Chinese Journal of Traumatology最新文献_第7页

Causes and global, regional, and national burdens of traumatic brain injury from 1990 to 2019 1990 年至 2019 年脑外伤的原因及全球、地区和国家负担

IF 1.8 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-18 DOI: 10.1016/j.cjtee.2024.03.007

Xiao-Fei Huang , Shuai-Feng Ma , Xu-Heng Jiang , Ren-Jie Song , Mo Li , Ji Zhang , Tian-Jing Sun , Quan Hu , Wen-Rui Wang , An-Yong Yu , He Li

Purpose

Traumatic brain injury (TBI), currently a major global public health problem, imposes a significant economic burden on society and families. We aimed to quantify and predict the incidence and severity of TBI by analyzing its incidence, prevalence, and years lived with disability (YLDs). The epidemiological changes in TBI from 1990 to 2019 were described and updated to provide a reference for developing prevention, treatment, and incidence-reducing measures for TBI.

Methods

A secondary analysis was performed on the incidence, prevalence, and YLDs of TBI by sex, age group, and region (n = 21,204 countries and territories) between 1990 and 2019 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Proportions in the age-standardized incidence rate due to underlying causes of TBI and proportions of minor and moderate or severe TBI were also reported.

Results

In 2019, there were 27.16 million (95% uncertainty intervals (UI): 23.36 − 31.42) new cases of TBI worldwide, with age-standardized incidence and prevalence rates of 346 per 100,000 population (95% UI: 298 – 401) and 599 per 100,000 population (95% UI: 573 – 627), respectively. From 1990 to 2019, there were no significant trends in global age-standardized incidence (estimated annual percentage changes: -0.11%, 95% UI: -0.18% − -0.04%) or prevalence (estimated annual percentage changes: 0.01%, 95% UI: -0.04% − 0.06%). TBI caused 7.08 million (95% UI: 5.00 − 9.59) YLDs in 2019, with age-standardized rates of 86.5 per 100,000 population (95% UI: 61.1 − 117.2). In 2019, the countries with higher incidence rates were mainly distributed in Central Europe, Eastern Europe, and Australia. The 2019 global age-standardized incidence rate was higher in males than in females. The 2019 global incidence of moderate and severe TBI was 182.7 per 100,000 population, accounting for 52.8% of all TBI, with falls and road traffic injuries being the main causes in most regions.

Conclusions

The incidence of moderate and severe TBI was slightly higher in 2019, and TBI still accounts for a significant portion of the global injury burden. The likelihood of moderate to severe TBI and the trend of major injury under each injury cause from 1990 to 2019 and the characteristics of injury mechanisms in each age group are presented, providing a basis for further research on injury causes in each age group and the future establishment of corresponding policies and protective measures.

目的创伤性脑损伤（TBI）是目前全球主要的公共卫生问题，给社会和家庭带来了巨大的经济负担。我们旨在通过分析创伤性脑损伤的发病率、流行率和残疾生活年数（YLDs）来量化和预测创伤性脑损伤的发病率和严重程度。方法利用《2019 年全球疾病负担、伤害和风险因素研究》对 1990 年至 2019 年间按性别、年龄组和地区（n = 21 204 个国家和地区）划分的创伤性脑损伤发病率、流行率和伤残生活年数进行了二次分析。结果2019年，全球新增创伤性脑损伤病例2716万例（95%不确定区间（UI）：2336 - 31.42），年龄标准化发病率和患病率分别为每10万人346例（95% UI：298 - 401）和每10万人599例（95% UI：573 - 627）。从 1990 年到 2019 年，全球年龄标准化发病率（估计年百分比变化率：-0.11%，95% UI：-0.18% -0.04%）或患病率（估计年百分比变化率：0.01%，95% UI：-0.04% -0.06%）均无明显趋势。2019年，创伤性脑损伤导致708万（95% UI：5.00 - 9.59）人YLD，年龄标准化发病率为每10万人86.5例（95% UI：61.1 - 117.2）。2019年，发病率较高的国家主要分布在中欧、东欧和澳大利亚。2019年全球年龄标准化发病率男性高于女性。2019年全球中度和重度创伤性脑损伤发病率为每10万人182.7例，占所有创伤性脑损伤的52.8%，大多数地区的主要原因是跌倒和道路交通伤害。结论2019年中度和重度创伤性脑损伤发病率略有上升，创伤性脑损伤仍占全球伤害负担的很大一部分。介绍了1990-2019年中重度创伤性脑损伤发生的可能性和各损伤原因下重大损伤的趋势，以及各年龄组损伤机制的特点，为进一步研究各年龄组损伤原因、未来制定相应的政策和保护措施提供了依据。

