Chinese Journal of Traumatology最新文献_第4页

Corrigendum to “Interposition of acellular amniotic membrane at the tendon to bone interface would be better for healing than overlaying above the tendon to bone junction in the repair of rotator cuff injury” [Chinese J Traumatol 28 (2025) 187–192] “在肌腱与骨交界面置入脱细胞羊膜比在肌腱与骨交界面上方覆盖修复肩袖损伤更有利于愈合”的更正[中国创伤杂志28(2025)187-192]。

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2025.09.001

Jiang-Tao Wang , Chun-Bao Li , Jia-Ting Zhang , Ming-Yang An , Gang Zhao , Yu-Jie Liu

引用次数: 0

Comments on “Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing”—The need for a large multi-center study to compare locked intramedullary nailing, titanium elastic intramedullary nailing and plate fixation for treatment of adolescent forearm fractures 关于“锁定髓内钉治疗青少年前臂骨折的成功结果”的评论-需要一项大型的多中心研究来比较锁定髓内钉、钛弹性髓内钉和钢板固定治疗青少年前臂骨折

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2022.04.006

Mohamed Kamal Mesregah

引用次数: 0

Comments on “finger pulp reconstruction with thenar flap: Aesthetic and functional outcome”-----relevant questions demanding attention related to the study 关于 "用肩胛骨瓣重建指髓：美学和功能结果"-----，与研究相关的问题需要关注。

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2021.07.008

Ilaria Papini Zorli , Stefano Lucchina

引用次数: 0

Bone loss in patients with spinal cord injury: Incidence and influencing factors 脊髓损伤患者骨质流失的发生率及影响因素。

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2024.05.003

Min Jiang , Jun-Wei Zhang , He-Hu Tang , Yu-Fei Meng , Zhen-Rong Zhang , Fang-Yong Wang , Jin-Zhu Bai , Shu-Jia Liu , Zhen Lyu , Shi-Zheng Chen , Jie-Sheng Liu , Jia-Xin Fu

Purpose

To investigate the incidence and influencing factors of bone loss in patients with spinal cord injury (SCI).

Methods

A retrospective case-control study was conducted. Patients with SCI in our hospital from January 2019 to March 2023 were collected. According to the correlation between bone mineral density (BMD) at different sites, the patients were divided into the lumbar spine group and the hip joint group. According to the BMD value, the patients were divided into the normal bone mass group (t > -1.0 standard deviation) and the osteopenia group (t ≤ -1.0 standard deviation). The influencing factors accumulated as follows: gender, age, height, weight, cause of injury, injury segment, injury degree, time after injury, start time of rehabilitation, motor score, sensory score, spasticity, serum value of alkaline phosphatase, calcium, and phosphorus. The trend chart was drawn and the influencing factors were analyzed. SPSS 26.0 was used for statistical analysis. Correlation analysis was used to test the correlation between the BMD values of the lumbar spine and bilateral hips. Binary logistic regression analysis was used to explore the influencing factors of osteoporosis after SCI. p < 0.05 was considered statistically significant.

Results

The incidence of bone loss in patients with SCI was 66.3%. There was a low concordance between bone loss in the lumbar spine and the hip, and the hip was particularly susceptible to bone loss after SCI, with an upward trend in incidence (36% − 82%). In this study, patients with SCI were divided into the lumbar spine group (n = 100) and the hip group (n = 185) according to the BMD values of different sites. Then, the lumbar spine group was divided into the normal bone mass group (n = 53) and the osteopenia group (n = 47); the hip joint group was divided into the normal bone mass group (n = 83) and the osteopenia group (n = 102). Of these, lumbar bone loss after SCI is correlated with gender and weight (p = 0.032 and < 0.001, respectively), and hip bone loss is correlated with gender, height, weight, and time since injury (p < 0.001, p = 0.015, 0.009, and 0.012, respectively).

Conclusions

The incidence of bone loss after SCI was high, especially in the hip. The incidence and influencing factors of bone loss in the lumbar spine and hip were different. Patients with SCI who are male, low height, lightweight, and long time after injury were more likely to have bone loss.

