Posttraumatic

创伤后
  • 文章类型: Journal Article
    脊柱后凸是一种脊柱弯曲导致背部弯曲的情况,这又导致了懒散的姿势或驼背。有几种类型的脊柱后凸,包括创伤后脊柱后凸,通常发生在胸部。有几种技术可用于创伤后胸腰椎后凸畸形的手术治疗。我们旨在讨论创伤后胸腰椎后凸畸形的手术治疗。我们使用不同的关键字通过科学网站搜索本评论中包含的文章。根据纳入标准选择文章。这篇综述中的文章发表于2006年至2018年之间。这篇评论是在讨论部分的标题下写的。创伤后胸腰椎后凸的手术治疗结果取决于正确选择适当的手术方法。
    Kyphosis is a condition in which there is a curvature of the spine that causes a bowing of the back, which in turn leads to slouching posture or hunchback. There are several types of Kyphosis, including posttraumatic Kyphosis, which usually occurs in the thoracic region. There are several techniques used for the surgical management of posttraumatic thoracolumbar Kyphosis. We aimed to discuss the surgical treatment of posttraumatic thoracolumbar Kyphosis. We searched for articles included in this review through scientific websites using different keywords. The articles were chosen based on inclusion criteria. The articles included in this review were published between 2006 and 2018. The review was written under titles in the discussion part. The outcome of the surgical management of posttraumatic thoracolumbar Kyphosis depends on the accurate selection of the proper surgical approach.
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  • 文章类型: Journal Article
    由于其独特的解剖结构和对炎症的深刻包膜反应,肘部易于僵硬。由此产生的运动障碍可能会严重干扰患者的日常生活活动。创伤(包括创伤手术),创伤后关节炎,异位骨化(HO)是肘部僵硬的最常见原因。软组织挛缩引起的僵硬,建议采用物理治疗(PT)和夹板固定的初始保守治疗。在骨畸形限制运动范围的情况下(例如,畸形,骨撞击,或HO),建议早期手术干预。开放和关节镜关节松解术是主要的手术选择。关节镜下关节松解术的并发症和翻修率较低,但适应症较窄。术后康复建议在术后使用PT进行早期主动动员,并可以通过夹板或连续被动运动疗法进行补充。大多数结果在最初的几个月内获得,但可以继续改善直到12个月。本文回顾了当前的文献,并提供了有关预防管理的最新指导,评估,和治疗肘部刚度。
    The elbow is prone to stiffness due to its unique anatomy and profound capsular reaction to inflammation. The resulting movement impairment may significantly interfere with a patient\'s activities of daily living. Trauma (including surgery for trauma), posttraumatic arthritis, and heterotopic ossification (HO) are the most common causes of elbow stiffness. In stiffness caused by soft tissue contractures, initial conservative treatment with physiotherapy (PT) and splinting is advised. In cases in which osseous deformities limit range of motion (e.g. malunion, osseous impingement, or HO), early surgical intervention is recommended. Open and arthroscopic arthrolysis are the primary surgical options. Arthroscopic arthrolysis has a lower complication and revision rate but has narrower indications. Early active mobilization using PT after surgery is recommended in postoperative rehabilitation and may be complemented by splinting or continuous passive motion therapy. Most results are gained within the first few months but can continue to improve until 12 months. This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness.
