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Relevance of intra-abdominal pressure monitoring in non-operative management of patients with blunt liver and splenic injuries. 腹腔内压力监测在非手术治疗钝性肝脾损伤患者中的相关性。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-10-30 DOI: 10.1016/j.cjtee.2024.02.006
Vivek Kumar, Ramesh Vaidyanathan, Dinesh Bagaria, Pratyusha Priyadarshini, Abhinav Kumar, Narendra Choudhary, Sushma Sagar, Amit Gupta, Biplab Mishra, Mohit Joshi, Kapil Dev Soni, Richa Aggarwal, Subodh Kumar

Purpose: Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury.

Method: A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q1, Q3) as indicated. χ2 or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance.

Results: Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention.

Conclusion: As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.

目的:非手术治疗(NOM)已被证实适用于钝性肝脾损伤。有关作为非手术治疗一部分的连续腹腔内压力(IAP)监测的文献仍不明确。本研究旨在找出临床参数与 IAP 之间的相关性,以及它们对肝脾钝性损伤患者 NOM 的影响:2018年10月至2020年1月,在一家一级创伤中心进行了一项前瞻性横断面研究,包括174名因肝脾钝性损伤而接受NOM的患者。排除了血流动力学不稳定或使用呼吸机的患者,以及头部、脊髓和/或膀胱严重损伤的患者。研究对象主要为男性(83.9%),平均年龄为 32.5 岁。对 IAP 进行了连续监测,并测量了 IAP 与各种参数、干预措施和结果的关系。数据以频率(百分比)或平均值 ± SD 或中位数(Q1、Q3)表示。分类变量采用χ2检验或费雪精确检验,连续变量则酌情采用参数检验(独立t检验)或非参数检验(Wilcoxon秩和检验)。IAP < 12 与 p 结果的临床和实验室相关性:19.0%的研究对象患有腹腔内高血压(IAH)。腹内高压与损伤严重程度评分较高密切相关(p 结论:腹内高压与损伤严重程度评分较低密切相关:作为 NOM 的一部分,应持续监测 IAP。但是,不能仅根据 IAP 值来决定是否进行手术或非手术干预。
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引用次数: 0
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
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
Dental trauma related to orotracheal intubation: Prospective study of 43 cases. 43例口气管插管所致牙外伤的前瞻性研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-13 DOI: 10.1016/j.cjtee.2024.08.007
Yosra Mabrouk, Mohamed Hbib Grissa, Souha Ben Youssef

Purpose: Orotracheal intubation is one of the most frequently used techniques in emergency procedures and especially in anesthesia and resuscitation. Teeth may be "victims" of the orotracheal intubation. Several factors may predispose to these accidents. The aim of this study is to determine the incidence of oral trauma that occurs during scheduled and urgent oral tracheal intubation, and identify the risk factors, the types and locations of these dental injuries.

Methods: It is a cross-sectional study that lasted 6 months from June to November 2022. This study was carried out in several departments. An examination of the dental and periodontal status of patients who will undergo surgery under general anesthesia was performed before the operation according to the surgical program. Yet, in emergency settings, this examination was not possible. Patients with anterior edentation and patients refusing participation in the study were excluded. After the surgery, included patients were examined to detect eventual dental trauma such as fracture, luxation, and contusion. Collected data were entered and analyzed using SPSS version 18 software. The Wilcoxon Mann-Whitney U test was used to compare quantitative variables. The Chi-square test was used to compare qualitative variables with a statistical significance level of 5% (p < 0.05).

Results: There were 43 patients included in the study, and dental trauma was noted in 11 patients (25.6%). Their mean age was (59.8 ± 15.4) years. The statistical analysis shows that there is a significant relationship between age (over 40 years old) and trauma (p = 0.004). Among the traumatized group, orotracheal intubation was undergone for 8 cases according to the surgical program whereas it was performed, for 3 cases, in emergency settings. The difference between the 2 types of intervention is statistically significant (p = 0.045). The odds ratio was 0.086 (95% CI: 0.008 - 0.942). A Mallampati score of 1 was rated for 6 injured (54.5%). The difference between the difficulty of the intubation evaluated by the Mallampati score and the occurrence of trauma was statistically insignificant (p = 0.278). The dental partial dislocation was the most frequent trauma (6 cases, 54.5%). The maxillary teeth were the most affected (n = 13, 72.2%).

Conclusion: According to the present study, the incidence of orotracheal intubation dental traumas is relatively high. The age of the patient is one of the factors predisposing to these traumas. In scheduled surgery, orotracheal intubation is quietly performed during general anesthesia, and the risk of incidence of dental trauma is reduced than in emergency settings.

