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Risky Factors of Early Death after Open Chest Injury and Seawater Immersion

目的　建立犬开放性气胸海水浸泡的实验模型 ,探讨实验动物早期死亡原因。　方法　 2 0条健康成年杂种犬随机分为两组。对照组 :实验动物受伤后直接观察 ;实验组 :动物受伤后置入人工配制的海水中。监测血流动力学、呼吸、血液渗透压、血液电解质、动脉血气变化以及肺部病理改变。　结果　实验组死亡率明显高于对照组 ,平均生存时间为 45分钟。实验组经海水浸泡后有急性呼吸和循环功能衰竭、严重电解质平衡紊乱、高渗血症、重度肺损伤以及严重代谢性和呼吸性酸中毒。　结论　开放性气胸后海水浸泡可引起一系列严重的病理生理变化 ,其结果是导致实验动物早期死亡的重要原因。

Observation of patient clinical outcomes based on the new subclassification of zone Ⅲ open-globe injury

ObjectiveTo compare and observe the visual acuity and ocular anatomical outcome of different subtypes in open-globe injury (OGI) Ⅲ. MethodsA retrospective study. A total of 187 eyes of 187 patients with OGI involving zone Ⅲ who were admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2020 to December 2023 were included in the study. According to the 2022 International Globe and Adnexal Trauma Epidemiology Study groups consensus, zone Ⅲ was further divided into Ⅲa zone (5-8 mm posterior to the limbus) and Ⅲb zone (＞8 mm posterior to the limbus), with 58 eyes (31%, 58/187) in group Ⅲa and 129 eyes (69%, 129/187) in group Ⅲb. Best corrected visual acuity (BCVA) was examined using the international standard decimal visual acuity chart, converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity when recorded. The injured zone, initial visual acuity, final visual acuity, retinal detachment (RD), uveal prolapse, and proliferative vitreoretinopathy (PVR) were collected. The follow-up time after surgery ≥ 6 months. The final visual acuity and anatomical prognosis of the two groups were observed. Silicone oil dependence, phthisis, and enucleation were defined as poor anatomical outcomes. Multiple linear regression analysis was performed to analyze the impact of zone Ⅲb of OGI on the final visual acuity. ResultsAt the 6-month follow-up, the logMAR BCVA of group Ⅲa and group Ⅲb was 1.49±1.0 and 2.51±0.85; there was a statistically significant difference in the logMAR BCVA between the two groups (t=−2.736, P＜0.05). Compared with group Ⅲa, the proportion with light perception in group Ⅲb was higher, and the proportions with visual acuity of hand movement, counting fingers, and ＞0.01 were lower, and the differences were all statistically significant (P＜0.05). Compared with group Ⅲa, RD and PVR were more likely to occur in group Ⅲb, and the differences were all statistically significant (χ2= 16.696, 8.697; P＜0.05). Among the affected eyes in group Ⅲa and group Ⅲb, there were 14 eyes (24.1%, 14/58) and 95 eyes (73.6%, 95/129) with poor final anatomical outcomes respectively; the incidence of poor final anatomical outcomes in group Ⅲb was higher, and the difference was statistically significant (χ2= 40.332, P＜0.01). The results of multiple linear regression analysis showed that initial visual acuity, RD, and uveal prolapse were independent risk factors affecting the final visual acuity (odds ratio=2.407, 4.162, 3.413; P＜0.05). ConclusionsPatients with OGI in zone Ⅲb have a worse visual prognosis and a higher incidence of poor anatomical outcomes. The subclassification of zone Ⅲ is helpful for better predicting the prognosis of OGI clinically.

