Pub Date : 2024-03-01DOI: 10.1016/j.cjtee.2023.08.001
Qing-Wei Lin , Lin-Cui Zhong , Long-Ping He , Qing-Bo Zeng , Wei Zhang , Qing Song , Jing-Chun Song
Purpose
In patients with heatstroke, disseminated intravascular coagulation (DIC) is associated with greater risk of in-hospital mortality. However, time-consuming assays or a complex diagnostic system may delay immediate treatment. Therefore, the present study proposes a new heatstroke-induced coagulopathy (HIC) score in patients with heat illness as an early warning indicator for DIC.
Methods
This retrospective study enrolled patients with heat illness in 24 Chinese hospitals from March 2021 to May 2022. Patients under 18 years old, with a congenital clotting disorder or liver disease, or using anticoagulants were excluded. Data were collected on demographic characteristics, routine blood tests, conventional coagulation assays and biochemical indexes. The risk factors related to coagulation function in heatstroke were identified by regression analysis, and used to construct a scoring system for HIC. The data of patients who met the diagnostic criteria for HIC and International Society on Thrombosis and Haemostasis defined-DIC were analyzed. All statistical analyses were performed using SPSS 26.0.
Results
The final analysis included 302 patients with heat illness, of whom 131 (43.4%) suffered from heatstroke, including 7 death (5.3%). Core temperature (OR = 1.681, 95% CI 1.291 − 2.189, p < 0.001), prothrombin time (OR = 1.427, 95% CI 1.175 − 1.733, p < 0.001) and D-dimer (OR = 1.242, 95% CI 1.049 − 1.471, p = 0.012) were independent risk factors for heatstroke, and therefore used to construct an HIC scoring system because of their close relation with abnormal coagulation. A total score ≥ 3 indicated HIC, and HIC scores correlated with the score for International Society of Thrombosis and Hemostasis -DIC (r = 0.8848, p < 0.001). The incidence of HIC (27.5%) was higher than that of DIC (11.2%) in all of 131 heatstroke patients. Meanwhile, the mortality rate of HIC (19.4%) was lower than that of DIC (46.7%). When HIC developed into DIC, parameters of coagulation dysfunction changed significantly: platelet count decreased, D-dimer level rose, and prothrombin time and activated partial thromboplastin time prolonged (p < 0.05).
Conclusions
The newly proposed HIC score may provide a valuable tool for early detection of HIC and prompt initiation of treatment.
目的 在中暑患者中，弥散性血管内凝血（DIC）与较高的院内死亡风险相关。然而，耗时的检测或复杂的诊断系统可能会延误及时治疗。因此，本研究提出了一种新的热病患者中暑诱发凝血病（HIC）评分，作为DIC的早期预警指标。方法这项回顾性研究招募了2021年3月至2022年5月期间在中国24家医院就诊的热病患者。研究排除了未满18岁、患有先天性凝血功能障碍或肝病、使用抗凝药物的患者。收集的数据包括人口统计学特征、血常规检查、常规凝血检测和生化指标。通过回归分析确定了与中暑凝血功能相关的危险因素，并利用这些因素构建了 HIC 评分系统。对符合 HIC 诊断标准和国际血栓与止血学会定义-DIC 的患者数据进行了分析。所有统计分析均使用 SPSS 26.0 进行。结果最终分析包括 302 名热病患者，其中 131 人（43.4%）中暑，包括 7 人死亡（5.3%）。核心温度（OR = 1.681，95% CI 1.291 - 2.189，p <0.001）、凝血酶原时间（OR = 1.427，95% CI 1.175 - 1.733，p <0.001）和 D-二聚体（OR = 1.242，95% CI 1.049 - 1.471，p = 0.012）是中暑的独立危险因素，因此用于构建 HIC 评分系统，因为它们与凝血异常密切相关。总分≥3分表示HIC，HIC得分与国际血栓与止血学会-DIC得分相关（r = 0.8848，p <0.001）。在所有 131 名中暑患者中，HIC 的发生率（27.5%）高于 DIC 的发生率（11.2%）。同时，HIC 的死亡率（19.4%）低于 DIC 的死亡率（46.7%）。当 HIC 发展为 DIC 时，凝血功能障碍的参数发生了显著变化：血小板计数减少，D-二聚体水平升高，凝血酶原时间和活化部分凝血活酶时间延长（p < 0.05）。
{"title":"A newly proposed heatstroke-induced coagulopathy score in patients with heat illness: A multicenter retrospective study in China","authors":"Qing-Wei Lin , Lin-Cui Zhong , Long-Ping He , Qing-Bo Zeng , Wei Zhang , Qing Song , Jing-Chun Song","doi":"10.1016/j.cjtee.2023.08.001","DOIUrl":"10.1016/j.cjtee.2023.08.001","url":null,"abstract":"<div><h3>Purpose</h3><p>In patients with heatstroke, disseminated intravascular coagulation (DIC) is associated with greater risk of in-hospital mortality. However, time-consuming assays or a complex diagnostic system may delay immediate treatment. Therefore, the present study proposes a new heatstroke-induced coagulopathy (HIC) score in patients with heat illness as an early warning indicator for DIC.</p></div><div><h3>Methods</h3><p>This retrospective study enrolled patients with heat illness in 24 Chinese hospitals from March 2021 to May 2022. Patients under 18 years old, with a congenital clotting disorder or liver disease, or using anticoagulants were excluded. Data were collected on demographic characteristics, routine blood tests, conventional coagulation assays and biochemical indexes. The risk factors related to coagulation function in heatstroke were identified by regression analysis, and used to construct a scoring system for HIC. The data of patients who met the diagnostic criteria for HIC and International Society on Thrombosis and Haemostasis defined-DIC were analyzed. All statistical analyses were performed using SPSS 26.0.</p></div><div><h3>Results</h3><p>The final analysis included 302 patients with heat illness, of whom 131 (43.4%) suffered from heatstroke, including 7 death (5.3%). Core temperature (<em>OR</em> = 1.681, 95% <em>CI</em> 1.291 − 2.189, <em>p</em> < 0.001), prothrombin time (<em>OR</em> = 1.427, 95% <em>CI</em> 1.175 − 1.733, <em>p</em> < 0.001) and D-dimer (<em>OR</em> = 1.242, 95% <em>CI</em> 1.049 − 1.471, <em>p</em> = 0.012) were independent risk factors for heatstroke, and therefore used to construct an HIC scoring system because of their close relation with abnormal coagulation. A total score ≥ 3 indicated HIC, and HIC scores correlated with the score for International Society of Thrombosis and Hemostasis -DIC (<em>r</em> = 0.8848, <em>p</em> < 0.001). The incidence of HIC (27.5%) was higher than that of DIC (11.2%) in all of 131 heatstroke patients. Meanwhile, the mortality rate of HIC (19.4%) was lower than that of DIC (46.7%). When HIC developed into DIC, parameters of coagulation dysfunction changed significantly: platelet count decreased, D-dimer level rose, and prothrombin time and activated partial thromboplastin time prolonged (<em>p</em> < 0.05).</p></div><div><h3>Conclusions</h3><p>The newly proposed HIC score may provide a valuable tool for early detection of HIC and prompt initiation of treatment.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 83-90"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523000706/pdfft?md5=8ca3a2a44898cc513fa7a9b69b08673b&pid=1-s2.0-S1008127523000706-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10448760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The role of topical vancomycin in fracture-related infection (FRI) is debatable. Very few studies have reported their efficacy in open and high-risk extremity fractures. This study aimed to assess topical vancomycin's role in reducing FRI in closed fractures undergoing open surgical intervention with an implant.