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引用次数: 0

Multimodal image fusion-assisted endoscopic evacuation of spontaneous intracerebral hemorrhage 多模态图像融合辅助自发性脑内出血内窥镜清除术

IF 1.8 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-16 DOI: 10.1016/j.cjtee.2024.03.006

Chao Zhang , Juan Li , Ping-Li Wang , Hua-Yun Chen , Yu-Hang Zhao , Ning Wang , Zhi-Tao Zhang , Yan-Wei Dang , Hong-Quan Wang , Jun Wang , Chu-Hua Fu

Purpose

Although traditional craniotomy (TC) surgery has failed to show benefits for the functional outcome of intracerebral hemorrhage (ICH). However, a minimally invasive hematoma removal plan to avoid white matter fiber damage may be a safer and more feasible surgical approach, which may improve the prognosis of ICH. We conducted a historical cohort study on the use of multimodal image fusion-assisted neuroendoscopic surgery (MINS) for the treatment of ICH, and compared its safety and effectiveness with traditional methods.

Methods

This is a historical cohort study involving 241 patients with cerebral hemorrhage. Divided into MINS group and TC group based on surgical methods. Multimodal images (CT skull, CT angiography, and white matter fiber of MRI diffusion-tensor imaging) were fused into 3 dimensional images for preoperative planning and intraoperative guidance of endoscopic hematoma removal in the MINS group. Clinical features, operative efficiency, perioperative complications, and prognoses between 2 groups were compared. Normally distributed data were analyzed using t-test of 2 independent samples, Non-normally distributed data were compared using the Kruskal-Wallis test. Meanwhile categorical data were analyzed via the Chi-square test or Fisher’s exact test. All statistical tests were two-sided, and p < 0.05 was considered statistically significant.

Results

A total of 42 patients with ICH were enrolled, who underwent TC surgery or MINS. Patients who underwent MINS had shorter operative time (p < 0.001), less blood loss (p < 0.001), better hematoma evacuation (p = 0.003), and a shorter stay in the intensive care unit (p = 0.002) than patients who underwent TC. Based on clinical characteristics and analysis of perioperative complications, there is no significant difference between the 2 surgical methods. Modified Rankin scale scores at 180 days were better in the MINS than in the TC group (p = 0.014).

Conclusions

Compared with TC for the treatment of ICH, MINS is safer and more efficient in cleaning ICH, which improved the prognosis of the patients. In the future, a larger sample size clinical trial will be needed to evaluate its efficacy.

目的虽然传统的开颅手术（TC）未能显示出对脑内出血（ICH）功能预后的益处。然而，避免白质纤维损伤的微创血肿清除计划可能是一种更安全、更可行的手术方法，可改善 ICH 的预后。我们对使用多模态图像融合辅助神经内镜手术（MINS）治疗 ICH 进行了历史队列研究，并比较了其与传统方法的安全性和有效性。根据手术方法分为 MINS 组和 TC 组。将多模态图像（头颅 CT、CT 血管造影和核磁共振成像弥散张量成像的白质纤维）融合为三维图像，用于 MINS 组的术前规划和内镜血肿清除术的术中指导。比较两组患者的临床特征、手术效率、围手术期并发症和预后。正态分布数据采用 2 个独立样本的 t 检验，非正态分布数据采用 Kruskal-Wallis 检验。同时，分类数据通过卡方检验或费雪精确检验进行分析。所有统计检验均为双侧检验，以 p < 0.05 为差异有统计学意义。与接受 TC 手术的患者相比，接受 MINS 手术的患者手术时间更短（p < 0.001），失血量更少（p < 0.001），血肿清除率更高（p = 0.003），在重症监护室的住院时间更短（p = 0.002）。根据临床特征和围手术期并发症分析，两种手术方法没有显著差异。结论与 TC 治疗 ICH 相比，MINS 在清理 ICH 方面更安全、更有效，改善了患者的预后。今后，需要进行更大样本量的临床试验来评估其疗效。