目的：探讨脊髓损伤（SCI）患者骨丢失的发生率及影响因素。方法：采用回顾性病例对照研究。收集2019年1月至2023年3月我院收治的SCI患者。根据不同部位骨密度（BMD）的相关性，将患者分为腰椎组(T)和髋关节组。根据骨密度值将患者分为正常骨量组（t≤-1.0标准差）和骨质减少组（t≤-1.0标准差）。影响因素累积如下：性别、年龄、身高、体重、损伤原因、损伤节段、损伤程度、损伤后时间、康复开始时间、运动评分、感觉评分、痉挛、血清碱性磷酸酶值、钙、磷。绘制了趋势图，并分析了影响因素。采用SPSS 26.0进行统计分析。采用相关分析检验腰椎与双侧髋关节骨密度值的相关性。采用二元logistic回归分析探讨脊髓损伤后骨质疏松的影响因素。结果：脊髓损伤患者骨丢失发生率为66.3%。腰椎和髋关节骨质流失的一致性较低，而髋关节在脊髓损伤后特别容易发生骨质流失，其发生率呈上升趋势（36% - 82%）。本研究根据不同部位BMD值将SCI患者分为腰椎组（n = 100）和髋关节组（n = 185）。然后将腰椎组分为骨量正常组（n = 53）和骨质减少组（n = 47）；将髋关节组分为骨量正常组（n = 83）和骨质减少组（n = 102）。其中，脊髓损伤后腰椎骨丢失与性别和体重相关（p分别= 0.032和< 0.001），髋部骨丢失与性别、身高、体重和损伤后时间相关（p分别< 0.001、p = 0.015、0.009和0.012）。结论：脊髓损伤后骨丢失的发生率较高，尤其是在髋关节。腰椎、髋部骨质流失的发生率及影响因素不同。男性、低身高、体重轻、伤后时间长的SCI患者更易发生骨质流失。

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引用次数: 0

Corrigendum to “Prediction of traumatic avascular necrosis of the femoral head by single photon emission computerized tomography and computerized tomography: An experimental study in dogs” [Chin J Traumatol 14 (2011) 227-232, 6] “单光子发射计算机断层扫描和计算机断层扫描对犬外伤性股骨头缺血性坏死的预测：一项实验研究”的更正[中国创伤杂志]14 (2011)227- 232,6]

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2025.04.001

Feng Shen, Zuo-Qin Yan, Chang-An Guo, Hong-Cheng Shi, Yu-Shen Gu, Meng-Su Zeng, Xiao-Yu Lu, Jun Liu

引用次数: 0

Comparative epidemiology and treatment outcomes at trauma centers: A cross-national analysis of the United States and China 创伤中心的比较流行病学和治疗结果：美国和中国的跨国分析。

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2025.03.001

Yong Fu , Liu-Yi Fan , Xin-Jie Luo , Lei Li , Delbrynth P. Mitchao , Kenji Inaba , Guan-Qiao Liu , Bin Yu

Purpose

Although there are significant differences between China and the United States (US) in trauma medical services, there has been no direct comparative research on the epidemiological data of trauma centers between the 2 countries. This study aims to fill this research gap by directly comparing trauma centers in China and the US, providing valuable data and insights for the development of trauma centers in both countries, promoting academic exchange and cooperation internationally, and enhancing the level of global trauma medical care.

Methods

This is a multicenter retrospective descriptive study. Data were collected for trauma patients with an injury severity score ≥16 treated from September 2013 to September 2019 at 2 hospital trauma centers in these 2 countries. Detailed clinical data (including injury mechanism, age, injury site, injury severity score, pre-hospital transport time, whether blood transfusion was performed, whether resuscitative thoracotomy was conducted, hospital and intensive care unit stay duration, the number of organ donor patients, mortality rates, and costs) were meticulously compiled and retrospectively analyzed to identify differences between the 2 trauma centers. The comparison was conducted using SPSS 23 software. Continuous variables are reported as median (Q₁, Q₃), and Mann Whitney U test is used to compare the median of continuous variables. Use clinically relevant critical points to classify continuous variables, with categorical variables represented as n (%), and comparisons were made between the 2 groups using the χ² test or Fisher's exact test. Statistical significance was defined as a 2-sided p < 0.05.

