Chinese expert consensus on echelons treatment of pelvic fractures in modern war

The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. In Level Ⅰ facilities, simple triage and rapid treatment following the principles of advanced trauma life support are recommended to evaluate combat casualties during the first-aid stage. Re-evaluation, further immobilization and fixation, and hemostasis are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, the main components of damage control surgery are recommended, including comprehensive hemostasis, a proper resuscitation strategy, the treatment of concurrent visceral and blood vessel damage, and battlefield intensive care. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Diagnosis and Treatment and Infection Protection Strategy of Osteoporotic Vertebral Compression Fractures Minimally Invasive Percutaneous Kyphoplasty Surgery during the Prevention and Control of COVID-19

Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.

Diagnosis and Treatment of a Case of Radius and Ulna Fracture in Dog

60% of a dog's body weight is supported by its fore limbs, while the hind limbs mainly play the role of power, so the probability of dog's radius and ulna fracture is greatly increased. This paper mainly introduced the diagnosis and treatment of a case of radius and ulna fracture in dog, with an attempt to provide reference for clinical practice.

Diagnosis and Treatment of a Case of Femoral Neck Fracture in Cat

Simple femoral neck fractures in dogs and cats are rare in clinic. The cause of the fracture is that the pelvis or femur is directly or indirectly subjected to external force,and it often occurs secondarily to osteoporosis caused by dysplasia of the hip joint. This paper described the diagnosis and treatment of a blue cat with femora neck fracture.

Diagnosis and Treatment of a Case of Femoral Fracture in Dog

Femoral fracture of dogs is common in daily life. This paper introduced the diagnosis and treatment of a case of femoral fracture in dog, providing reference for clinical practice.

Update on diagnosis and management of cuboid fractures

Cuboid fractures due to the particular bone anatomy and its protected location in the midfoot are rare, and they are usually associated with complex injuries of the foot. Clinical examination to diagnose these fractures should be detailed and the differential diagnosis, especially in the case of vague symptoms, should include the exclusion of all lateral foot pain causes. Conventional radiographs do not always reveal occult fractures, which can be under diagnosed especially in children. In this case, further investigation including magnetic resonance imaging or scintigraphy may be required. The treatment of these injuries depends on the particular fracture characteristics. Non-displaced isolated fractures of the cuboid bone can be effectively treated conservatively by immobilization and by avoiding weight bearing on the injured leg. In the case of shortening of the lateral column> 3 mm or articular displacement > 1 mm, surgical management of the fracture is mandatory in order to avoid negative biomechanical and functional consequences for the foot and adverse effects such as arthritis and stiffness as well as painful gait. In this review, an update on diagnosis and management of cuboid fractures is presented.

Lateral pelvic lymph nodes for rectal cancer:A review of diagnosis and management

The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node(LPLN)metastasis of rectal cancer are described in this review.Magnetic resonance imaging(MRI)is recommended for the diagnosis of LPLN metastasis.A LPLN-positive status on MRI is a strong risk factor for metastasis,and evaluation by MRI is important for deciding treatment strategy.LPLN dissection(LPLD)has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications;therefore,LPLD may not be appropriate for cases that are less likely to have LPLN metastasis.Radiation therapy(RT)and chemoradiation therapy(CRT)have limited effects in cases with suspected LPLN metastasis,but a combination of preoperative CRT and LPLD may improve the treatment outcome.Thus,RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19

Outbreak of COVID-19 is ongoing all over the world.Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production.Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery.The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients.To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease,multidisciplinary collaboration is needed.This expert consensus is formulated in order to(1)prevent and control the epidemic,(2)diagnose and treat patients with spine trauma reasonably,and(3)reduce the risk of cross-infection between patients and medical personnel during the treatment.

Penile Fracture at the Department of Urology and Andrology, University Hospital, Brazzaville

Objective: The objectives of this study, was to analyze epidemiological diagnosis, therapeutic option and evolutionary aspects. Materials and methods: This is a retrospective study regarding clinical data of nine penile fracture patients who have been admitted in the department of urology (university hospital, Brazzaville) from January 2006 to December 2018. The study parameters were: epidemiological, diagnosis, operative details, outcomes after treatment, and sexual disorders. Results: The mean age was 46.3 ± 14 years, ranged from 25 to 73 years. The etiology of penile fracture was coitus in 5 cases, masturbation in 3 cases and rolling of the penis on the bed in one case. 8 patients were managed surgically. The complications noticed in the postoperative period and during the follow-up visits were penile curvature in 2 cases, and erectyl dysfunction in 2 cases. Conclusion: The diagnosis of penile fracture remains clinic. Immediate surgical management is necessary for good functional result.