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引用次数: 0

A retrospective study of occlusal reconstruction in patients with old jaw fractures and dentition defects 对陈旧性颌骨骨折和牙列缺损患者进行咬合重建的回顾性研究。

IF 1.8 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-11 DOI: 10.1016/j.cjtee.2024.03.004

<div><h3>Purpose</h3><p>This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.</p></div><div><h3>Methods</h3><p>Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct 3-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean ± standard deviation and compared using independent sample <em>t</em>-tests.</p></div><div><h3>Results</h3><p>In 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%).</p><p>The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthet

目的：该研究评估了多学科协作治疗陈旧性颌骨骨折和牙列缺损患者咬合重建的方法和临床效果：入选 2018 年 1 月至 2022 年 12 月在空军军医大学第三附属医院接受咬合重建的陈旧性颌骨骨折和牙列缺损患者。临床治疗分为3个阶段。第一阶段，采用正颌外科、显微外科、牵引成骨等技术重建正确的三维（3D）颌骨位置关系。在第二阶段，采用骨增量和软组织管理技术来解决牙槽骨量不足和牙龈软组织条件差的问题。在第三阶段，使用种植体支持的覆盖义齿或固定义齿进行咬合重建。通过治疗方法总结、临床疗效评估、影像学检查对比分析和满意度问卷调查，对创伤性陈旧性颌骨骨折和牙列缺损患者的疗效进行评估。所有数据均采用算术平均数和标准差进行汇总，并采用独立样本 t 检验进行比较：在 15 例陈旧性颌骨骨折和牙列缺损患者（平均年龄 32 岁，18 至 53 岁不等）中，7 例为单一上颌骨骨折错颌畸形，6 例为单一下颌骨骨折错颌畸形，2 例为上颌骨和下颌骨同时骨折错颌畸形。5例患者为单一上颌牙合缺损，2例患者为单一下颌牙合缺损，8例患者同时存在上颌和下颌牙合缺损。为了重建正确的三维颌骨位置关系，5 名患者接受了上颌骨勒堡 I 型截骨术，3 名患者接受了下颌骨双侧矢状劈裂嵴截骨术，4 名患者接受了陈旧性颌骨骨折切开复位内固定术，3 名患者接受了颞下颌关节手术，4 名患者接受了牵张成骨术。所有患者都接受了颌骨增量手术，其中4名患者接受了游离复合血管骨瓣手术（26.66%），其余患者接受了局部牙槽骨增量手术。游离牙龈移植和结缔组织移植是软组织增量的主要方法（73.33%）。15 名患者共接受了 81 枚种植体，其中 11 人接受了种植体支持的固定义齿，4 人接受了种植体支持的活动义齿。所有种植体的存活率为 93.82%。15 名患者的最终影像学检查证实，错颌畸形得到了矫正，临床治疗最终实现了咬合功能的重建。患者满意度问卷调查显示，他们对治疗后的疗效、语音、美观和舒适度均表示满意：结论：陈旧性颌骨骨折和牙列缺损的咬合重建需要分阶段循序渐进的综合治疗，包括三维空间颌骨矫正、牙槽骨增量和软组织增量、种植体支持的咬合重建，才能取得满意的临床疗效。

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引用次数: 0

Management of multiple and displaced mandibular fractures in a pediatric patient sans mandibular immobilization, sans open reduction and internal fixation 无需下颌骨固定、无需切开复位和内固定的儿科多发性移位下颌骨骨折的处理方法