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  • 文章类型: Journal Article
    骨关节炎(OA)是一种慢性,影响关节软骨的进行性退行性全关节病,软骨下骨,韧带,胶囊,和滑膜。虽然它仍然被认为是一种机械驱动的疾病,共同存在的潜在炎症过程和介质在OA发病及其进展中的作用现在得到了更多的重视.创伤后骨关节炎(PTOA)是OA的一种亚型,继发于创伤性关节损伤,广泛用于临床前模型以帮助一般理解OA。迫切需要开发新的治疗方法,因为全球负担相当大,而且在不断扩大。在这次审查中,我们关注最近在治疗OA方面的药理学进展,并根据其分子效应总结了最有意义的有前途的药物。这些在这里被分为几大类:抗炎,基质金属蛋白酶活性的调节,合成代谢,和非常规多效性药物。我们对这些领域的药理学进展进行了全面分析,并强调了OA领域的未来见解和方向。
    Osteoarthritis (OA) is a chronic, progressive degenerative whole joint disease that affects the articular cartilage, subchondral bone, ligaments, capsule, and synovium. While it is still believed to be a mechanically driven disease, the role of underlying co-existing inflammatory processes and mediators in the onset of OA and its progression is now more appreciated. Post-traumatic osteoarthritis (PTOA) is a subtype of OA that occurs secondary to traumatic joint insults and is widely used in pre-clinical models to help understand OA in general. There is an urgent need to develop new treatments as the global burden is considerable and expanding. In this review, we focus on the recent pharmacological advances in the treatment of OA and summarize the most significant promising agents based on their molecular effects. Those are classified here into broad categories: anti-inflammatory, modulation of the activity of matrix metalloproteases, anabolic, and unconventional pleiotropic agents. We provide a comprehensive analysis of the pharmacological advances in each of these areas and highlight future insights and directions in the OA field.
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  • 文章类型: Case Reports
    我们报告一例创伤性尺骨移位,这是在从六英尺高的梯子上摔下来后造成的。这个病人颅骨多处受伤,脸,和四肢。在最初的X光片上未诊断出尺骨易位。尺骨易位需要很高的临床怀疑指数,应在手腕受到任何严重影响的情况下考虑。在radial骨关节表面远端的掌侧斑点代表了韧带破裂的证据,应提醒医生可能会出现更严重的损伤。回顾了非手术和手术治疗方案。
    We report a case of posttraumatic ulnar translocation of the carpus, which resulted after a fall from a six-foot ladder. This patient presented with multiple injuries to the skull bones, face, and limbs. A diagnosis of ulnar translocation of the carpus was missed on initial radiographs. Ulnar translocations require a high clinical index of suspicion and should be considered in the context of any high-impact injury to the wrist. A volar fleck just distal to the radial articular surface represents evidence of ligamentous disruption and should alert physicians that a more severe injury may be present. Nonsurgical and surgical treatment options are reviewed.
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  • 文章类型: Journal Article
    A 10-year-old, male patient with a head injury caused by a fall presented with chemosis, exophthalmos, right orbital bruit, and intracranial venous reflux, based on which posttraumatic carotid cavernous fistula (CCF) was diagnosed. Coil embolization was semi-urgently performed for the dangerous venous drainage. After the treatment, right abducens nerve palsy newly appeared. To treat the neurological symptoms and preserve the parent artery, curative endovascular treatment using a pipeline embolization device (PED) with coil embolization was performed after starting dual antiplatelet therapy (DAPT). The CCF and abducens nerve palsy finally resolved, and the internal carotid artery (ICA) was remodeled. Use of the PED with adjunctive coil embolization was effective and safe in the present case of pediatric traumatic direct CCF.