Research Progress of Male Osteoporotic Fracture

The diagnosis and recognition of male osteoporosis is still insufficient.The male patients with low-energy fracture were less evaluated and treated for osteoporosis.The risk of osteoporotic fracture in elderly men may be between 13%and 25%.With the extension of men’s life,the risk of fracture increases,which makes the management of men with fracture risk challenging.A consensus is emerging on targeted treatment guidelines for male osteoporosis,especially for elderly patients with high fracture risk.This paper aims to seek evidence through literature review,and put forward the most effective clinical strategies and schemes for the diagnosis and treatment of senile osteoporosis,so as to provide some theoretical guidance for clinical practice.

女性盆底功能障碍性疾病诊治流程及物理治疗康复临床应用——康复流程、原则及智能诊疗

女性盆底功能障碍性疾病(FPFD)发生机制复杂,专科的临床医师往往无法覆盖妇产、泌尿、肛肠、影像等各专科全面的医学专业信息,限制了对于该疾病的系统、全面诊治。FPFD的治疗需要遵循康复流程,制定个性化物理治疗干预措施,同时结合其他方式制定综合性治疗策略。人工智能在盆底领域的应用,不仅可以提高医生诊断效率,还可以为综合治疗方案的制定提供参考和依据,实现智能诊疗与精准医疗。本文从FPFD康复流程出发,分析康复原则及内容,探究人工智能在FPFD诊疗中的应用现状,旨在为实现盆底疾病智能诊疗提供参考。

严重创伤救治信息交互联动系统结合外固定架技术的救治模式在骨盆骨折中的应用

目的探讨“全国严重创伤救治信息交互联动系统”结合外固定架技术的救治模式在骨盆骨折急救中的临床效果。方法采用回顾性对照性研究方法,选取2021年5月至2023年4月救治的114例骨盆骨折患者作为研究对象。根据“全国严重创伤救治信息交互联动系统(紫云急诊室)”联合外固定架固定救治应用的时间节点,将严重骨盆骨折患者分为观察组与对照组:其中2021年5月至2022年4月采用常规院前急救配合绿色通道技术进行救治的55例骨盆骨折患者为对照组,2022年5月至2023年4月采用“全国严重创伤救治信息交互联动系统(紫云急诊室)”结合外固定架技术救治的59例骨盆骨折患者为观察组。对照组患者采用常规救治模式,患者经过院前急救救治-急诊室救治-收入科室救治,待病情平稳后,向手术室提出申请后再进行手术;观察组采用“全国严重创伤救治信息交互联动系统(紫云急诊室)”结合外固定架技术在急诊手术室早期急诊给予骨盆固定,患者在院前急救中即通过“全国严重创伤救治信息交互联动系统(紫云急诊室)”与院内骨盆救治小组联系,实现上车即入院,院前与院内救治一体化。结果共纳入114例骨盆骨折患者,对照组55例,其中男33例,女22例;年龄(40.96±13.47)岁。观察组59例,其中男36例,女23例;年龄(40.85±12.24)岁。2组患者的年龄、性别比、受伤机制及在救治前RTS评分比较,差异均无统计学意义(P>0.05)。与对照组相比,观察组收缩压、舒张压、血红蛋白更高,休克指数、血小板、红细胞压积与乳酸值更低(P<0.05)。观察组患者的呼叫至转运至急诊时间,急诊至放射科出片时间,急诊至入科时间及入院至治疗时间均明显短于对照组(P<0.01)。观察组患者的临床救治总有效率为96.6%,对照组有效率为85.5%,观察组的治疗效果明显升高(P<0.05)。救治后2组RTS评分均提高,观察组明显高于对照组(P<0.01)。观察组轻度疼痛患者数占比优于对照组(P<0.05)。Matta标准评价2组骨折复位效果差异不大,差异无统计学意义(P>0.05)。结论利用“全国严重创伤救治信息交互联动系统”结合外固定架技术的这一新型救治模式救治急症骨盆骨折,可明显缩短救治时间、减少失血、有效降低死亡率、伤残率,提高抢救成功率,值得临床应用推广。