Results

These results point to significant differences in trauma center capacity, pre-hospital transport times, treatment procedures, hospital stay duration, mortality rates, and costs between the 2 centers. The volume of patients in trauma centers is less in China (2465 vs. 5288). Pre-hospital transport time was notably longer in China (180 min vs. 14 min), and the rate of emergency blood transfusions was lower in China (18.4% vs. 50.6%), Emergency thoracotomy was not performed in China but was conducted in 9.8% of cases in the US. Hospitalization costs were significantly lower in China than in the US ($5847 vs. $75,671).

Conclusion

There are clear differences in trauma center capacity (number of patients treated), pre-hospital transport time, age distribution of injured patients, injury mechanisms, injury sites, whether emergency thoracotomy is performed, hospital costs, and length of stay between the 2 trauma centers in China and America. Understanding these differences can help us further recognize the characteristics of Eastern and Western trauma patients.

目的：虽然中美两国在创伤医疗服务方面存在显著差异，但尚未对两国创伤中心的流行病学数据进行直接比较研究。本研究旨在通过对中美创伤中心的直接比较，填补这一研究空白，为中美创伤中心的发展提供有价值的数据和见解，促进国际间的学术交流与合作，提升全球创伤医疗水平。方法：这是一项多中心回顾性描述性研究。收集了2013年9月至2019年9月在这两个国家的2家医院创伤中心治疗的损伤严重程度评分≥16的创伤患者的数据。详细的临床资料（包括损伤机制、年龄、损伤部位、损伤严重程度评分、院前转运时间、是否输血、是否进行复苏开胸、住院和重症监护病房住院时间、器官供体患者人数、死亡率和费用）被精心整理和回顾性分析，以确定两个创伤中心之间的差异。采用SPSS 23软件进行比较。连续变量报告为中位数（Q1, Q3），使用Mann Whitney U检验比较连续变量的中位数。采用临床相关临界点对连续变量进行分类，分类变量用n（%）表示，两组间比较采用χ2检验或Fisher精确检验。统计学显著性定义为双侧p < 0.05。结果：这些结果表明两个中心在创伤中心容量、院前转运时间、治疗程序、住院时间、死亡率和费用方面存在显著差异。中国创伤中心的患者数量较少（2465对5288）。中国院前转运时间明显更长（180分钟vs. 14分钟），紧急输血率较低（18.4% vs. 50.6%），中国没有进行紧急开胸手术，但在美国有9.8%的病例进行了开胸手术。中国的住院费用明显低于美国（5847美元对75,671美元）。结论：中美两国创伤中心在创伤中心容量（收治人数）、院前转运时间、受伤患者年龄分布、损伤机制、损伤部位、是否急诊开胸、住院费用、住院时间等方面存在明显差异。了解这些差异可以帮助我们进一步认识东西方创伤患者的特点。

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引用次数: 0

One-year recovery after lateral retinaculum release combined with chondroplasty in patients with lateral patellar compression syndrome 外侧支持带释放联合软骨成形术治疗外侧髌骨压迫综合征患者一年的康复。

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2025.08.005

Zhen-Long Liu , Yi-Ting Wang , Jin-Ming Lin , Wu-Ji Zhang , Jiong-Yuan Li , Zhi-Hui He , Yue-Yang Hou , Jian-Li Gao , Wei-Li Shi , Yu-Ping Yang

Purpose

Lateral patellar compression syndrome (LPCS) is characterized by a persistent abnormally high stress exerted on the lateral articular surface of the patella due to lateral patellar tilt without dislocation and lateral retinaculum contracture, leading to anterior knee pain. The purpose of this study is to evaluate the efficacy and prognosis of lateral retinaculum release (LRR) combined with chondroplasty in the treatment of LPCS.