Methods
This prospective randomized cohort study was carried out between February 2021 to January 2022. Patients with isolated closed fractures, who were planned for open reduction and internal fixation within 2 weeks from the time of injury were included for this study. The data collected included age, gender, socioeconomic status, mechanism of injury, diagnosis, Tscherne classification, and time interval to take up for surgery. Patients were randomized into the intervention and control groups using the block randomization technique. The control group received only systemic antibiotic prophylaxis, whereas the intervention group received topical application of vancomycin powder in the surgical wound alongside systemic antibiotic prophylaxis. The primary outcome measure was the incidence of FRI among these individuals. Clinical and radiological findings and culture reports (in cases with infection) were recorded during the post-operative period and at 6 weeks of follow-up. All relevant statistical calculations were done using STATA statistical/data analysis-parallel edition version 16.0 (StataCorp LLC). The quantitative variables like age and duration of the surgery were assessed for normalcy by Shapiro-Wilk W test. An independent samples t-test with equal variances was applied to the age data. Fisher's exact test was used for the analysis of the primary outcome measure (presence of FRI following surgery), and “Risk of FRI” and “Risk difference” between the 2 groups was calculated. The strength of the association between qualitative variables was assessed using the Fisher's exact and Chi-square tests, respectively.
Results
There were 88 patients included in this study. No statistical significance was found about FRI between both groups (p = 0.494). At 6 weeks following surgery, no incidence of infection was observed in the intervention group. Two infections (4.5%) were found in the control group, with positive cultures reported in one of them but none in the treatment group. Radiologically, 15.9% of patients in the control group showed lysis around the implant compared to 2.3% in the intervention group. Impaired fracture healing was observed in 22.7% of patients in the intervention group compared to 15.9% in the control group.
Conclusion
Applying topical vancomycin in closed fractures undergoing open reduction and internal fixation does not significantly reduce the incidence of FRI until the end of 6 weeks following surgery.
{"title":"Does topical vancomycin prevent fracture-related infections in closed fractures undergoing open reduction and internal fixation? A randomised controlled trial","authors":"Mohit Gandhi , Gopisankar Balaji , Jagdish Menon , Ruben Raj Thomas","doi":"10.1016/j.cjtee.2023.11.006","DOIUrl":"10.1016/j.cjtee.2023.11.006","url":null,"abstract":"<div><h3>Purpose</h3><p>The role of topical vancomycin in fracture-related infection (FRI) is debatable. Very few studies have reported their efficacy in open and high-risk extremity fractures. This study aimed to assess topical vancomycin's role in reducing FRI in closed fractures undergoing open surgical intervention with an implant.</p></div><div><h3>Methods</h3><p>This prospective randomized cohort study was carried out between February 2021 to January 2022. Patients with isolated closed fractures, who were planned for open reduction and internal fixation within 2 weeks from the time of injury were included for this study. The data collected included age, gender, socioeconomic status, mechanism of injury, diagnosis, Tscherne classification, and time interval to take up for surgery. Patients were randomized into the intervention and control groups using the block randomization technique. The control group received only systemic antibiotic prophylaxis, whereas the intervention group received topical application of vancomycin powder in the surgical wound alongside systemic antibiotic prophylaxis. The primary outcome measure was the incidence of FRI among these individuals. Clinical and radiological findings and culture reports (in cases with infection) were recorded during the post-operative period and at 6 weeks of follow-up. All relevant statistical calculations were done using STATA statistical/data analysis-parallel edition version 16.0 (StataCorp LLC). The quantitative variables like age and duration of the surgery were assessed for normalcy by Shapiro-Wilk W test. An independent samples <em>t</em>-test with equal variances was applied to the age data. Fisher's exact test was used for the analysis of the primary outcome measure (presence of FRI following surgery), and “Risk of FRI” and “Risk difference” between the 2 groups was calculated. The strength of the association between qualitative variables was assessed using the Fisher's exact and Chi-square tests, respectively.</p></div><div><h3>Results</h3><p>There were 88 patients included in this study. No statistical significance was found about FRI between both groups (<em>p</em> = 0.494). At 6 weeks following surgery, no incidence of infection was observed in the intervention group. Two infections (4.5%) were found in the control group, with positive cultures reported in one of them but none in the treatment group. Radiologically, 15.9% of patients in the control group showed lysis around the implant compared to 2.3% in the intervention group. Impaired fracture healing was observed in 22.7% of patients in the intervention group compared to 15.9% in the control group.</p></div><div><h3>Conclusion</h3><p>Applying topical vancomycin in closed fractures undergoing open reduction and internal fixation does not significantly reduce the incidence of FRI until the end of 6 weeks following surgery.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 71-76"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523001281/pdfft?md5=5c4d0fd5c2e191fe393ca625c3dd6e06&pid=1-s2.0-S1008127523001281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.cjtee.2023.10.003
Li Zhong , Ming Wu , Zhe-Ying Liu , Yan Liu , Zhi-Feng Liu
Purpose
Minimal data exist on brain injury in patients with exertional heatstroke (EHS) in developing country. In this study, we explored the risk factors for brain injury induced by EHS 90-day after onset.