MSCT三维骨重建技术在髋关节骨折诊断及治疗中的应用

目的探讨多排螺旋CT(MSCT)三维骨重建技术在髋关节骨折诊断及治疗中的应用。方法选择2020年1月~2022年8月我院收治98例髋关节骨折患者,均行常规X线检查和MSCT检查,并进行MSCT三维重建,观察X线片、二维MSCT图像和MSCT骨三维重建图像。结果手术显示,98例患者共发现101处髋中骨折,其中35处为股骨头骨折,24处为股骨颈骨折,21处为粗隆间骨折,21处为髋臼骨折。X线漏检12处骨折,二维CT漏检7处骨折,MSCT三维骨重建未见漏检,其对髋关节骨折检出率显著高于X线及二维CT(P<0.05)。MSCT三维重建对髋臼骨折分型正确检出率高于二维CT和X线,但比较差异未见统计学意义(P>0.05)。根据患者术前MSCT骨三维重建资料设计治疗方案,术中所见与资料吻合,患者手术时间(106.30±27.40)min,术中出血量(356.60±54.17)mL,术中透视时间(21.35±5.11)s,骨折愈合时间(80.46±12.29)d;术后随访显示治疗优良率为94.90%,且暂未发生并发症。结论MSCT三维骨重建可清晰显示髋关节骨折情况,有利于髋关节骨折及骨折分型诊断,对临床手术方案制定及术后关节功能恢复具有重要价值。

机器人辅助骶髂贯穿螺钉置入治疗骨盆后环骨折的精确性及临床疗效研究

目的:探讨骨科手术机器人辅助置入骶髂贯穿螺钉治疗骨盆后环骨折的精准性及临床疗效。方法:回顾性分析2022年8月至2023年8月行机器人辅助置入骶髂贯穿螺钉治疗的骨盆后环骨折24例患者的临床资料,其中男10例,女14例;年龄21~73(49.29±14.48)岁;骨折按照Tile骨盆分型,B型13例,C型11例。根据术后CT扫描结果采用Gras标准评估螺钉置入效果。末次随访根据Matta评分标准评估骨折愈合情况,采用Majeed评分标准评估功能恢复情况。结果:24例患者获得随访,时间3~13(6.00±3.28)个月。总计置入骶髂贯穿螺钉36枚,S1贯穿螺钉18枚,S2贯穿螺钉18枚;依据Gras标准,优29枚,良7枚。总螺钉调整次数0.00(0.00,0.75)次。末次随访时Matta评分标准,优18例,良5例,中1例;最大位移距离2.55(0.00,5.65) mm。Majeed评分总分(84.37±8.38)分,优15例,良7例,中2例。结论:机器人能够精准、安全地辅助完成骶髂关节螺钉置入治疗骨盆后环骨折,促使患者术后功能恢复。

女性盆腔炎性疾病中西医结合诊治指南

盆腔炎性疾病(Pelvic inflammatory disease,PID)是指女性上生殖道的一组感染性疾病,包括子宫内膜炎、输卵管炎、输卵管卵巢脓肿、盆腔腹膜炎。炎症可以局限于一个部分,也可以同时累及几个部位。严重的PID可引起弥漫性腹膜炎、败血症、感染性休克,甚至危及生命。若PID未接受及时彻底的治疗可转为盆腔炎性疾病后遗症(Sequelae of pelvic inflammatory disease,SPID),主要包括慢性盆腔痛、PID反复发作、不孕和输卵管妊娠,严重影响了育龄期女性的身心健康。盆腔炎性疾病多归属于中医学“妇人腹痛”“带下病”和“癥瘕”等范畴,盆腔炎性疾病后遗症多归属于中医学“妇人腹痛”“带下病”“癥瘕”和“不孕”等病证范畴。

人工智能在骨质疏松症诊疗中的应用进展

骨质疏松症是一种以低骨量和骨微结构退化为特点的代谢性疾病,从而导致骨折风险增加。骨质疏松性骨折通常发生在脊椎、髋关节、前臂远端和肱骨近端,但其他部位骨骼也可受累。尽管骨质疏松症的诊断是基于双能X射线吸收仪测量的骨密度(BMD)上,但多数发生骨质疏松性骨折患者的BMD尚未达到骨质疏松症的诊断标准。不管有无发生脆性骨折,骨质疏松症的诊断率仍然很低。此外,对于骨质疏松症的治疗时机、治疗对象和药物选择等诸多方面尚无标准指南。在此背景下,人工智能(AI)研发人员根据骨质疏松症的特点开发出多种算法,有望提高该疾病的诊疗水平。现就AI在骨质疏松症诊断和治疗中的最新应用进行简要概述。