Methods

This retrospective study evaluated 40 patients who underwent LRR combined with chondroplasty for LPCS between 2020 and 2021. The assessment included improvement in postoperative tenderness and knee joint function. Patients were evaluated using the Lysholm, Tegner, and International Knee Documentation Committee 2000 scoring systems, as well as the visual analog scale, both preoperatively and postoperatively, with the paired comparisons analyzed using a t-test. Additionally, intraoperative observations were made regarding knee joint lesions, including cartilage damage and osteophyte formation, with analysis by the Chi-square test.

Results

The visual analog scale score for tenderness showed a significant decrease after surgery (p < 0.001). Evaluation of knee joint function also indicated significant improvements, as demonstrated by increased Lysholm, Tegner, and International Knee Documentation Committee 2000 scores postoperatively (p < 0.001, p = 0.011, p < 0.001, respectively). Furthermore, all LPCS patients included in the study presented with cartilage injuries and osteophyte formation. Significant differences were noted in the incidence of cartilage damage and osteophyte formation at different locations within the knee among patients with LPCS.

Conclusion

LRR combined with chondroplasty is an effective surgical approach for treating patients with LPCS, with satisfactory recovery observed at the 1-year follow-up. Additionally, the incidence of cartilage damage and osteophyte formation in LPCS patients varies significantly depending on the specific location within the knee joint.

目的：外侧髌骨压迫综合征（LPCS）的特征是由于外侧髌骨倾斜导致髌骨外侧关节面持续受到异常高的应力，而无脱位和外侧支持带挛缩，导致膝关节前侧疼痛。本研究的目的是评价外侧网膜释放联合软骨成形术治疗LPCS的疗效和预后。方法：本回顾性研究评估了40例在2020年至2021年间接受LRR联合软骨成形术治疗LPCS的患者。评估包括术后压痛和膝关节功能的改善。术前和术后采用Lysholm， Tegner和国际膝关节文献委员会2000评分系统以及视觉模拟量表对患者进行评估，配对比较采用t检验进行分析。此外，术中观察膝关节病变，包括软骨损伤和骨赘形成，并通过卡方检验进行分析。结果：术后压痛视觉模拟评分明显降低（p < 0.001）。术后Lysholm， Tegner和International knee Documentation Committee 2000评分增加（p < 0.001, p = 0.011, p < 0.001），膝关节功能评估也显示有显著改善。此外，研究中所有LPCS患者均出现软骨损伤和骨赘形成。在LPCS患者中，膝关节不同部位软骨损伤和骨赘形成的发生率存在显著差异。结论：LRR联合软骨成形术是治疗LPCS患者的有效手术方法，随访1年恢复满意。此外，LPCS患者的软骨损伤和骨赘形成的发生率因膝关节内的特定位置而有显著差异。

{"title":"One-year recovery after lateral retinaculum release combined with chondroplasty in patients with lateral patellar compression syndrome","authors":"Zhen-Long Liu , Yi-Ting Wang , Jin-Ming Lin , Wu-Ji Zhang , Jiong-Yuan Li , Zhi-Hui He , Yue-Yang Hou , Jian-Li Gao , Wei-Li Shi , Yu-Ping Yang","doi":"10.1016/j.cjtee.2025.08.005","DOIUrl":"10.1016/j.cjtee.2025.08.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Lateral patellar compression syndrome (LPCS) is characterized by a persistent abnormally high stress exerted on the lateral articular surface of the patella due to lateral patellar tilt without dislocation and lateral retinaculum contracture, leading to anterior knee pain. The purpose of this study is to evaluate the efficacy and prognosis of lateral retinaculum release (LRR) combined with chondroplasty in the treatment of LPCS.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated 40 patients who underwent LRR combined with chondroplasty for LPCS between 2020 and 2021. The assessment included improvement in postoperative tenderness and knee joint function. Patients were evaluated using the Lysholm, Tegner, and International Knee Documentation Committee 2000 scoring systems, as well as the visual analog scale, both preoperatively and postoperatively, with the paired comparisons analyzed using a <em>t</em>-test. Additionally, intraoperative observations were made regarding knee joint lesions, including cartilage damage and osteophyte formation, with analysis by the Chi-square test.</div></div><div><h3>Results</h3><div>The visual analog scale score for tenderness showed a significant decrease after surgery (<em>p</em> < 0.001). Evaluation of knee joint function also indicated significant improvements, as demonstrated by increased Lysholm, Tegner, and International Knee Documentation Committee 2000 scores postoperatively (<em>p</em> < 0.001, <em>p</em> = 0.011, <em>p</em> < 0.001, respectively). Furthermore, all LPCS patients included in the study presented with cartilage injuries and osteophyte formation. Significant differences were noted in the incidence of cartilage damage and osteophyte formation at different locations within the knee among patients with LPCS.</div></div><div><h3>Conclusion</h3><div>LRR combined with chondroplasty is an effective surgical approach for treating patients with LPCS, with satisfactory recovery observed at the 1-year follow-up. Additionally, the incidence of cartilage damage and osteophyte formation in LPCS patients varies significantly depending on the specific location within the knee joint.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 6","pages":"Pages 462-468"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402729","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