Methods
A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019. Patients were divided into non-brain injury (fully recovered) and brain injury groups (comprising deceased patients or those with neurological sequelae). The brain injury group was further subdivided into a death group and a sequela group for detailed analysis. General information, neurological performance and information on important organ injuries in the acute stage were recorded and analysed. Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury, and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.
Results
Out of the 147 EHS patients, 117 were enrolled, of which 96 (82.1%) recovered, 13 (11.1%) died, and 8 (6.8%) experienced neurological sequelae. Statistically significant differences were found between non-brain injury and brain injury groups in age, hypotension, duration of consciousness disorders, time to drop core body temperature below 38.5°C, lymphocyte counts, platelet counts, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, cystatin C, coagulation parameters, international normalized ratio, acute physiology and chronic health evaluation II scores, sequential organ failure assessment (SOFA) scores, and Glasgow coma scale scores (all p < 0.05). Multivariate logistic regression showed that age (OR = 1.090, 95% CI: 1.02 − 1.17, p = 0.008), time to drop core temperature (OR = 8.223, 95% CI: 2.30 − 29.40, p = 0.001), and SOFA scores (OR = 1.676, 95% CI: 1.29 − 2.18, p < 0.001) are independent risk factors for brain injury induced by EHS. The Kaplan-Meier curves suggest significantly prolonged survival (p < 0.001) in patients with early Glasgow coma scale score > 8 and duration of consciousness disorders ≤ 24 h.
Conclusions
Advanced age, delayed cooling, and higher SOFA scores significantly increase the risk of brain injury post-EHS. These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.
{"title":"Risk factors for brain injury in patients with exertional heatstroke: A 5-year experience","authors":"Li Zhong , Ming Wu , Zhe-Ying Liu , Yan Liu , Zhi-Feng Liu","doi":"10.1016/j.cjtee.2023.10.003","DOIUrl":"10.1016/j.cjtee.2023.10.003","url":null,"abstract":"<div><h3>Purpose</h3><p>Minimal data exist on brain injury in patients with exertional heatstroke (EHS) in developing country. In this study, we explored the risk factors for brain injury induced by EHS 90-day after onset.</p></div><div><h3>Methods</h3><p>A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019. Patients were divided into non-brain injury (fully recovered) and brain injury groups (comprising deceased patients or those with neurological sequelae). The brain injury group was further subdivided into a death group and a sequela group for detailed analysis. General information, neurological performance and information on important organ injuries in the acute stage were recorded and analysed. Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury, and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.</p></div><div><h3>Results</h3><p>Out of the 147 EHS patients, 117 were enrolled, of which 96 (82.1%) recovered, 13 (11.1%) died, and 8 (6.8%) experienced neurological sequelae. Statistically significant differences were found between non-brain injury and brain injury groups in age, hypotension, duration of consciousness disorders, time to drop core body temperature below 38.5°C, lymphocyte counts, platelet counts, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, cystatin C, coagulation parameters, international normalized ratio, acute physiology and chronic health evaluation II scores, sequential organ failure assessment (SOFA) scores, and Glasgow coma scale scores (all <em>p</em> < 0.05). Multivariate logistic regression showed that age (<em>OR</em> = 1.090, 95% <em>CI</em>: 1.02 − 1.17, <em>p</em> = 0.008), time to drop core temperature (<em>OR</em> = 8.223, 95% <em>CI</em>: 2.30 − 29.40, <em>p</em> = 0.001), and SOFA scores (<em>OR</em> = 1.676, 95% <em>CI</em>: 1.29 − 2.18, <em>p</em> < 0.001) are independent risk factors for brain injury induced by EHS. The Kaplan-Meier curves suggest significantly prolonged survival (<em>p</em> < 0.001) in patients with early Glasgow coma scale score > 8 and duration of consciousness disorders ≤ 24 h.</p></div><div><h3>Conclusions</h3><p>Advanced age, delayed cooling, and higher SOFA scores significantly increase the risk of brain injury post-EHS. These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 91-96"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523001013/pdfft?md5=cd4fbcd96e1695609ce12fffe0c97c9b&pid=1-s2.0-S1008127523001013-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute kidney injury (AKI) is one of the most common functional injuries observed in trauma patients. However, certain trauma medications may exacerbate renal injury. Therefore, the early detection of trauma-related AKI holds paramount importance in improving trauma prognosis.