超声在儿童骨科常见疾病中的应用研究进展

目的回顾超声在儿童骨科常见疾病诊断与治疗中的最新应用研究进展,探讨其临床应用价值。方法检索中英文数据库查阅超声在儿童骨科常见疾病中应用的文献,纳入超声在儿童肘部损伤、孕产期先天性/发育性畸形(发育性髋关节脱位、马蹄内翻足、斜颈)以及特发性脊柱侧弯诊疗中应用相关文献。结果超声在儿童肘部损伤治疗中应用具有微创、无辐射特点,可动态观察骨折的对位对线,在评估软骨、韧带、血管的损伤具有独特优势,实现了医学成像“辐射防护与安全最优化”理念。超声在孕产期先天性/发育性畸形以及特发性脊柱侧弯筛查中的应用,有助于该类疾病的早期诊断与治疗,多数情况下通过非手术治疗即可获得良好的畸形矫治效果,降低了医疗花费并减轻患者疼痛。结论超声在儿童骨科常见疾病诊疗中具有极高的应用价值,该技术的应用极大地降低了患者与医务人员的辐射暴露风险,并提高了该类疾病的诊治效果,值得推广应用。本文就超声在儿童骨科常见疾病诊疗中的应用进展作一综述,以期为临床治疗提供参考。

盆底超声参数诊断产后压力性尿失禁及康复治疗疗效价值

目的:分析盆底超声参数对产后压力性尿失禁(PSUI)的诊断价值及评估运动康复治疗后疗效价值。方法:选取2020年7月-2023年7月本院妇科收治的PSUI产妇155例(PSUI组)及健康产妇155例(对照组),PSUI组施予凯格尔康复运动治疗,并依据训练是否有效分为有效组(n=123)与无效组(n=32)。采用盆底超声检查PSUI组治疗前与对照组、有效组与无效组治疗后盆底超声参数指标及尿道内口漏斗有否形成,采用多因素logistic回归分析康复治疗疗效影响因素,采用受试者工作特征曲线(ROC)分析膀胱相关参数指标评估PSUI疗效价值。结果:PSUI组治疗前盆底超声膀胱相关参数指标均高于对照组,尿道内口漏斗形成率高于对照组;PSUI组经凯格尔康复运动治疗后总有效率为79.4%,无效组治疗前盆底超声参数相关指标均高于有效组,尿道内口漏斗形成率高于有效组(均P<0.05)。经多因素logistic回归分析,盆底超声参数指标升高均是PSUI产妇接受凯格尔康复运动疗效的独立危险因素,ROC分析显示超声相关参数指标均对评估PSUI产妇凯格尔康复运动疗效有一定价值,曲线下面积0.683~0.790。结论:PSUI产妇盆底超声相关参数指标均异常升高,各超声参数指标在PSUI产妇康复治疗疗效评估中均有一定价值。

温建民微创[足母]外翻病症诊疗体系学术思想及运用

[足母]外翻病症作为常见的前足疾病,其诊疗体系一直备受关注。该文介绍了温建民教授基于中医阴阳平衡和筋骨理论,结合现代手术经验,历经40余年的深入临床实践和研究,构建了以“阴阳平衡”“筋骨并重”“动静结合”“内外兼治”为原则的中西医结合微创治疗[足母]外翻病症诊疗体系(包括第一跖骨微创切骨手法整复术、“裹帘”外固定、围手术期中药的辨证应用以及中医的康复调护等四大关键技术),该体系为[足母]外翻病症的标准化微创治疗提供了系统指南,亦为中西医结合治疗其他骨伤科疾病提供了重要思路,具有极高的借鉴及推广价值,是温建民教授的重要科研成果及心血结晶。

经皮桥接钢板内固定与内置外固定支架治疗骨盆前环骨折的临床效果

【目的】探讨经皮桥接钢板内固定与内置外固定支架治疗骨盆前环骨折的临床效果。【方法】选取2020年1月至2022年12月在本院接受手术治疗的72例骨盆前环骨折患者,按照随机数字表法分为内固定组(接受经皮桥接钢板内固定治疗)和外固定组(行内置外固定支架治疗),每组36例。比较两组手术相关指标、术后并发症发生率、骨折愈合时间、术后完全负重时间、骨折复位优良率、功能恢复状态及手术前后骨保护素(OPG)、骨钙素(BGP)水平。【结果】内固定组手术时间长于外固定组(P<0.05),术中出血量多于外固定组(P<0.05)。两组术中透视次数比较,差异无统计学意义(P>0.05)。内固定组骨折复位优良率高于外固定组(P<0.05),骨折愈合时间及术后完全负重时间均短于外固定组(P<0.05)。两组患者术后站、坐、工作、性功能、疼痛评分及总分比较,差异无统计学意义(P>0.05)。术后,两组OPG、BGP水平高于术前(P<0.05),但两组OPG、BGP水平比较,差异无统计学意义(P>0.05)。外固定组术后并发症发生率高于内固定组(P<0.05)。【结论】经皮桥接钢板内固定与内置外固定支架治疗骨盆前环骨折,均可促进患者术后肢体功能的恢复,但内置外固定支架术的手术时间更短、出血量更少,而经皮桥接钢板内固定术后骨折复位效果更优、愈合时间更短。