IF 1.8 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-08 DOI: 10.1016/j.cjtee.2024.03.005

Maxillofacial fractures in the pediatric population are generally managed by conservative approaches such as soft diet and medication or semi-invasive procedures namely inter-maxillary fixation or circum-mandibular wiring. These approaches are preferred over any invasive treatment to minimize injury to the growing skeleton and tooth germs. Displaced fractures that cause functional problems such as restricted mouth opening, malocclusion or impaired breathing, mandate open reduction and internal fixation. However, surgical management is associated with morbidity related to general anesthesia, risk of injury to vital structures, and potential, skeletal or dental growth disturbances. This case report describes a non-invasive method of managing displaced, multiple fractures of the mandible in a pediatric patient, with the use of low intensity pulsed ultrasound to achieve favorable clinical outcomes and nil complications. Neither immobilization of the mandible with inter-maxillary fixation nor open reduction and internal fixation was used. Low intensity pulsed ultrasound therapy is painless and patient-friendly.

小儿颌面部骨折一般采用保守疗法，如软饮食和药物治疗，或采用半侵入性治疗方法，即颌骨间固定术或颌周套扎术。这些方法比任何侵入性治疗都更可取，以尽量减少对正在生长的骨骼和牙齿细菌的伤害。造成张口受限、咬合不正或呼吸障碍等功能性问题的移位骨折必须进行切开复位和内固定术。然而，手术治疗与全身麻醉的发病率、损伤重要结构的风险以及潜在的骨骼或牙齿生长障碍有关。本病例报告介绍了一种非侵入性方法，通过使用低强度脉冲超声波来治疗一名儿童下颌骨移位性多发性骨折，取得了良好的临床效果，且无并发症。该方法既没有使用颌骨间固定术固定下颌骨，也没有使用切开复位内固定术。低强度脉冲超声疗法无痛苦，对患者友好。

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引用次数: 0

Clinical characteristics associated with pediatric traumatic intracranial hemorrhage 与小儿外伤性颅内出血相关的临床特征。

IF 1.8 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-07 DOI: 10.1016/j.cjtee.2024.03.003

Pattama Tanaanantarak , Soraya Suntornsawat , Srila Samphao

Purpose

Traumatic brain injury (TBI) can cause significant morbidity and mortality in the pediatric population. Brain CT is the mainstay in the diagnosis of intracranial hemorrhage (ICH). The aim of this study was to explore the clinical characteristics that can predict ICH on brain CT in pediatric TBI patients, to assist physicians in deciding on the use of brain CT.

Methods

A total of 475 pediatric TBI patients who underwent brain CT within 24 h after injury from January 2012 to December 2021 in the level 1 trauma center in Thailand were included in this cross-sectional study. Clinical data and brain CT findings were collected. Logistic regression analysis was applied to evaluate clinical characteristics that could predict ICH on brain CT in pediatric TBI patients. A p value was less than 0.05 being indicated that the difference is statistically significant. R software version 3.6.1 was used to statistical analysis.

Results

The included cases have a median (Q₁, Q₃) age of 7.7 (3.5, 12.6) years. ICH was found in 98 (20.6%) pediatric patients based on brain CT findings. On multivariable analysis, high blunt energy injury (odds ratio (OR) = 2.79, 95% CI 1.27 – 6.11, p = 0.010), motor vehicle accidents (OR = 2.04, 95% CI: 1.14 – 3.67, p = 0.017), Glasgow coma scale score <13 (OR = 4.28, 95% CI: 1.87 – 9.78, p < 0.001), palpable skull fractures (OR = 7.30, 95% CI: 1.44 – 37.04, p = 0.016), signs of basilar skull fracture (OR = 6.10, 95% CI: 2.16 – 17.24, p < 0.001), and vomiting ≥ 3 times (OR = 2.60, 95% CI: 1.17 – 5.77, p = 0.022) were statistically significant predictive factors for ICH in pediatric TBI patients.

