多发伤诊断包括损伤诊断、损伤并发症诊断和并存疾病诊断,其中损伤诊断遗漏指入院24小时后发现并导致不良后果的损伤,发生率2%-40%[1]。导致漏诊的因素主要有医师缺乏整体观念、影像学误导、忽视隐蔽损伤、缺乏损伤机制认识,以及伤情危...多发伤诊断包括损伤诊断、损伤并发症诊断和并存疾病诊断,其中损伤诊断遗漏指入院24小时后发现并导致不良后果的损伤,发生率2%-40%[1]。导致漏诊的因素主要有医师缺乏整体观念、影像学误导、忽视隐蔽损伤、缺乏损伤机制认识,以及伤情危重、意识障碍、致伤机制和病史不详等因素。多发伤紧急伤情评估策略包括根据致伤机制评估,合理应用影像学技术精确评估,按照CRASH PLAN程序系统（C=circulation循环,R=respiratory呼吸,A=abdomen腹部,S=spine脊柱,H=head头颅,P=pelvis骨盆,L=limbs四肢,A=arteries and veins动静脉,N=nerves神经）评估,复苏无效时重点评估,以及动态、反复评估。展开更多
Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complicatio...Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.展开更多
This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in additi...This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.展开更多
目的探讨损害控制外科理论(damage control surgery,DCS)在不稳定骨盆骨折为主的严重多发伤救治中的作用。方法回顾分析我科2006年1月～2010年12月36例不稳定骨盆骨折为主的严重多发伤患者应用DCS方法救治,第1阶段为控制出血和不稳定骨...目的探讨损害控制外科理论(damage control surgery,DCS)在不稳定骨盆骨折为主的严重多发伤救治中的作用。方法回顾分析我科2006年1月～2010年12月36例不稳定骨盆骨折为主的严重多发伤患者应用DCS方法救治,第1阶段为控制出血和不稳定骨折的早期临床固定;第2阶段行ICU复苏;第3阶段行确定性手术。观察其死亡率及后遗症发生。结果 2例死亡,2例未随访,获得随访32例,随访17.6个月。1例合并胸腰椎骨折发生截瘫,3例远期出现跛行、行走痛。按Matta标准评定疗效:优19例,良10例,可3例;优良率90.6%。结论应用DCS理论救治不稳定骨盆骨折为主的严重多发伤,能明显提高其抢救成功率、减少并发症。展开更多
Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, t...Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.展开更多
文摘多发伤诊断包括损伤诊断、损伤并发症诊断和并存疾病诊断,其中损伤诊断遗漏指入院24小时后发现并导致不良后果的损伤,发生率2%-40%[1]。导致漏诊的因素主要有医师缺乏整体观念、影像学误导、忽视隐蔽损伤、缺乏损伤机制认识,以及伤情危重、意识障碍、致伤机制和病史不详等因素。多发伤紧急伤情评估策略包括根据致伤机制评估,合理应用影像学技术精确评估,按照CRASH PLAN程序系统（C=circulation循环,R=respiratory呼吸,A=abdomen腹部,S=spine脊柱,H=head头颅,P=pelvis骨盆,L=limbs四肢,A=arteries and veins动静脉,N=nerves神经）评估,复苏无效时重点评估,以及动态、反复评估。
文摘Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.
文摘This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.
文摘目的探讨损害控制外科理论(damage control surgery,DCS)在不稳定骨盆骨折为主的严重多发伤救治中的作用。方法回顾分析我科2006年1月～2010年12月36例不稳定骨盆骨折为主的严重多发伤患者应用DCS方法救治,第1阶段为控制出血和不稳定骨折的早期临床固定;第2阶段行ICU复苏;第3阶段行确定性手术。观察其死亡率及后遗症发生。结果 2例死亡,2例未随访,获得随访32例,随访17.6个月。1例合并胸腰椎骨折发生截瘫,3例远期出现跛行、行走痛。按Matta标准评定疗效:优19例,良10例,可3例;优良率90.6%。结论应用DCS理论救治不稳定骨盆骨折为主的严重多发伤,能明显提高其抢救成功率、减少并发症。
文摘Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.