Methods
Qualified datasets were selected from public databases, and common differentially expressed genes related to trauma-induced AKI and hub genes were identified through enrichment analysis and the establishment of protein-protein interaction (PPI) networks. Additionally, the specificity of these hub genes was investigated using the sepsis dataset and conducted a comprehensive literature review to assess their plausibility. The raw data from both datasets were downloaded using R software (version 4.2.1) and processed with the "affy" package19 for correction and normalization.
Results
Our analysis revealed 585 upregulated and 629 downregulated differentially expressed genes in the AKI dataset, along with 586 upregulated and 948 downregulated differentially expressed genes in the trauma dataset. Concurrently, the establishment of the PPI network and subsequent topological analysis highlighted key hub genes, including CD44, CD163, TIMP metallopeptidase inhibitor 1, cytochrome b-245 beta chain, versican, membrane spanning 4-domains A4A, mitogen-activated protein kinase 14, and early growth response 1. Notably, their receiver operating characteristic curves displayed areas exceeding 75%, indicating good diagnostic performance. Moreover, our findings postulated a unique molecular mechanism underlying trauma-related AKI.
Conclusion
This study presents an alternative strategy for the early diagnosis and treatment of trauma-related AKI, based on the identification of potential biomarkers and therapeutic targets. Additionally, this study provides theoretical references for elucidating the mechanisms of trauma-related AKI.
目的急性肾损伤（AKI）是创伤患者最常见的功能性损伤之一。然而，某些创伤药物可能会加重肾损伤。方法从公共数据库中筛选出合格的数据集，通过富集分析和建立蛋白-蛋白相互作用（PPI）网络，确定与创伤诱导的 AKI 相关的常见差异表达基因和枢纽基因。此外，还利用败血症数据集研究了这些中心基因的特异性，并进行了全面的文献综述以评估其合理性。我们使用 R 软件（4.2.1 版）下载了这两个数据集的原始数据，并使用 "affy "软件包19 对其进行了校正和归一化处理。结果我们的分析发现，在 AKI 数据集中有 585 个上调和 629 个下调的差异表达基因，在创伤数据集中有 586 个上调和 948 个下调的差异表达基因。同时，PPI 网络的建立和随后的拓扑分析突出显示了关键的枢纽基因，包括 CD44、CD163、TIMP 金属肽酶抑制剂 1、细胞色素 b-245 beta 链、versican、膜跨越 4 域 A4A、丝裂原活化蛋白激酶 14 和早期生长应答 1。值得注意的是，它们的接收者操作特征曲线显示面积超过 75%，表明诊断性能良好。此外，我们的研究结果还推测了创伤相关性 AKI 的独特分子机制。此外，本研究还为阐明创伤相关性 AKI 的机制提供了理论参考。
{"title":"Exploration of potential biomarkers and therapeutic targets for trauma-related acute kidney injury","authors":"Peng Qi , Meng-Jie Huang , Wei Wu , Xue-Wen Ren , Yong-Zhi Zhai , Chen Qiu , Hai-Yan Zhu","doi":"10.1016/j.cjtee.2024.01.002","DOIUrl":"10.1016/j.cjtee.2024.01.002","url":null,"abstract":"<div><h3>Purpose</h3><p>Acute kidney injury <strong>(</strong>AKI) is one of the most common functional injuries observed in trauma patients. However, certain trauma medications may exacerbate renal injury. Therefore, the early detection of trauma-related AKI holds paramount importance in improving trauma prognosis.</p></div><div><h3>Methods</h3><p>Qualified datasets were selected from public databases, and common differentially expressed genes related to trauma-induced AKI and hub genes were identified through enrichment analysis and the establishment of protein-protein interaction (PPI) networks. Additionally, the specificity of these hub genes was investigated using the sepsis dataset and conducted a comprehensive literature review to assess their plausibility. The raw data from both datasets were downloaded using R software (version 4.2.1) and processed with the \"affy\" package19 for correction and normalization.</p></div><div><h3>Results</h3><p>Our analysis revealed 585 upregulated and 629 downregulated differentially expressed genes in the AKI dataset, along with 586 upregulated and 948 downregulated differentially expressed genes in the trauma dataset. Concurrently, the establishment of the PPI network and subsequent topological analysis highlighted key hub genes, including CD44, CD163, TIMP metallopeptidase inhibitor 1, cytochrome <em>b</em>-245 beta chain, versican, membrane spanning 4-domains A4A, mitogen-activated protein kinase 14, and early growth response 1. Notably, their receiver operating characteristic curves displayed areas exceeding 75%, indicating good diagnostic performance. Moreover, our findings postulated a unique molecular mechanism underlying trauma-related AKI.</p></div><div><h3>Conclusion</h3><p>This study presents an alternative strategy for the early diagnosis and treatment of trauma-related AKI, based on the identification of potential biomarkers and therapeutic targets. Additionally, this study provides theoretical references for elucidating the mechanisms of trauma-related AKI.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 97-106"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127524000026/pdfft?md5=e48979840bbd6107eda4617d09a207ba&pid=1-s2.0-S1008127524000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.cjtee.2024.01.004
Hui-Dan Jing , Jun-Ying Tian , Wei Li , Bing-Ling He , Hong-Chao Li , Fu-Xia Jian , Cui Shang , Feng Shen
Purpose
To assess the value of the driving pressure variation rate (ΔP%) in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.
Methods
In this case-control study, a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled. Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days. Outcome measures including driving pressure, PaO2:FiO2, and positive end-expiratory pressure, etc. were assessed every 24 h from day 0 to day 14 until successful weaning was achieved. The measurement data of non-normal distribution were presented as median (Q1, Q3), and the differences between groups were compared by Wilcoxon rank sum test. And categorical data use the Chi-square test or Fisher's exact test to compare. The predictive value of ΔP% in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.
