk of mortality. This article provides a comprehensive review of the etiology, pathogenesis, complications, diagnostic, and treatment methods of RM. It also aims to offer new perspectives on the diagnosis and prognosis of RM by integrating machine learning and artificial intelligence. It is believed that this article can help pre-hospital rescuers and in-hospital doctors have a comprehensive understanding of RM to improve the patients' outcomes and overcome the challenges.

Purpose: Anatomical studies provide the foundation for surgical advancements, particularly in perforator-based procedures. Despite safety measures, hand injuries continue to occur, making reconstructive surgery essential for improving quality of life. Magnification techniques have transformed plastic surgery, aiding perforator-based surgeries and improving outcomes. This study aims to bridge the gap in anatomical knowledge and explore the potential benefits of dorsal metacarpal artery flap.

Methods: This prospective study, conducted from July 2021 to June 2023, focused on the dorsal metacarpal artery perforators in fresh frozen cadavers. Fresh un-embalmed cadavers without signs of trauma or deformity to the upper limb were included. The anatomical study comprised the process of injecting red latex into the arteries located at the wrist, followed by dissection and measurements of number of perforators, calibre, distance of perforators from metacarpal head and radial styloid. In the clinical phase, hand held doppler was used to locate the perforators of the metacarpal arteries between metacarpal heads. Based on these perforators, flaps were raised for the patients with defects over the proximal fingers. Details about defect, flap and patients characteristics were tabulated and presented.

Results: The study was carried out on 6 fresh frozen cadavers (12 hands). Anatomical findings revealed the anatomical location, calibre, and consistent number of metacarpal artery perforators and dorsal carpal artery perforators supplying the dorsum of the hand. There was one perforator from 1st, 2nd, and 3rd metacarpal arteries. More than on perforators were found originating from 4th and 5th metacarpal arteries. Perforator of 1st metacarpal artery was largest in size (1.23 ± 0.27) mm. The study included 25 patients with finger defects. Metacarpal artery perforator flaps were planned to cover these defects. Successful outcome were achieved in 92% of patients.

Conclusion: Perforator-based flaps are effective for small to medium-sized hand defects, reducing the need for distant pedicled flaps. These flaps provide functional and aesthetic benefits while minimizing donor site complications. The unique anatomical insights from our study include the consistent number and location of dorsal metacarpal artery perforators, as well as their relation to key landmarks such as the juncturae tendineae and 2 bony prominences (first metacarpal head and radial styloid process).

Purpose: To construct a decision-making app for pre-hospital damage control resuscitation (PHDCR) for severely injured patients, and to make a preliminary trial test on the effectiveness and usability aspects of the constructed app.

Methods: Decision-making algorithms were first established by a thorough literature review, and were then used to be learned by computer with 3 kinds of text segmentation algorithms, i.e., dictionary-based segmentation, machine learning algorithms based on labeling, and deep learning algorithms based on understanding. B/S architecture mode and Spring Boot were used as a framework to construct the app. A total of 16 Grade-5 medical students were recruited to test the effectiveness and usability aspects of the app by using an animal model-based test on simulated PHDCR. Twelve adult Bama miniature pigs were subjected to penetrating abdominal injuries and were randomly assigned to the 16 students, who were randomly divided into 2 groups (n = 8 each): group A (decided on PHDCR by themselves) and group B (decided on PHDCR with the aid of the app). The students were asked to complete the PHDCR within 1 h, and then blood samples were taken and thromboelastography, routine coagulation test, blood cell count, and blood gas analysis were examined. The lab examination results along with the value of mean arterial pressure were used to compare the resuscitation effects between the 2 groups. Furthermore, a 4-statement-based post-test survey on a 5-point Likert scale was performed in group B students to test the usability aspects of the constructed app.

Results: With the above 3 kinds of text segmentation algorithm, B/S architecture mode, and Spring Boot as the development framework, the decision-making app for PHDCR was successfully constructed. The time to decide PHDCR was (28.8 ± 3.41) sec in group B, much shorter than that in group A (87.5 ± 8.53) sec (p < 0.001). The outcomes of animals treated by group B students were much better than that by group A students as indicated by higher mean arterial pressure, oxygen saturation and fibrinogen concentration and maximum amplitude, and lower R values in group B than those in group A. The post-test survey revealed that group B students gave a mean score of no less than 4 for all 4 statements.