目的:气管插管是急诊手术中最常用的技术之一,特别是在麻醉和复苏中。牙齿可能是气管插管的“受害者”。有几个因素可能导致这些事故的发生。本研究的目的是确定在定期和紧急口腔气管插管中发生的口腔创伤的发生率,并确定这些口腔损伤的危险因素、类型和位置。方法:采用横断面研究方法,于2022年6月至11月进行为期6个月的研究。这项研究是在几个部门进行的。术前应根据手术方案对全麻手术患者的牙齿和牙周状况进行检查。然而,在紧急情况下,这种检查是不可能的。排除有前牙缺的患者和拒绝参加研究的患者。手术后,对纳入的患者进行检查,以发现最终的牙齿创伤,如骨折、脱臼和挫伤。使用SPSS 18版软件对收集到的数据进行录入和分析。采用Wilcoxon Mann-Whitney U检验比较定量变量。采用卡方检验比较定性变量,差异有统计学意义,差异为5% (p)。结果:纳入研究的43例患者中,有11例患者有牙外伤,占25.6%。平均年龄(59.8±15.4)岁。统计分析显示,年龄(40岁以上)与创伤有显著相关(p = 0.004)。在创伤组中,有8例根据手术方案进行了口气管插管,而有3例是在紧急情况下进行的。两种干预方式差异有统计学意义(p = 0.045)。优势比为0.086 (95% CI: 0.008 - 0.942)。6例受伤患者(54.5%)Mallampati评分为1分。Mallampati评分评价插管困难程度与创伤发生率的差异无统计学意义(p = 0.278)。牙部分脱位是最常见的外伤(6例,54.5%)。上颌牙受影响最大(n = 13, 72.2%)。结论:根据目前的研究,口腔气管插管牙外伤的发生率较高。患者的年龄是诱发这些创伤的因素之一。在预定的手术中,在全身麻醉下进行口气管插管,并且发生牙齿创伤的风险比急诊情况下要低。
{"title":"Dental trauma related to orotracheal intubation: Prospective study of 43 cases.","authors":"Yosra Mabrouk, Mohamed Hbib Grissa, Souha Ben Youssef","doi":"10.1016/j.cjtee.2024.08.007","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.08.007","url":null,"abstract":"<p><strong>Purpose: </strong>Orotracheal intubation is one of the most frequently used techniques in emergency procedures and especially in anesthesia and resuscitation. Teeth may be \"victims\" of the orotracheal intubation. Several factors may predispose to these accidents. The aim of this study is to determine the incidence of oral trauma that occurs during scheduled and urgent oral tracheal intubation, and identify the risk factors, the types and locations of these dental injuries.</p><p><strong>Methods: </strong>It is a cross-sectional study that lasted 6 months from June to November 2022. This study was carried out in several departments. An examination of the dental and periodontal status of patients who will undergo surgery under general anesthesia was performed before the operation according to the surgical program. Yet, in emergency settings, this examination was not possible. Patients with anterior edentation and patients refusing participation in the study were excluded. After the surgery, included patients were examined to detect eventual dental trauma such as fracture, luxation, and contusion. Collected data were entered and analyzed using SPSS version 18 software. The Wilcoxon Mann-Whitney U test was used to compare quantitative variables. The Chi-square test was used to compare qualitative variables with a statistical significance level of 5% (p < 0.05).</p><p><strong>Results: </strong>There were 43 patients included in the study, and dental trauma was noted in 11 patients (25.6%). Their mean age was (59.8 ± 15.4) years. The statistical analysis shows that there is a significant relationship between age (over 40 years old) and trauma (p = 0.004). Among the traumatized group, orotracheal intubation was undergone for 8 cases according to the surgical program whereas it was performed, for 3 cases, in emergency settings. The difference between the 2 types of intervention is statistically significant (p = 0.045). The odds ratio was 0.086 (95% CI: 0.008 - 0.942). A Mallampati score of 1 was rated for 6 injured (54.5%). The difference between the difficulty of the intubation evaluated by the Mallampati score and the occurrence of trauma was statistically insignificant (p = 0.278). The dental partial dislocation was the most frequent trauma (6 cases, 54.5%). The maxillary teeth were the most affected (n = 13, 72.2%).</p><p><strong>Conclusion: </strong>According to the present study, the incidence of orotracheal intubation dental traumas is relatively high. The age of the patient is one of the factors predisposing to these traumas. In scheduled surgery, orotracheal intubation is quietly performed during general anesthesia, and the risk of incidence of dental trauma is reduced than in emergency settings.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781783","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
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。
{"title":"Morphometric and anatomic characteristics of pronator quadratus muscle.","authors":"Nurşen Zeybek, Özcan Gayretli, Yüsra Nur Şanlıtürk, Ayşin Kale","doi":"10.1016/j.cjtee.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.09.004","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332155","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
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。
{"title":"The surveillance and assessment of acute injuries in different age categories in national wrestling championships.","authors":"Sema Can, Erkan Demirkan, Mustafa Arıcı, Mehmet İsmail Tosun, Halil İbrahim Cicioğlu","doi":"10.1016/j.cjtee.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.09.001","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300511","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
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。
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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

The case series study 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
期刊
Chinese Journal of Traumatology
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