Results
Of the total 35 patients included in the study, 17 were successful vs. 18 failed in weaning from a ventilator after 14 days of mechanical ventilation. The cut-off values of the median ΔP% measured by Operator 1 vs. Operator 2 in the first 4 days were ≥ 4.17% and 4.55%, respectively (p < 0.001), with the area under curve of 0.804 (sensitivity of 88.2%, specificity of 64.7%) and 0.770 (sensitivity of 88.2%, specificity of 64.7%), respectively. There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group (8 (6, 13) vs. 12 (7.5, 17.3), p = 0.043). The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group (0.2‰ vs. 2.3‰, p = 0.001). There was a significant difference noted between these 2 groups in the 28-day mortality (11.8% vs. 66.7%, p = 0.003).
Conclusion
The median ΔP% in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days. Further study is needed to confirm this finding.
{"title":"Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome","authors":"Hui-Dan Jing , Jun-Ying Tian , Wei Li , Bing-Ling He , Hong-Chao Li , Fu-Xia Jian , Cui Shang , Feng Shen","doi":"10.1016/j.cjtee.2024.01.004","DOIUrl":"10.1016/j.cjtee.2024.01.004","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the value of the driving pressure variation rate (ΔP%) in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.</p></div><div><h3>Methods</h3><p>In this case-control study, a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled. Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days. Outcome measures including driving pressure, PaO<sub>2</sub>:FiO<sub>2</sub>, and positive end-expiratory pressure, etc. were assessed every 24 h from day 0 to day 14 until successful weaning was achieved. The measurement data of non-normal distribution were presented as median (Q<sub>1</sub>, Q<sub>3</sub>), and the differences between groups were compared by Wilcoxon rank sum test. And categorical data use the Chi-square test or Fisher's exact test to compare. The predictive value of ΔP% in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.</p></div><div><h3>Results</h3><p>Of the total 35 patients included in the study, 17 were successful <em>vs.</em> 18 failed in weaning from a ventilator after 14 days of mechanical ventilation. The cut-off values of the median ΔP% measured by Operator 1 <em>vs.</em> Operator 2 in the first 4 days were ≥ 4.17% and 4.55%, respectively (<em>p</em> < 0.001), with the area under curve of 0.804 (sensitivity of 88.2%, specificity of 64.7%) and 0.770 (sensitivity of 88.2%, specificity of 64.7%), respectively. There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group (8 (6, 13) <em>vs.</em> 12 (7.5, 17.3), <em>p</em> = 0.043). The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group (0.2‰ <em>vs.</em> 2.3‰, <em>p</em> = 0.001). There was a significant difference noted between these 2 groups in the 28-day mortality (11.8% <em>vs.</em> 66.7%, <em>p</em> = 0.003).</p></div><div><h3>Conclusion</h3><p>The median ΔP% in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days. Further study is needed to confirm this finding.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 107-113"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S100812752400004X/pdfft?md5=c449e3403731415fcd104e0ede5c7eb7&pid=1-s2.0-S100812752400004X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139637237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.cjtee.2023.05.005
Sheng-Feng Chen , Bo-Yao Yang , Tie-Yuan Zhang , Xiang-Yu Song , Zhi-Bo Jia , Lei-Jia Chen , Meng-Yi Cui , Wen-Jing Xu , Jiang Peng
Purpose
Ischemia and hypoxia are the main factors limiting limb replantation and transplantation. Static cold storage (SCS), a common preservation method for tissues and organs, can only prolong limb ischemia time to 4 – 6 h. The normothermic machine perfusion (NMP) is a promising method for the preservation of tissues and organs, which can extend the preservation time in vitro by providing continuous oxygen and nutrients. This study aimed to evaluate the difference in the efficacy of the 2 limb preservation methods.
Methods
The 6 forelimbs from beagle dogs were divided into 2 groups. In the SCS group (n = 3), the limbs were preserved in a sterile refrigerator at 4 °C for 24 h, and in the NMP group (n = 3), the perfusate prepared with autologous blood was used for the oxygenated machine perfusion at physiological temperature for 24 h, and the solution was changed every 6 h. The effects of limb storage were evaluated by weight gain, perfusate biochemical analysis, enzyme-linked immunosorbent assay, and histological analysis. All statistical analyses and graphs were performed using GraphPad Prism 9.0 one-way or two-way analysis of variance. The p value of less than 0.05 was considered to indicate statistical significance.
Results
In the NMP group, the weight gained percentage was 11.72% ± 4.06%; the hypoxia-inducible factor-1α contents showed no significant changes; the shape of muscle fibers was normal; the gap between muscle fibers slightly increased, showing the intercellular distance of (30.19 ± 2.83) μm; and the vascular α-smooth muscle actin (α-SMA) contents were lower than those in the normal blood vessels. The creatine kinase level in the perfusate of the NMP group increased from the beginning of perfusion, decreased after each perfusate change, and remained stable at the end of perfusion showing a peak level of 4097.6 U/L. The lactate dehydrogenase level of the NMP group increased near the end of perfusion and reached the peak level of 374.4 U/L. In the SCS group, the percentage of weight gain was 0.18% ± 0.10%, and the contents of hypoxia-inducible factor-1α increased gradually and reached the maximum level of (164.85 ± 20.75) pg/mL at the end of the experiment. The muscle fibers lost their normal shape and the gap between muscle fibers increased, showing an intercellular distance of (41.66 ± 5.38) μm. The contents of vascular α-SMA were much lower in the SCS group as compared to normal blood vessels.