Flexible intramedullary nails for the treatment of metacarpal fractures: A systematic review 弹性髓内钉治疗掌骨骨折：系统回顾。

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2024.08.013

Oliver Scott Brown , Toby Oliver Smith , Ravi Kanth Mallina

Purpose

Flexible intramedullary nails (FIN) enable minimally invasive and immediate fracture stabilisation, while facilitating early active movement in metacarpal fractures. This systematic review aims to compare locked, non-locked, single, and double FIN and their post-operative outcomes in metacarpal fractures.

Methods

A primary literature search was performed on July 15, 2024. English-language studies investigating acute metacarpal fractures, treated with FIN were included. Analyses included: the 5th metacarpal neck fractures locked vs. non-locked FIN; 5th metacarpal neck fractures non-locked single vs. dual FIN; and the 2nd–5th metacarpal fractures locked vs. non-locked FIN. The National Institute for Health tool and the JBI tool were used to assess study quality for controlled trials and case series, respectively.

Results

Thirteen studies (n=649 fractures) were eligible, with 12 low risks of bias. There was no difference in overall complication rates between locked and non-locked, and single and double non-locked FIN. Non-locked FIN demonstrated reduced metacarpophalangeal joint penetration (odds ratio (OR): 3.30 (95% confidence interval (CI): 1.23–8.80; p=0.017 and delayed union (OR: 6.95; 95% CI: 1.86–25.97; p=0.004), but increased tendon irritation (OR: 0.19; 95% CI: 0.05–0.83; p=0.027 vs. locked FIN. Overall operative times were lower for single vs. double non-locked nails (mean difference: 9.17; 95% CI: 6.12–12.22; p<0.001).

Conclusions

These findings demonstrate low complication rates and excellent functional results using FIN to fix displaced metacarpal fractures. Although complication profiles are contrasting, there is no clear benefit in using locked or double nails compared to a single non-locked FIN.

目的：灵活的髓内钉（FIN）可以实现微创和即时骨折稳定，同时促进掌骨骨折的早期主动运动。本系统综述旨在比较锁定、非锁定、单鳍和双鳍及其在掌骨骨折中的术后疗效。方法：于2024年7月15日进行初步文献检索。纳入了用FIN治疗的急性掌骨骨折的英文研究。分析包括：第5掌骨颈骨折锁定与非锁定FIN；5号掌骨颈骨折非锁定单鳍与双鳍；以及第2 -5掌骨骨折锁定与非锁定FIN。分别使用国家卫生研究所工具和JBI工具来评估对照试验和病例系列的研究质量。结果：13项研究（n = 649例骨折）符合条件，其中12项为低偏倚风险。非锁定FIN与非锁定FIN的总并发症发生率无差异，非锁定FIN显示掌指关节穿透减少(优势比（OR）： 3.30(95%可信区间（CI）： 1.23-8.80；p=0.017，延迟联合(OR: 6.95；95% ci: 1.86-25.97；p=0.004)，但肌腱刺激增加(OR: 0.19；95% ci: 0.05-0.83；p=0.027与锁定FIN相比，单钉与双非锁定钉的总手术时间较低(平均差异：9.17；95% ci: 6.12-12.22；结论：使用FIN固定移位的掌骨骨折并发症发生率低，功能效果好。虽然并发症情况不同，但与单个非锁定FIN相比，使用锁定或双钉并没有明显的好处。