锁定接骨板外固定和组合臂式外固定架治疗胫骨开放性骨折的比较研究

目的 比较组合臂式外固定架与锁定接骨板外固定治疗胫骨开放性骨折的临床疗效。 方法 回顾分析 2011 年 6 月—2015 年 1 月采用锁定接骨板外固定治疗的 37 例胫骨开放性骨折患者临床资料，并与同期采用组合臂式外固定架治疗的 55 例患者进行比较。两组患者年龄、Gustilo 分型、合并伤、软组织缺损范围等一般资料比较，差异均无统计学意义（P>0.05），具有可比性。 结果 所有患者均获随访，随访时间 9～14 个月，平均 12 个月。两组患者手术时间、术中失血量、住院时间比较差异无统计学意义（P>0.05）；研究组骨折愈合时间及治疗费用均低于对照组（P<0.05）。术后 8 个月，对照组外固定架针道松动发生率为 76.4%（42/55），骨不连发生率为 29.1%（16/55），返岗工作率为 70.9%（39/55）；研究组分别为 8.1%（3/37）、8.1%（3/37）和 91.9%（34/37），两组比较差异均有统计学意义（P<0.05）。对照组 42 例患者发生畸形愈合，而研究组未见钢板扭曲、螺钉退出等并发症。末次随访时按 Johner & Wruhs 评价法评价，对照组优良率为 60.0%（33/55），研究组为 91.9%（34/37），比较差异有统计学意义（χ2=2.704，P=0.002）。 结论 锁定接骨板外固定治疗胫骨开放性骨折，操作简便、骨折愈合快，可有效固定骨折。

Systematic Review of Transfusion Strategies for Cardiac Surgery

This paper is aimed to assess the effects of red blood cell (RBC) transfusion on clinical outcomes in cardiac surgery. Trials were identified by computer searches of the Pubmed,MEDLINE,Cochrane Library (Issue10,2012),from January 1980 to October 2012. References in identified trials and review articles were checked and experts contacted to identify any additional trials. The homogeneous randomized controlled trials (RCTs) were analyzed with RevMan 5.1 software. Five trials involving a total of 1,203 patients were identified. The results of meta-analyses showed that restrictive transfusion strategies reduced the risk of receiving a RBC transfusion (MD=-1.46,95% CI -1.18--1.1) and the volume of RBCs transfusion (RR=0.69,95% CI 0.53-0.89). No significant difference was noted between the two strategies in terms of mortality,adverse events and hospital or intensive care length of stay. Based on the results mentioned above, one can draw a conclusion that restrictive transfusion strategies reduced the risk of receiving RBC transfusion and the volume of RBCs transfused. Restrictive transfusion strategies did not appear to impact on the rate of adverse events and hospital or intensive care length of stay, compared to liberal transfusion strategies.

Relationship Between External Branch of Superior Laryngeal Nerve Injury and Surgical Approach

Objective To explore the relationship between external branch of superior laryngeal nerve (EBSLN) injury and the approachs of surgery in open thyroidectomy, and to summarize the preventive methods. Methods The clinical data of 985 patients who had consecutively underwent open thyroidectomy from January 2009 to June 2012 were retrospectively analyzed, to explore the relationship between EBSLN injury and the approachs of surgery in open thyroidectomy. Results The overall incidence of EBSLN injury was 2.6% (26/985), and 959 patients (97.4%) didn’t suffered from EBSLN injury. Results of logistic regression showed that the extent of surgery (OR=4.536, P=0.004) and identification of the EBSLN (OR=0.126, P=0.044) were influence factors of EBSLN injury after open thyroidectomy, but age (OR=1.108, P=0.823), gender (OR=0.604, P=0.260), benign or malignant tumor (OR=1.871, P=0.186), anesthesia methods (OR=0.659, P=0.372), and the application of ultrasonic scalpel (OR=0.473, P=0.248) were not associated with EBSLN injury. Conclusion In open thyroidectomy, the extent of surgery and identification of EBSLN are the independent factors of EBSLN injury, which are important to avoid EBSLN injury.

推进腓肠肌皮瓣修复跟腱开放性缺损

目的 探讨跟腱开放性缺损的治疗方法及临床效果。 方法 2001 年5 月－ 2008 年8 月，采用推进内外侧腓肠肌联合肌皮瓣治疗8 例外伤致跟腱开放性缺损。男5 例，女3 例；年龄15 ～ 36 岁，平均25 岁。左足3 例，右足5 例。伤后至手术时间为7 ～ 65 d。创面范围6.0 cm × 4.5 cm ～ 8.0 cm × 6.5 cm。跟腱缺损长度为5.0 ～ 7.5 cm，平均6.0 cm。术中肌皮瓣切取范围为22.5 cm × 7.8 cm ～ 28.0 cm × 11.5 cm，供区皮肤行V-Y 推进缝合。 结果 术后第2 天3 例肌皮瓣出现张力性水疱，经对症处理后成活；其余肌皮瓣均顺利成活，创面Ⅰ期愈合。供区切口Ⅰ期愈合。术后患者均获随访，随访时间6 个月～ 7 年，中位时间2 年3 个月。术后肌皮瓣质地、外观满意。末次随访时，按Arner-Lindholm跟腱损伤疗效评定标准，获优6 例，良2 例。 结论 内外侧腓肠肌联合肌皮瓣具有感觉、耐磨、对供区影响较小，是修复跟腱开放性缺损较理想的组织瓣。

