Evaluation of the Effects of Standard Rescue Procedure on Severe Trauma Treatment in China

Background：This study aimed to evaluate the effects of standard rescue procedure （SRP） in improving severe trauma treatments in China.Methods：This study was conducted in 12 hospitals located in geographically and industrially different cities in China.A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment.A regional network （system） efficiently integrating prehospital rescue,emergency room treatments,and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments.Treatment outcomes were compared between before and I year after the implementation of the SRP.Results：The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP.Implementation of the SRP led to efficient cooperation and information sharing of different treatment services.The emergency response time,prehospital transit time,emergency rescue time,consultation call time,and mortality rate of patients were 24.24 ± 4.32 min,45.69 ± 3.89 min,6.38 ± 1.05 min,17.53 ± 0.72 min,and 33.82% ± 3.87% （n =441）,respectively,before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min,22.39 ± 4.32 min,3.26 ± 0.89 min,3.45 ± 0.45 min,and 20.49% ± 3.11%,separately （n =495,P 〈 0.05） after that.Conclusions：Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.

Cross-sectional Anatomy of Ilium for Guiding Acetabular Component Placement Using High Hip Center Technique in Asian Population

Background：Many clinical studies have been published involving the use of a high hip center （HHC）,achieved good follow-up.However,there is a little anatomic guidance in the literature regarding the amount of bone stock available for initial implant coverage in this area of the ilium.The purpose of this study was to evaluate the thickness and width of the human ilium and related acetabular cup coverage for guiding acetabular component placement in HHC.Methods：A total of 120 normal hips in 60 cases of adult patients from lower extremities computer tomographic angiography Digital Imaging and Communications in Medicine data were chosen for the study.After importing the data to the mimics software,we chose the cross sections every 5-mm increments from the rotational center of the hip to the cephalic of the ilium according the body sagittal axis,then we measured the thickness and width of the ilium for each cross section in axial plane,calculated the cup coverage at each chosen section.Results：At the acetabular dome,the mean thickness and width of the ilium were 49.71 ± 4.88 mm and 38.92 ± 3.67 mm,respectively,whereas at 1 cm above the dome,decreased to 41.35 ± 5.13 and 31.13 ± 3.37 respectively,and 2 cm above the dome,decreased to 31.25 ± 4.04 and 26.65 ± 3.43,respectively.Acetabular cup averaged coverage for 40-,50-,and 60-mm hemispheric shells,was 100%,89%,and 44% at the acetabular dome,100%,43.7%,and 27.5% for 1 cm above the dome,and 37.5%,21.9%,and 14.2% for 2 cm above the dome.Conclusions：HHC reconstructions within 1cm above the acetabular dome will be an acceptable and smaller diameter prosthesis would be better.

Three-dimensional reconstruction method for measuring the knee valgus angle of the femur in northern Chinese adults

The purpose of this study was to establish a method for measuring the knee valgus angle from the ana- tomical and mechanical axes on three-dimensional reconstruction imaging models, and to use this method for estimating an average knee valgus angle value for northern Chinese adults. Computed tomographic angiography data in DICOM format for 128 normal femurs from 64 adult subjects were chosen for analysis. After the femur images were subjected to three-dimensional reconstruction, the deepest point in the intercondylar notch （point A）, the midpoint of the medullary cavity 20 cm above the knee-joint line （point B）, and the landmark of the femoral head rotation center （point C） were identified on each three-dimensional model. The knee valgus angle was defined as the angle enclosed by the distal femoral anatomical axis （line AB） and the femoral mechanical axis （line AC）. The average （mean＋SD） of knee valgus angle for the 128 femurs was 6.20°±1.20° （range, 3.05° to 10.64°）. Significant positive correlations were found between the knee valgus angles of the right and left sides and between the knee valgus angle and age. During total knee arthroplasty, choosing a valgus cut angle of approximately 6° may achieve a good result in reestablishing the natural mechanical alignment of the lower extremity for patients of northern Chinese ethnicity. Larger valgus cut angles should be chosen for older patients.