Conclusion: A decision-making app for PHDCR was constructed in the present study and the preliminary trial test revealed that it could help to improve the resuscitation effect in animal models of penetrating abdominal injury.

Purpose: The fixation method commonly employed worldwide for treating unstable fractures of the posterior pelvic ring is the percutaneous iliosacral screw technique. However, prolonged operation time and frequent fluoroscopies result in surgical risks. This study aimed to investigate whether a new triangulation method could reduce operative and fluoroscopy times and increase the accuracy of screw placement.

Methods: This study is a real-world retrospective cohort analysis that examined a patient cohort who underwent percutaneous iliosacral screw fixation between January 1, 2019 and December 31, 2022. Inclusion criteria were patients (1) diagnosed with posterior pelvic ring instability who underwent pelvic fracture closed reduction and percutaneous S1 transverse-penetrating iliosacral screw placement and (2) aged >18 years. Exclusion criteria were: (1) combined proximal femoral fractures, (2) severe soft tissue injury in the surgical area, (3) incomplete imaging data, and (4) declining to provide written informed consent by the patient. The patients were divided into 2 groups according to the screw insertion method: conventional and triangulation methods. Screw placement and fluoroscopy times recorded by the C-arm were compared between the 2 methods. The accuracy of screw placement was evaluated by Smith grading on postoperative CT. Normality tests were conducted to assess the distribution of the quantitative variables and the Chi-square test was used to compare the qualitative variables.

Results: The study included a total of 94 patients diagnosed with posterior pelvic ring instability, who underwent percutaneous iliosacral screw placement. The patients were divided into 2 groups: 46 patients treated with the conventional surgical method and 48 patients received the triangulation method. The operation time (61.13±9.69 vs. 35.77±6.27) min and fluoroscopy frequency times (52.15±9.29 vs 24.40±4.04) of the triangulation method were significantly reduced (p<0.001).

Conclusions: The use of a triangular positioning technique for the surface positioning of percutaneous iliosacral screws could reduce the operative time and fluoroscopy frequency. And screw placement accuracy using this new method was comparable to that using other conventional methods.

Purpose: Attention-deficit/hyperactivity disorder (ADHD) increases the risk of road traffic injuries through various mechanisms including higher risky driving behaviors. Therefore, drivers with ADHD are shown to be more prone to road traffic injuries. This study was conducted in a community-based sample of drivers to determine how ADHD affects driving behavior components.

Methods: At the cross-sectional phase of a national population-based cohort, a representative sample of 1769 drivers were enrolled. Manchester driving behavior questionnaire and Conners' adult ADHD rating scales were used to assess driving behavior and ADHD symptom scores, respectively. Data were analyzed using Stata version 17. Multiple linear regression was used to investigate the association of driving behavior with ADHD while adjusting for the potential confounding role of age, sex, marital status, educational level, driving history, etc. RESULTS: According to the results, the normalized driving behavior score of drivers with ADHD was 4.64 points higher than drivers without ADHD. Having an academic compared to school education, increased the driving behavior score by 1.73 points. The normalized driving behavior score of drivers under 18 years of age was 6.27 points higher than drivers aged 31 - 45 years. The score of the aggressive violation subscale of drivers with ADHD was 7.33 points higher than drivers without ADHD compared to an increment of a range of 4.50-4.82 points for other driving subscales. The score of the ordinary violation subscale of female drivers was 2.23 points lower than that of male drivers. No significant relationship was found between sex and other subscales of driving.

Conclusion: Drivers with ADHD who are in adolescence or early adulthood exhibit more dangerous and aggressive driving behaviors than those who are older. Implementing training interventions to increase awareness of drivers with ADHD, their families, and psychologists regarding the effects of ADHD on driving is an essential step in preventing motor vehicle crashes among drivers with ADHD.