Conclusion

These factors might aid clinicians in making an appropriate decision regarding the use of brain CT in pediatric TBI cases.

目的：创伤性脑损伤（TBI）可导致儿童严重的发病率和死亡率。脑 CT 是诊断颅内出血（ICH）的主要手段。本研究旨在探讨可通过脑 CT 预测小儿 TBI 患者 ICH 的临床特征，以帮助医生决定是否使用脑 CT：方法：本横断面研究共纳入了 475 名小儿创伤性脑损伤患者，这些患者于 2012 年 1 月至 2021 年 12 月期间在泰国一级创伤中心接受了伤后 24 小时内的脑 CT 检查。研究收集了临床数据和脑 CT 结果。应用逻辑回归分析评估了可预测儿童创伤性脑损伤患者脑CT上ICH的临床特征。P值小于0.05表示差异具有统计学意义。统计分析采用 R 软件 3.6.1 版：纳入病例的平均年龄为 7.7 岁（四分位距（IQR）为 3.5 - 12.6 岁）。98例（20.63%）儿科患者根据脑CT结果发现了ICH。在多变量分析中，高钝能损伤（几率比（OR）= 2.79，95% CI 1.27 - 6.11，P = 0.010）、机动车事故（OR = 2.04，95% CI：1.14 - 3.67，P = 0.017）、格拉斯哥昏迷量表评分结论：这些因素可能有助于临床医生做出判断：这些因素可能有助于临床医生就小儿创伤性脑损伤病例中脑 CT 的使用做出适当的决定。

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引用次数: 0

A systematic analysis on global epidemiology and burden of foot fracture over three decades. 对三十年来全球足部骨折的流行病学和负担进行系统分析。

IF 2.1 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-07 DOI: 10.1016/j.cjtee.2024.03.001

Cheng Chen, Jin-Rong Lin, Yi Zhang, Tian-Bao Ye, Yun-Feng Yang

Purpose: To comprehensively analyze the geographic and temporal trends of foot fracture, understand its health burden by age, sex, and sociodemographic index (SDI), and explore its leading causes from 1990 to 2019.

Methods: The datasets in the present study were generated from the Global Burden of Diseases Study 2019, which included foot fracture data from 1990 to 2019. We extracted estimates along with the 95% uncertainty interval (UI) for the incidence and years lived with disability (YLDs) of foot fracture by location, age, gender, and cause. The epidemiology and burden of foot fracture at the global, regional, and national level was exhibited. Next, we presented the age and sex patterns of foot fracture. The leading cause of foot fracture was another focus of this study from the viewpoint of age, sex, and location. Then, Pearson's correlations between age-standardized rate (ASR), SDI, and estimated annual percentage change were calculated.

Results: The age-standardized incidence rate was 138.68 (95% UI: 104.88 - 182.53) per 100,000 persons for both sexes, 174.24 (95% UI: 134.35 - 222.49) per 100,000 persons for males, and 102.19 (95% UI: 73.28 - 138.00) per 100,000 persons for females in 2019. The age-standardized YLDs rate was 5.91 (95% UI: 3.58 - 9.25) per 100,000 persons for both genders, 7.35 (95% UI: 4.45 - 11.50) per 100,000 persons for males, and 4.51 (95% UI: 2.75 - 7.03) per 100,000 persons for females in 2019. The global incidence and YLDs of foot fracture increased in number and decreased in ASR from 1990 to 2019. The global geographical distribution of foot fracture is uneven. The incidence rate for males peaked at the age group of 20 - 24 years, while that for females increased with advancing age. The incidence rate of older people was rising, as younger age incidence rate declined from 1990 to 2019. Falls, exposure to mechanical forces, and road traffic injuries were the 3 leading causes of foot fracture. Correlations were observed between ASR, estimated annual percentage change, and SDI.

Conclusions: The burden of foot fracture remains high globally, and it poses an enormous public health challenge, with population ageing. It is necessary to allocate more resources to the high-risk populations. Targeted realistic intervention policies and strategies are warranted.