Conclusions
NMP caused lesser muscle damage and contained more vascular α-SMA as compared to SCS. This study demonstrated that NMP of the amputated limb with perfusate solution based on autologous blood could maintain the physiological activities of the limb for at least 24 h.
{"title":"Study on the preservation effects of the amputated forelimb by machine perfusion at physiological temperature","authors":"Sheng-Feng Chen , Bo-Yao Yang , Tie-Yuan Zhang , Xiang-Yu Song , Zhi-Bo Jia , Lei-Jia Chen , Meng-Yi Cui , Wen-Jing Xu , Jiang Peng","doi":"10.1016/j.cjtee.2023.05.005","DOIUrl":"10.1016/j.cjtee.2023.05.005","url":null,"abstract":"<div><h3>Purpose</h3><p>Ischemia and hypoxia are the main factors limiting limb replantation and transplantation. Static cold storage (SCS), a common preservation method for tissues and organs, can only prolong limb ischemia time to 4 – 6 h. The normothermic machine perfusion (NMP) is a promising method for the preservation of tissues and organs, which can extend the preservation time <em>in vitro</em> by providing continuous oxygen and nutrients. This study aimed to evaluate the difference in the efficacy of the 2 limb preservation methods.</p></div><div><h3>Methods</h3><p>The 6 forelimbs from beagle dogs were divided into 2 groups. In the SCS group (<em>n</em> = 3), the limbs were preserved in a sterile refrigerator at 4 °C for 24 h, and in the NMP group (<em>n</em> = 3), the perfusate prepared with autologous blood was used for the oxygenated machine perfusion at physiological temperature for 24 h, and the solution was changed every 6 h. The effects of limb storage were evaluated by weight gain, perfusate biochemical analysis, enzyme-linked immunosorbent assay, and histological analysis. All statistical analyses and graphs were performed using GraphPad Prism 9.0 one-way or two-way analysis of variance. The <em>p</em> value of less than 0.05 was considered to indicate statistical significance.</p></div><div><h3>Results</h3><p>In the NMP group, the weight gained percentage was 11.72% ± 4.06%; the hypoxia-inducible factor-1α contents showed no significant changes; the shape of muscle fibers was normal; the gap between muscle fibers slightly increased, showing the intercellular distance of (30.19 ± 2.83) μm; and the vascular α-smooth muscle actin (α-SMA) contents were lower than those in the normal blood vessels. The creatine kinase level in the perfusate of the NMP group increased from the beginning of perfusion, decreased after each perfusate change, and remained stable at the end of perfusion showing a peak level of 4097.6 U/L. The lactate dehydrogenase level of the NMP group increased near the end of perfusion and reached the peak level of 374.4 U/L. In the SCS group, the percentage of weight gain was 0.18% ± 0.10%, and the contents of hypoxia-inducible factor-1α increased gradually and reached the maximum level of (164.85 ± 20.75) pg/mL at the end of the experiment. The muscle fibers lost their normal shape and the gap between muscle fibers increased, showing an intercellular distance of (41.66 ± 5.38) μm. The contents of vascular α-SMA were much lower in the SCS group as compared to normal blood vessels.</p></div><div><h3>Conclusions</h3><p>NMP caused lesser muscle damage and contained more vascular α-SMA as compared to SCS. This study demonstrated that NMP of the amputated limb with perfusate solution based on autologous blood could maintain the physiological activities of the limb for at least 24 h.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 114-120"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523000470/pdfft?md5=1e4d8f9f54ffd8d7b219abc24710316e&pid=1-s2.0-S1008127523000470-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9982937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Hoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate.
Method: This was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0.
Results: In the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with p < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months.
Conclusions: Fixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.
目的：Hoffa 骨折是冠状面上的股骨髁骨折。外侧髁更常受累。常规X光片往往难以诊断。保守治疗会导致骨折不愈合、错位和其他并发症，如膝关节僵硬。因此，对于移位骨折必须进行手术治疗。以往的研究建议仅应用松质骨螺钉固定，但这不足以对抗垂直剪切应力。因此，本研究将评估使用松质骨螺钉与后托板对Letenneur I型Hoffa骨折进行切开复位内固定的临床效果：这是一项前瞻性队列研究，经机构伦理委员会批准后，于2017年3月至2022年7月在三级医疗中心骨科开展。研究共纳入36例Letenneur I型骨折患者，均采用后托钢板和松质骨螺钉进行切开复位内固定治疗。随访4个月和12个月后，对患者的X光片和临床疗效、活动范围（ROM）、骨结合情况和膝关节社会评分（KSS）进行评估。所有统计分析均使用 Epi info 7.2.1.0 版进行：在36名Letenneur I型骨折患者中，大多数年龄在25至54岁之间，其中男性22人，女性14人。受伤方式为道路交通事故（25 例）和高空坠落（11 例）。21例患者右膝受累，15例患者左膝受累。外侧髁受累 27 例，内侧髁受累 9 例。所有 36 例 Letenneur I 型霍法骨折患者均在手术治疗 4 个月后接受了评估。患者的活动度（ROM）为120.4°±5.0°，KSS为85.0±4.2，均有明显改善。在 12 个月的随访中，在 ROM 128.1° ± 5.2°和 KSS 89.3 ± 4.8（P）方面保持了更好的结果：用松质骨螺钉和后托板固定 Letenneur I 型 Hoffa 骨折是有效、可靠的，并能提供足够的稳定性。对接钢板辅助固定是对传统的 Hoffa 骨折滞后螺钉固定技术的重要改进。
{"title":"Novel approach of plate assisted buttressing in Hoffa fracture.","authors":"Amit Singh, Nirottam Singh, Gaurav Siwach, Mohit Bansal, Hemant Jain, Kishore Raichandani","doi":"10.1016/j.cjtee.2024.02.003","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.02.003","url":null,"abstract":"<p><strong>Purpose: </strong>Hoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate.</p><p><strong>Method: </strong>This was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0.</p><p><strong>Results: </strong>In the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with p < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months.</p><p><strong>Conclusions: </strong>Fixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133248","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}
Pub Date : 2024-01-29DOI: 10.1016/j.cjtee.2024.01.006
Xiang-Ping Luo, Jian Peng, Ling Zhou, Hao Liao, Xiao-Chun Jiang, Xiong Tang, Dun Tang, Chao Liu, Jian-Hui Liu
Purpose: Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals.