腓肠肌肌瓣修复小腿胫前中上段感染性软组织缺损

目的 总结应用腓肠肌肌瓣修复小腿胫前中上段感染性软组织缺损的疗效。 方法2007年4月－2011年7月，收治11例胫骨开放性骨折固定术后并发胫前中上段感染性软组织缺损患者。男8例，女3例；年龄12～86岁，中位年龄34岁。交通事故伤9例，重物砸伤2例。于骨折固定术后7～12 d 出现创面软组织坏死、感染，细菌培养均呈阳性。伤后至此次入院时间为7～15 d，平均12 d。软组织缺损范围8 cm × 6 cm～16 cm × 10 cm。术中切取大小为11 cm × 7 cm～19 cm × 11 cm的腓肠肌肌瓣修复软组织缺损合并胫骨外露或骨髓腔，大腿中厚皮片覆盖肌瓣表面。 供瓣区间断缝合。 结果术后腓肠肌肌瓣及皮片均成活，供、受区创面Ⅰ期愈合。患者均获随访，随访时间6～57个月，平均21个月。受区外形饱满，皮片柔软、耐磨，无溃疡形成。X线片检查示骨折均愈合，愈合时间5～13个月。 结论腓肠肌肌瓣是修复小腿胫前中上段感染性软组织缺损的有效方法之一，具有血循环可靠、肌肉组织量丰富、切取简便、供区损伤小、并发症少等优点。

Gustilo Ⅲ型及Sanders Ⅳ型跟骨骨折的治疗

目的总结手术治疗GustiloⅢ型及Sanders Ⅳ型跟骨骨折的疗效。 方法2011年5月－2014年6月，收治9例GustiloⅢ型及Sanders Ⅳ型跟骨骨折患者。男7例，女2例；年龄21～56岁，平均37.6岁。致伤原因：高处坠落伤7例，交通事故伤2例。左侧6例，右侧3例。伤后至入院时间2～18 h，平均7.2 h。一期行彻底清创、封闭式负压引流（vacuum sealing drainage,VSD）治疗，二期行跟骨骨折复位内固定、小腿内侧胫后动脉穿支皮瓣修复创面。 结果术后2例跟骨内侧创面发生浅表感染、1例跟骨外侧切口愈合不良；其他患者切口均Ⅰ期愈合，皮瓣均顺利成活。患者均获随访，随访时间7～26个月，平均12.8个月。X线片复查示骨折均愈合。末次随访时，根据美国矫形足踝协会（AOFAS）踝与后足评分标准为78～88分，平均81.3分。 结论一期彻底清创、VSD治疗，二期行跟骨内固定及胫后动脉穿支皮瓣移位修复是治疗GustiloⅢ型及Sanders Ⅳ型跟骨骨折的一种有效方法。

开放性心脏创伤的急救处理

开放性尿道手术术前会阴部泡洗方法探讨

目的探索3种不同泡洗溶液在开放性尿道手术术前会阴部泡洗中的效果。 方法将2012年4月-12月行开放性尿道手术的36例患者随机分为A、B、C组，每组各12例，术前会阴部泡洗分别采取：A组应用0.1%聚维酮碘进行泡洗，B组应用0.1%聚维酮碘+1.6%食盐水进行泡洗，C组应用1.6%的食盐水进行泡洗。比较3种泡洗方法的安全性、有效性及差异。 结果36例患者中A、B组各有1例仅在首次泡洗过程中的前2 min稍感瘙痒、皮肤发红等不适，尔后症状逐渐消失，顺利完成相应泡洗方案，3种泡洗方案均为安全。A、B、C组共34例完成手术，其中B、C组各1例出现感染，3组患者伤口感染率差异无统计学意义（P＞0.05）；3组患者伤口痊愈时间差异无统计学意义（P＞0.05）。 结论A、B、C 3种泡洗方法运用于开放性尿道手术术前准备时是安全的，患者耐受性较好；仅从预防感染的效果上来说，A组泡洗溶液更优，但三者在预防感染和促进伤口痊愈时效果无明显差异。