目的：全面分析足部骨折的地域和时间趋势，按年龄、性别和社会人口指数（SDI）了解其健康负担，并探讨1990年至2019年足部骨折的主要原因：本研究的数据集来自《2019 年全球疾病负担研究》，其中包括 1990 年至 2019 年的足部骨折数据。我们按地点、年龄、性别和原因提取了足部骨折发病率和残疾生活年数（YLDs）的估计值以及 95% 的不确定性区间（UI）。在全球、地区和国家层面展示了足部骨折的流行病学和负担。接下来，我们介绍了足部骨折的年龄和性别模式。从年龄、性别和地点的角度来看，足部骨折的主要原因是本研究的另一个重点。然后，计算了年龄标准化发病率（ASR）、SDI 和估计年百分比变化之间的皮尔逊相关性：2019年，男女的年龄标准化发病率为138.68（95% UI：104.88 - 182.53）/10万人，男性为174.24（95% UI：134.35 - 222.49）/10万人，女性为102.19（95% UI：73.28 - 138.00）/10万人。2019年，男女两性的年龄标准化YLDs率为每10万人5.91例（95% UI：3.58 - 9.25），男性为每10万人7.35例（95% UI：4.45 - 11.50），女性为每10万人4.51例（95% UI：2.75 - 7.03）。从 1990 年到 2019 年，全球足部骨折的发病率和 YLDs 在数量上有所增加，而 ASR 则有所下降。足部骨折的全球地理分布不均衡。男性的发病率在 20-24 岁年龄段达到高峰，而女性的发病率则随着年龄的增长而增加。从 1990 年到 2019 年，老年人的发病率呈上升趋势，而年轻人的发病率则有所下降。跌倒、机械外力作用和道路交通伤害是导致足部骨折的三大主要原因。ASR、估计年度百分比变化和SDI之间存在相关性：全球足部骨折的负担仍然很重，随着人口老龄化，足部骨折对公共卫生构成了巨大挑战。有必要为高危人群分配更多资源。有必要制定有针对性的现实干预政策和战略。

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引用次数: 0

Ipsilateral fractures of the acromion and coracoid processes of the scapula 肩峰和肩胛骨冠突同侧骨折

IF 2.1 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-01 DOI: 10.1016/j.cjtee.2023.04.003

Yusuf Omar Qalib , Srinivasa Reddy Medagam , Sunil Dachepalli

A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.

肩峰和肩胛骨冠突骨折在门诊中很少见，这是由于肩峰的解剖位置和形状，以及与之相连的强大韧带和肌肉所致。这些骨折是由于肩关节受到直接或间接的高能量创伤造成的，会导致剧烈疼痛和活动范围严重受限。有报道称肩峰有多种分类，但我们病例中的肩峰突纵向平面骨折类型在目前的文献中尚未见描述。我们的病例是一种罕见的肩峰突和不稳定肩峰骨质投影骨折的组合，这种类型的骨折以前从未报道过。与此最接近的是库恩的 III 型分类。一名 51 岁的男性患者在一次两轮摩托车事故后到我院急诊科就诊，主诉右肩疼痛，手臂抬起困难。患者接受了切开复位内固定术，并用3枚插管松质骨螺钉固定，术后进展顺利，未出现并发症。术后无症状，4 个月后恢复了完全活动范围。

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引用次数: 0

FM1-Editorial board FM1-编辑部

IF 2.1 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-01 DOI: 10.1016/S1008-1275(24)00018-X

引用次数: 0

The value of the INFECTIONS scoring system in identifying bacterial infections among patients presenting at the emergency department of a middle-income country: A pilot study INFECTIONS 评分系统在识别中等收入国家急诊科患者细菌感染方面的价值：试点研究

IF 2.1 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-01 DOI: 10.1016/j.cjtee.2023.09.001

Dooshanveer C. Nuckchady

Purpose

To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country, and to validate a new scoring system to predict bacterial infections.