Methods: A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired t-test or Mann-Whitney U test, and categorical data was analyzed by Pearson Chi-square test.
Results: The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 vs. 716.89 ± 420.30, p = 0.031). The post-operative transfusion rate was 30.67 % in the TXA group and 47.95 % in the saline group (p = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups.
Conclusion: We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.
目的：接受股骨近端钉抗旋转（PFNA）手术的转子间骨折与大量隐性失血有关。本研究旨在探讨髓内注射氨甲环酸（TXA）能否减少老年人股骨转子间骨折 PFNA 手术中的出血量：方法：2019年1月至2022年12月进行了一项随机对照试验。年龄在60岁以上、接受PFNA髓内固定手术的转子间骨折患者均符合纳入条件，并根据随机编号进行分组。共有249名患者被初步纳入，其中83人被随机分配到TXA组，82人被分配到生理盐水组。TXA组在骨髓扩孔后接受髓内TXA灌注。主要结果是围手术期总失血量和术后输血率。此外，还记录了不良事件的发生情况。连续数据采用非配对 t 检验或 Mann-Whitney U 检验，分类数据采用 Pearson Chi-square 检验：TXA组的围手术期总失血量（毫升）明显低于生理盐水组（577.23 ± 358.02 vs. 716.89 ± 420.30，P = 0.031）。TXA 组的术后输血率为 30.67%，生理盐水组为 47.95%（P = 0.031）。两组的术后深静脉血栓形成程度和 3 个月死亡率相似：我们观察到，在老年转子间骨折的 PFNA 手术中，髓内注射 TXA 可减少围手术期失血，降低输血率，且无任何不良反应，因此值得推荐。
{"title":"Intramedullary administration of tranexamic acid reduces bleeding in proximal femoral nail antirotation surgery for intertrochanteric fractures in elderly individuals: A randomized controlled trial.","authors":"Xiang-Ping Luo, Jian Peng, Ling Zhou, Hao Liao, Xiao-Chun Jiang, Xiong Tang, Dun Tang, Chao Liu, Jian-Hui Liu","doi":"10.1016/j.cjtee.2024.01.006","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.01.006","url":null,"abstract":"<p><strong>Purpose: </strong>Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired t-test or Mann-Whitney U test, and categorical data was analyzed by Pearson Chi-square test.</p><p><strong>Results: </strong>The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 vs. 716.89 ± 420.30, p = 0.031). The post-operative transfusion rate was 30.67 % in the TXA group and 47.95 % in the saline group (p = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups.</p><p><strong>Conclusion: </strong>We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013740","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}
<div><h3>Purpose</h3><div>To explore the clinical characteristics of pediatric pelvic fracturs caused by traffic accidents and to analyze the accompanying injuries and complications.</div></div><div><h3>Methods</h3><div>A total of 222 cases involved traffic accidents was enrolled in this case-control study. The data of children with pelvic fractures caused by traffic accidents who were admitted to our hospital from January 2006 to December 2021 were analyzed retrospectively. Sex, age, Tile classification, abbreviated injury scale score, injury severity score, mortality, and accompanying injuries were studied. The ANOVA was used for measurement data, and the non-parametric rank sum test was used for non-normally distributed data. The Fisher's exact probability method was used for the count data.</div></div><div><h3>Results</h3><div>Of all enrolled cases, 140 are boys and 82 are girls, including 144 cases aged < 6 years, 65 aged between 6 and 12 years, and 13 aged > 12 years. Depending on the injury mechanism, there are 15 cases involving pedestrians <em>vs</em>. motorcycles (PVM), 91 cases involving pedestrians <em>vs</em>. passenger cars (PVC), 78 cases involving pedestrians <em>vs</em>. commercial vehicles (PVV), and 38 cases involving motor vehicles <em>vs</em>. motor vehicles (MVM). Associated injuries are reported in 198 cases (89.2%), primarily involving the abdomen injury in 144 cases (64.9%), and lower limb injury in 99 cases (44.6%). PVV injury involves longer hospital stay (<em>p</em> = 0.004). Intensive care unit admission rate is significantly higher in the MVM group than in other groups (<em>p</em> = 0.004). Head injury (<em>p</em> = 0.001) and face injury (<em>p</em> = 0.037) are more common in the MVM group, whereas abdominal injury (<em>p</em> = 0.048) and lower limb injury (<em>p</em> = 0.037) are more common in the PVV group. In the MVM group, the brain injury (<em>p</em> = 0.004) and femoral neck injury (<em>p</em> = 0.044) are more common. In the PVM group, the mediastinum (<em>p</em> = 0.004), ear (<em>p</em> = 0.009), lumbar vertebrae (<em>p</em> = 0.008), and spinal cord (<em>p</em> = 0.011) are the most vulnerable regions, while in the PVV group, the perineum (<em>p</em> < 0.001), urethra (<em>p</em> = 0.001), rectum (<em>p</em> = 0.006), anus (<em>p</em> = 0.004), and lower limb soft tissues (<em>p</em> = 0.024) are the most vulnerable regions. Children aged > 12 years have higher pelvic abbreviated injury scale scores (<em>p</em> = 0.019). There are significant differences in the classification of pelvic fractures among children < 6, 6 – 12, and > 12 years of age, with Tile C being more likely to occur in children > 12 years of age (<em>p</em> = 0.033). Children aged > 12 years are more likely to sustain injuries to the spleen (<em>p</em> = 0.022), kidneys (<em>p</em> = 0.019), pancreas (<em>p</em> < 0.001), lumbar vertebrae (<em>p</em> = 0.013), and sacrum (<em>p</em> = 0.024). The MVM group ha