{"title":"Flexible intramedullary nails for the treatment of metacarpal fractures: A systematic review","authors":"Oliver Scott Brown , Toby Oliver Smith , Ravi Kanth Mallina","doi":"10.1016/j.cjtee.2024.08.013","DOIUrl":"10.1016/j.cjtee.2024.08.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Flexible intramedullary nails (FIN) enable minimally invasive and immediate fracture stabilisation, while facilitating early active movement in metacarpal fractures. This systematic review aims to compare locked, non-locked, single, and double FIN and their post-operative outcomes in metacarpal fractures.</div></div><div><h3>Methods</h3><div>A primary literature search was performed on July 15, 2024. English-language studies investigating acute metacarpal fractures, treated with FIN were included. Analyses included: the 5th metacarpal neck fractures locked <em>vs.</em> non-locked FIN; 5th metacarpal neck fractures non-locked single <em>vs.</em> dual FIN; and the 2nd–5th metacarpal fractures locked <em>vs.</em> non-locked FIN. The National Institute for Health tool and the JBI tool were used to assess study quality for controlled trials and case series, respectively.</div></div><div><h3>Results</h3><div>Thirteen studies (<em>n</em>=649 fractures) were eligible, with 12 low risks of bias. There was no difference in overall complication rates between locked and non-locked, and single and double non-locked FIN. Non-locked FIN demonstrated reduced metacarpophalangeal joint penetration (<em>odds ratio</em> (<em>OR</em>): 3.30 (95% <em>confidence interval</em> (<em>CI</em>): 1.23–8.80; <em>p</em>=0.017 and delayed union (<em>OR</em>: 6.95; 95% <em>CI</em>: 1.86–25.97; <em>p</em>=0.004), but increased tendon irritation (<em>OR</em>: 0.19; 95% <em>CI</em>: 0.05–0.83; <em>p</em>=0.027 <em>vs</em>. locked FIN. Overall operative times were lower for single <em>vs</em>. double non-locked nails (mean difference: 9.17; 95% <em>CI</em>: 6.12–12.22; <em>p</em><0.001).</div></div><div><h3>Conclusions</h3><div>These findings demonstrate low complication rates and excellent functional results using FIN to fix displaced metacarpal fractures. Although complication profiles are contrasting, there is no clear benefit in using locked or double nails compared to a single non-locked FIN.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 6","pages":"Pages 427-435"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295368","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

The observational chart for traumatic limb swelling enhances diagnostic accuracy for osteofascial compartment syndrome 创伤性肢体肿胀的观察图提高了骨筋膜室综合征的诊断准确性。

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2025.08.004

Zhi-Wei Yang , Zhao-Di Wang , Jun-Sheng Yang , Liang-Cheng Tong , Lei Zhao , Wei Dai , Kun Pang , Ying Li