Methods

This was a retrospective, single-center study among patients who were admitted via the emergency department of a public hospital. All patients who were started on antibiotics were included in the study, while patients aged < 18 years were excluded. Data collected includeding patients' demographics, vital signs and basic laboratory parameters like white blood cell count and creatinine. The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values. Logistic regression was used to derive a novel early warning system for bacterial infections. The area under the receiver operating characteristic (AUROC) was computed for each scoring model.

Results

In total, 109 patients were included in this study. The quick sequential organ failure assessment (qSOFA), search out severity and rapid acute physiology score had the highest AUROC (≥ 0.89) for predicting mortality, while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC > 0.85; however, these scoring systems failed to predict whether patients were truly infected. The INFECTIONS (short for impaired mental status, not conscious, fast heart rate, elevated creatinine, high temperature, on inotrope, low oxygen, high neutrophils and high sugar) model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient.

Conclusions

Middle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department. The INFECTIONS score may help recognize patients with bacterial infections, but it should be further validated in multiple countries prior to widely use.

目的研究哪种评分系统是预测中等收入国家急诊科感染患者死亡率的最准确工具，并验证预测细菌感染的新评分系统。所有开始使用抗生素的患者都被纳入研究范围，而年龄在 18 岁以下的患者则被排除在外。收集的数据包括患者的人口统计学特征、生命体征和基本实验室指标，如白细胞计数和肌酐。计算了不同评分系统的敏感性和特异性，以及它们的阴性和阳性预测值。利用逻辑回归得出了一种新型细菌感染预警系统。本研究共纳入了 109 名患者。快速序贯器官衰竭评估（qSOFA）、严重程度搜索和快速急性生理学评分预测死亡率的AUROC最高（≥ 0.89），而qSOFA和通用生命评估是最简单的评分系统，AUROC为0.85；但是，这些评分系统无法预测患者是否真正受到感染。INFECTIONS（精神状态受损、意识不清、心率过快、肌酐升高、高热、肌注、低氧、高中性粒细胞和高糖的简称）模型的AUROC达到0.88，能更准确地预测患者的感染状态。结论中等收入国家应使用qSOFA或通用生命评估评分来识别急诊科中病情最严重的患者。INFECTIONS评分可能有助于识别细菌感染患者，但在广泛使用前应在多个国家进一步验证。

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引用次数: 0

Clinical practice of sepsis-induced immunosuppression: Current immunotherapy and future options 败血症所致免疫抑制的临床实践：当前的免疫疗法和未来的选择

IF 2.1 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology

Pub Date : 2024-03-01 DOI: 10.1016/j.cjtee.2023.11.001

Fei Pei , Bin Gu , Shu-Min Miao , Xiang-Dong Guan , Jian-Feng Wu

Sepsis is a potentially fatal condition characterized by the failure of one or more organs due to a disordered host response to infection. The development of sepsis is closely linked to immune dysfunction. As a result, immunotherapy has gained traction as a promising approach to sepsis treatment, as it holds the potential to reverse immunosuppression and restore immune balance, thereby improving the prognosis of septic patients. However, due to the highly heterogeneous nature of sepsis, it is crucial to carefully select the appropriate patient population for immunotherapy. This review summarizes the current and evolved treatments for sepsis-induced immunosuppression to enhance clinicians' understanding and practical application of immunotherapy in the management of sepsis.

败血症是一种潜在的致命疾病，其特点是由于宿主对感染的反应失调而导致一个或多个器官功能衰竭。败血症的发生与免疫功能失调密切相关。因此，免疫疗法有望逆转免疫抑制，恢复免疫平衡，从而改善脓毒症患者的预后，已成为治疗脓毒症的一种有前途的方法。然而，由于脓毒症具有高度异质性，因此谨慎选择合适的患者人群接受免疫疗法至关重要。本综述总结了目前针对脓毒症引起的免疫抑制的治疗方法和发展，以提高临床医生对免疫疗法在脓毒症治疗中的理解和实际应用。

引用次数: 0