Objective： Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with mos...Objective： Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma. Methods： A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries. Results： The average age was 3 l years with most of the patients being male （14：1）. Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma （blunt and penetrating trauma）. Eightpatients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% （1 patient）. Most patients survived with no sequelae （10 patients） while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management. Conclusions： Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.展开更多
Purpose： To investigate the diagnostic value of multi-slice computed tomography （MSCT） for combined thoracoabdominal injury. Methods： A retrospective study was conducted to analyze the clinical data and MSCT image...Purpose： To investigate the diagnostic value of multi-slice computed tomography （MSCT） for combined thoracoabdominal injury. Methods： A retrospective study was conducted to analyze the clinical data and MSCT images of 68 patients who sustained a combined thoracoabdominal injury associated with diaphragm rupture, and 18 patients without diaphragm rupture. All the patients were admitted and treated in the Chongqing Emergency Medical Center （a level I trauma center） between July 2005 and February 2014. There were 71 males and 15 females with a mean age of 39.1 years （range 13-88 years）. Among the 86 patients, 40 patients suffered a penetrating injury, 46 suffered a blunt injury as a result of road traffic accident in 21 cases, fall from a height in 16, and crushing injury in 9. The MSCT images were retrospectively reviewed by two radiologists. The results of CT diagnosis were compared with surgical findings and/or follow-up results. Results： Among the 86 cases, diaphragm discontinuity was found in 29 cases, segmental nonrecognition of the diaphragm in 14, diaphragmatic hernia in 21, collar sign in 14, dependent viscera sign in 18, elevated abdominal organs in 21, bowel wall thickening and/or hematoma in 6, and pneumoperitoneum in 8. CT diagnostic accuracy for diaphragm rupture was 88.4% in the right side and 90.7% in the left side. CT diagnostic accuracy for hemopneumothorax, pulmonary contusion, mediastinal hemorrhage, kidney and adrenal gland injuries was 100%, while for liver, spleen and pancreas injuries was 96.5%, 96.5g, 94.2% respectively. Conclusion： To reach an early diagnosis of combined thoracoabdominal injury, surgeons and radiologists should be familiar with all kinds of images which might show signs of diaphragm rupture, such as diaphragm discontinuity, segmental nonrecognition of the diaphragm, dangling diaphragm sign, diaphragm herniation, collar sign, dependent viscera sign, and elevated abdominal organs.展开更多
Purpose： To investigate the early and mid-term results of open reduction and internal fixation （ORIF） with transarticular external fixation （TEF） but no deltoid ligament repair （DLR） in the treatment of supinat...Purpose： To investigate the early and mid-term results of open reduction and internal fixation （ORIF） with transarticular external fixation （TEF） but no deltoid ligament repair （DLR） in the treatment of supination-external rotation type Ⅳ equivalent （SER Ⅳ E） ankle fractures （AO/OTA classification 44-B 3.1 ） and provide evidence for clinical practice. Methods： This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014, There were 13 males and 9 females, mean age 38.9 years （range, 17-73 years）. Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents （11 cases）, falling from height （6 cases） and sports injuries （5 cases）. The mean period of hospitalization was 9.8 days （range, 6 14 days）. For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score was 56.86 m 4.400, the Medical Outcomes Short Form 36-item （SF-36） questionnaire score was 57.41 ± 4.102 and the visual analog score （VAS） was 5.50 m 1.058. Patients＇ main complaints about inconvenience of daily life were also recorded. Results： All the 22 patients were followed up for 24 63 months （mean, 33.6 months）. None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 e 5.096, 79.59± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data （t - 26.221, p 〈 0.001; t - 11.910, p 〈 0.001; t - 11.571, p 〈 0.001）. The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients＇ main complaints were inconvenience of clothing （17 cases） and extremity cleaning （5 cases）. Conclusion： In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satis- factory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.展开更多
文摘Objective： Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma. Methods： A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries. Results： The average age was 3 l years with most of the patients being male （14：1）. Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma （blunt and penetrating trauma）. Eightpatients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% （1 patient）. Most patients survived with no sequelae （10 patients） while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management. Conclusions： Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.
基金This work was financially supported by the Nature Science Foundation of Chongqing Municipality （Grant No. 2012jjB10021） and the Medical Science Research Foundation of Chongqing Health Bureau （Grant No. 2010-1-52）.
文摘Purpose： To investigate the diagnostic value of multi-slice computed tomography （MSCT） for combined thoracoabdominal injury. Methods： A retrospective study was conducted to analyze the clinical data and MSCT images of 68 patients who sustained a combined thoracoabdominal injury associated with diaphragm rupture, and 18 patients without diaphragm rupture. All the patients were admitted and treated in the Chongqing Emergency Medical Center （a level I trauma center） between July 2005 and February 2014. There were 71 males and 15 females with a mean age of 39.1 years （range 13-88 years）. Among the 86 patients, 40 patients suffered a penetrating injury, 46 suffered a blunt injury as a result of road traffic accident in 21 cases, fall from a height in 16, and crushing injury in 9. The MSCT images were retrospectively reviewed by two radiologists. The results of CT diagnosis were compared with surgical findings and/or follow-up results. Results： Among the 86 cases, diaphragm discontinuity was found in 29 cases, segmental nonrecognition of the diaphragm in 14, diaphragmatic hernia in 21, collar sign in 14, dependent viscera sign in 18, elevated abdominal organs in 21, bowel wall thickening and/or hematoma in 6, and pneumoperitoneum in 8. CT diagnostic accuracy for diaphragm rupture was 88.4% in the right side and 90.7% in the left side. CT diagnostic accuracy for hemopneumothorax, pulmonary contusion, mediastinal hemorrhage, kidney and adrenal gland injuries was 100%, while for liver, spleen and pancreas injuries was 96.5%, 96.5g, 94.2% respectively. Conclusion： To reach an early diagnosis of combined thoracoabdominal injury, surgeons and radiologists should be familiar with all kinds of images which might show signs of diaphragm rupture, such as diaphragm discontinuity, segmental nonrecognition of the diaphragm, dangling diaphragm sign, diaphragm herniation, collar sign, dependent viscera sign, and elevated abdominal organs.
文摘Purpose： To investigate the early and mid-term results of open reduction and internal fixation （ORIF） with transarticular external fixation （TEF） but no deltoid ligament repair （DLR） in the treatment of supination-external rotation type Ⅳ equivalent （SER Ⅳ E） ankle fractures （AO/OTA classification 44-B 3.1 ） and provide evidence for clinical practice. Methods： This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014, There were 13 males and 9 females, mean age 38.9 years （range, 17-73 years）. Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents （11 cases）, falling from height （6 cases） and sports injuries （5 cases）. The mean period of hospitalization was 9.8 days （range, 6 14 days）. For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score was 56.86 m 4.400, the Medical Outcomes Short Form 36-item （SF-36） questionnaire score was 57.41 ± 4.102 and the visual analog score （VAS） was 5.50 m 1.058. Patients＇ main complaints about inconvenience of daily life were also recorded. Results： All the 22 patients were followed up for 24 63 months （mean, 33.6 months）. None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 e 5.096, 79.59± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data （t - 26.221, p 〈 0.001; t - 11.910, p 〈 0.001; t - 11.571, p 〈 0.001）. The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients＇ main complaints were inconvenience of clothing （17 cases） and extremity cleaning （5 cases）. Conclusion： In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satis- factory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.