<div><h3>Purpose</h3><div>To evaluate the diagnostic accuracy of the observational chart for traumatic limb swelling (OCTLS) for osteofascial compartment syndrome (OCS).</div></div><div><h3>Methods</h3><div>This was a descriptive-longitudinal study. Data of 316 patients who underwent surgical treatment for tibial fractures in our department from January 2015 to December 2023 were collected. Patients with Gustilo type II or higher open fractures, vascular injury, or bilateral fractures were excluded from the study. Two groups of double-blinded investigators independently assessed patients for the presence of OCS using 2 distinct diagnostic methods. Three senior orthopedic trauma surgeons evaluated patients with post-fracture calf swelling for OCS and the need for fasciotomy based on clinical signs and their extensive clinical experience. Subsequently, fasciotomy was performed according to their judgment, followed by postoperative examination of muscle and soft tissue conditions. Additionally, a follow-up evaluation was conducted to assess for complications such as ischemic muscle contracture. Another 3 trained researchers used OCTLS to grade swelling severity and determine the need for fasciotomy. The final diagnostic gold standard of OCS was determined by referring to whether there was escape of muscles at fasciotomy and/or color change in the muscles or muscle necrosis intraoperatively, and neurological abnormality or contracture at the last follow-up. The results of the 2 diagnostic methods were compared with the final diagnostic result. Kappa consistency test, paired χ<sup>2</sup> test (McNemar test), and receiver operating characteristic curve were used to evaluate the diagnostic efficacy of the 2 diagnostic methods.</div></div><div><h3>Results</h3><div>Of the 316 patients, 211 were finally included in the study, including 160 males and 51 females, with an average follow-up time of (14.5 ± 2.7) months. Among the 211 patients with tibial fracture-associated swelling, 42 were definitively diagnosed with OCS. Based on clinical symptoms and signs judgment, among the 65 fasciotomy patients, 38 were confirmed as correct, while among the 146 non-fasciotomy patients, 4 developed ischemic muscle contractures. Based on the OCTLS for assessment, fasciotomy was correctly recommended in 36 out of 43 cases, while 6 out of 168 non-fasciotomy patients developed OCS. Compared to the use of the gold standard, clinical signs judgment showed moderate consistency (McNemar's test <em>p</em> < 0.001, Kappa = 0.618, <em>p</em> < 0.001), whereas OCTLS demonstrated strong agreement (McNemar's test <em>p</em> = 1.000, Kappa = 0.808, <em>p</em> < 0.001). Receiver operating characteristic analysis revealed higher diagnostic accuracy for OCTLS (area under curve = 0.908, 95% <em>CI</em>: 0.843 – 0.972) compared to clinical signs judgment (area under curve = 0.872, 95% <em>CI</em>: 0.812 – 0.933). OCTLS achieved superior accuracy (93.8% <em>vs</em>. 85.3%, χ<sup>2<

目的：评价创伤性肢体肿胀（OCTLS）观察图对骨筋膜室综合征（OCS）的诊断准确性。方法：采用描述性纵向研究。收集2015年1月至2023年12月我科316例胫骨骨折手术患者的资料。Gustilo II型或更高级别开放性骨折、血管损伤或双侧骨折的患者被排除在研究之外。两组双盲研究人员使用两种不同的诊断方法独立评估患者是否存在OCS。三位资深骨科创伤外科医生根据临床症状和他们丰富的临床经验评估骨折后小腿肿胀患者的OCS和筋膜切开术的必要性。然后根据他们的判断行筋膜切开术，术后检查肌肉和软组织状况。此外，还进行了随访评估，以评估缺血性肌肉挛缩等并发症。另外3名训练有素的研究人员使用OCTLS对肿胀严重程度进行分级并确定是否需要进行筋膜切开术。最终诊断OCS的金标准是根据切开筋膜时是否有肌肉逃逸和/或术中是否有肌肉颜色改变或肌肉坏死，末次随访时是否有神经异常或挛缩。将两种诊断方法的结果与最终诊断结果进行比较。采用Kappa一致性检验、配对χ2检验（McNemar检验）和受试者工作特征曲线评价两种诊断方法的诊断效果。结果：316例患者中，211例最终纳入研究，其中男性160例，女性51例，平均随访时间（14.5±2.7）个月。211例胫骨骨折相关肿胀患者中，42例确诊为OCS。根据临床症状和体征判断，65例筋膜切开术患者中，38例确认正确，146例未切开术患者中，4例出现缺血性肌挛缩。基于OCTLS评估，43例患者中有36例筋膜切开术被正确推荐，而168例非筋膜切开术患者中有6例发生了OCS。与使用金标准相比，临床体征判断具有中等一致性（McNemar检验p < 0.001, Kappa = 0.618, p < 0.001），而OCTLS具有很强的一致性（McNemar检验p = 1.000, Kappa = 0.808, p < 0.001）。受试者工作特征分析显示，OCTLS的诊断准确率（曲线下面积= 0.908,95% CI: 0.843 ~ 0.972）高于临床体征判断（曲线下面积= 0.872,95% CI: 0.812 ~ 0.933）。OCTLS具有更高的准确率（93.8%比85.3%,χ2 = 8.221, p < 0.001）和更低的筋膜切开率（20.4%比30.8%,χ2 = 6.023, p = 0.014）。结论：与临床体征判断相比，OCTLS可显著减少不必要的筋膜切开术，提高对OCS的诊断准确性，且可实现无创、动态、定量评估，具有临床应用价值。