{"title":"Comparison of pediatric pelvic fractures and associated injuries caused by different types of road traffic accidents","authors":"Bao-Jian Song, Qiang Wang, Wei Feng, Dan-Jiang Zhu, Xue-Jun Zhang","doi":"10.1016/j.cjtee.2024.01.005","DOIUrl":"10.1016/j.cjtee.2024.01.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore the clinical characteristics of pediatric pelvic fracturs caused by traffic accidents and to analyze the accompanying injuries and complications.</div></div><div><h3>Methods</h3><div>A total of 222 cases involved traffic accidents was enrolled in this case-control study. The data of children with pelvic fractures caused by traffic accidents who were admitted to our hospital from January 2006 to December 2021 were analyzed retrospectively. Sex, age, Tile classification, abbreviated injury scale score, injury severity score, mortality, and accompanying injuries were studied. The ANOVA was used for measurement data, and the non-parametric rank sum test was used for non-normally distributed data. The Fisher's exact probability method was used for the count data.</div></div><div><h3>Results</h3><div>Of all enrolled cases, 140 are boys and 82 are girls, including 144 cases aged < 6 years, 65 aged between 6 and 12 years, and 13 aged > 12 years. Depending on the injury mechanism, there are 15 cases involving pedestrians <em>vs</em>. motorcycles (PVM), 91 cases involving pedestrians <em>vs</em>. passenger cars (PVC), 78 cases involving pedestrians <em>vs</em>. commercial vehicles (PVV), and 38 cases involving motor vehicles <em>vs</em>. motor vehicles (MVM). Associated injuries are reported in 198 cases (89.2%), primarily involving the abdomen injury in 144 cases (64.9%), and lower limb injury in 99 cases (44.6%). PVV injury involves longer hospital stay (<em>p</em> = 0.004). Intensive care unit admission rate is significantly higher in the MVM group than in other groups (<em>p</em> = 0.004). Head injury (<em>p</em> = 0.001) and face injury (<em>p</em> = 0.037) are more common in the MVM group, whereas abdominal injury (<em>p</em> = 0.048) and lower limb injury (<em>p</em> = 0.037) are more common in the PVV group. In the MVM group, the brain injury (<em>p</em> = 0.004) and femoral neck injury (<em>p</em> = 0.044) are more common. In the PVM group, the mediastinum (<em>p</em> = 0.004), ear (<em>p</em> = 0.009), lumbar vertebrae (<em>p</em> = 0.008), and spinal cord (<em>p</em> = 0.011) are the most vulnerable regions, while in the PVV group, the perineum (<em>p</em> < 0.001), urethra (<em>p</em> = 0.001), rectum (<em>p</em> = 0.006), anus (<em>p</em> = 0.004), and lower limb soft tissues (<em>p</em> = 0.024) are the most vulnerable regions. Children aged > 12 years have higher pelvic abbreviated injury scale scores (<em>p</em> = 0.019). There are significant differences in the classification of pelvic fractures among children < 6, 6 – 12, and > 12 years of age, with Tile C being more likely to occur in children > 12 years of age (<em>p</em> = 0.033). Children aged > 12 years are more likely to sustain injuries to the spleen (<em>p</em> = 0.022), kidneys (<em>p</em> = 0.019), pancreas (<em>p</em> < 0.001), lumbar vertebrae (<em>p</em> = 0.013), and sacrum (<em>p</em> = 0.024). The MVM group ha","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 6","pages":"Pages 372-379"},"PeriodicalIF":1.8,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The treatment strategy for blast injuries is closely linked to the clinical outcome of blast injury casualties. However, the application of military surgery experience to blast injuries caused by production safety accidents is relatively uncommon. In this study, the authors present 2 cases of blast injuries caused by one gas explosion, both cases involved individuals of the same age and gender and experienced similar degree of injury. The authors highlight the importance of using a military surgery treatment strategy, specifically emphasizing the need to understand the concept of damage control and disposal. It is recommended that relevant training in this area should be strengthened to improve the clinical treatment of such injuries. This study provides a valuable reference for healthcare professionals dealing with blast injuries.
{"title":"Blast injuries with contrasting outcomes treated by military surgery strategies: A case report","authors":"Di-You Chen , Xi-Yan Zhu , Wei Ma , Shi-Feng Shao , Liang Zhang , Jing-Ru Xie , Yao-Li Wang , Hui Zhao","doi":"10.1016/j.cjtee.2024.01.003","DOIUrl":"10.1016/j.cjtee.2024.01.003","url":null,"abstract":"<div><div>The treatment strategy for blast injuries is closely linked to the clinical outcome of blast injury casualties. However, the application of military surgery experience to blast injuries caused by production safety accidents is relatively uncommon. In this study, the authors present 2 cases of blast injuries caused by one gas explosion, both cases involved individuals of the same age and gender and experienced similar degree of injury. The authors highlight the importance of using a military surgery treatment strategy, specifically emphasizing the need to understand the concept of damage control and disposal. It is recommended that relevant training in this area should be strengthened to improve the clinical treatment of such injuries. This study provides a valuable reference for healthcare professionals dealing with blast injuries.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 6","pages":"Pages 414-419"},"PeriodicalIF":1.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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