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引用次数: 0

Establishment of a nomogram for early risk prediction of severe trauma in primary medical institutions: A multi-center study 建立基层医疗机构严重创伤早期风险预测nomogram：一项多中心研究

IF 1.9 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2025-11-01 DOI: 10.1016/j.cjtee.2025.10.001

Wang Bo , Ming-Rui Zhang , Gui-Yan Ma , Zhan-Fu Yang , Rui-Ning Lu , Xu-Sheng Zhang , Shao-Guang Liu

Purpose

To analyze risk factors for severe trauma and establish a nomogram for early risk prediction, to improve the early identification of severe trauma.

Methods

This study was conducted on the patients treated in 81 trauma treatment institutions in Gansu province from 2020 to 2022. Patients were grouped by year, with 5364 patients from 2020 to 2021 as the training set and 1094 newly admitted patients in 2020 as the external validation set. Based on the injury severity score (ISS), patients in the training set were classified into 2 subgroups of the severe trauma group (n = 478, ISS scores ≥25) and the non-severe trauma group (n = 4886, ISS scores <25). Univariate and binary logistic regression analyses were employed to identify independent risk factors for severe trauma. Subsequently, a predictive model was developed using the R software environment. Furthermore, the model was subjected to internal and external validation via the Hosmer–Lemeshow test and receiver operating characteristic curve analysis.

Results

In total, 6458 trauma patients were included in this study. Initially, this study identified several independent risk factors for severe trauma, including multiple traumatic injuries (polytrauma), external hemorrhage, elevated shock index, elevated respiratory rate, decreased peripheral oxygen saturation, and decreased Glasgow coma scale score (all p < 0.05). For internal validation, the area under the receiver operating characteristic curve was 0.914, with the sensitivity and specificity of 88.4% and 87.6%, respectively; while for external validation, the area under the receiver operating characteristic curve was 0.936, with the sensitivity and specificity of 84.6% and 93.7%, respectively. In addition, a good model fitting was observed through the Hosmer–Lemeshow test and calibration curve analysis (p > 0.05).

Conclusion

This study establishes a nomogram for early risk prediction of severe trauma, which is suitable for primary healthcare institutions in underdeveloped western China. It facilitates early triage and quantitative assessment of trauma severity by clinicians prior to clinical interventions.

目的：分析严重创伤的危险因素，建立早期风险预测nomogram，提高对严重创伤的早期识别。方法：选取2020 - 2022年甘肃省81家创伤治疗机构收治的患者为研究对象。患者按年份分组，以2020 - 2021年5364例患者为训练集，2020年1094例新入院患者为外部验证集。根据损伤严重程度评分（ISS），将训练集中的患者分为重度创伤组（n = 478， ISS评分≥25）和非重度创伤组（n = 4886， ISS评分）2个亚组。结果：本研究共纳入6458例创伤患者。首先，本研究确定了严重创伤的几个独立危险因素，包括多发创伤（polytrauma）、外出血、休克指数升高、呼吸频率升高、外周氧饱和度降低、格拉斯哥昏迷评分降低（p < 0.05）。内验证时，受试者工作特征曲线下面积为0.914，灵敏度为88.4%，特异度为87.6%；外部验证的受试者工作特征曲线下面积为0.936，灵敏度为84.6%，特异度为93.7%。此外，通过Hosmer-Lemeshow检验和校准曲线分析，模型拟合良好（p > 0.05）。结论：本研究建立了一种适合西部欠发达地区初级卫生保健机构的严重创伤早期风险预测模式。它有助于临床医生在临床干预之前对创伤严重程度进行早期分类和定量评估。

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引用次数: 0