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  • 文章类型: Journal Article
    背景:加拿大武装部队中超过85%的活跃成员已暴露于与创伤后应激障碍(PTSD)发展有关的潜在创伤事件。在向平民生活过渡的时候,八分之一的退伍军人可能被诊断为PTSD。鉴于PTSD在军人和退伍军人人群中的高患病率,考虑到他们独特的挑战和经验,提供有效的治疗对于这些人群的心理健康支持和福祉至关重要。
    目的:本文提出了一项荟萃分析和系统评价方案,该方案将研究军事相关PTSD的治疗方法的有效性。
    方法:本PROSPERO预注册的荟萃分析是根据PRISMA(系统评价和荟萃分析的首选报告项目)和Cochrane指南进行的。使用PsycInfo数据库对文献进行了全面搜索,Medline,Embase,CINAHL,和ProQuest论文和论文。使用验证的PTSD量表,将根据研究中PTSD症状评分随时间的变化来计算效果大小。多层次荟萃分析将检查总体效果,研究之间的影响,以及军事人群PTSD治疗的现有证据的研究内效果。效果大小将在药物治疗之间进行比较,心理治疗,和替代/新兴治疗干预措施。最后,荟萃回归和亚组分析将探讨临床特征的调节作用(例如,创伤后应激障碍症状群),治疗方法(例如,心理治疗和替代疗法的治疗方向以及药物治疗中的药物分类),以及治疗特征(例如,干预时间)对治疗结果的影响。
    结果:文献检索于2021年4月14日完成。删除副本后,共筛选了12,002项研究纳入.截至2021年7月,标题和摘要筛选已经完成,纳入12,002项研究中的1469项(12.23%)用于全文审查。全面审查预计将于2021年夏季完成,初步结果预计将于2021年初冬公布。
    结论:本荟萃分析将提供有关军事相关PTSD的各种治疗方法的疗效和有效性的证据的当前状态的信息,并确定可能影响治疗结果的因素。结果将为服务提供商和服务用户提供临床决策。最后,研究结果将为未来的治疗发展和实践建议提供见解,以更好地支持军人和退伍军人人群的福祉。
    背景:PROSPEROCRD42021245754;https://tinyurl.com/y9u57c59.
    DERR1-10.2196/33151。
    BACKGROUND: Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations.
    OBJECTIVE: This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD.
    METHODS: This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes.
    RESULTS: The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021.
    CONCLUSIONS: This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations.
    BACKGROUND: PROSPERO CRD42021245754; https://tinyurl.com/y9u57c59.
    UNASSIGNED: DERR1-10.2196/33151.
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  • 文章类型: Systematic Review
    在不可挽救的手指PIPJ的情况下,从脚趾的近端指间关节(PIPJ)进行血管化关节转移(VJT)是一种有吸引力的重建选择,但受到模棱两可的功能结果的限制。本系统综述旨在提供血管化脚趾到手指PIPJ转移的最新信息。检查功能结果,并发症,以及手术技术的最新改进。根据系统审查和荟萃分析(PRISMA)指南的首选报告项目对现有文献进行了系统审查。包括研究血管化脚趾到手指的PIPJ转移以进行创伤后适应症的研究。评估的结果包括术后活动范围,扩展滞后,和并发症。分析了13项检查210项VJT的研究。五个VJT经历了显微外科手术失败,总生存率为97.6%。术后平均PIPJ活动活动度(ROM)为40.3°±12.9°,平均伸肌滞后29°±10.5°,平均屈曲68.9°±10.9°。对于报告并发症结果的研究,59/162例出现并发症。在比较数字ROM时,2013年之前和2013年之后发表的研究之间没有显着差异(P=.123),屈曲(P=.602),和伸肌滞后(P=.280)。基于先前对供体脚趾中央滑脱和受体手指解剖结构的评估,使用重建算法的研究显着改善了ROM结果(P=.013)。尽管VJT为创伤后关节的自体重建提供了可靠的选择,它受到术后ROM受损的限制。仔细评估供体脚趾和受体手指解剖结构,然后进行系统和细致的重建可能会改善功能结果。
    Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ but is limited by equivocal functional outcomes. This systematic review aims to provide an update on vascularized toe-to-finger PIPJ transfers, examining functional outcomes, complications, and the latest refinements in operative technique. A systematic review of the available literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining vascularized toe-to-finger PIPJ transfer for post-traumatic indications were included for analysis. Outcomes assessed included postoperative active range of motion, extension lag, and complications. Thirteen studies examining 210 VJTs were analyzed. Five VJTs experienced microsurgical failure giving an overall survival rate of 97.6%. Average postoperative PIPJ active range of motion (ROM) was 40.3° ± 12.9°, with an average extensor lag of 29° ± 10.5° and mean flexion of 68.9° ± 10.9°. For studies reporting complication outcomes, 59/162 complications were seen. No significant differences were seen between studies published prior to 2013 and after 2013 when comparing digital ROM (P = .123), flexion (P = .602), and extensor lag (P = .280). Studies using a reconstructive algorithm based on prior assessment of the donor toe central slip and recipient finger anatomy had significantly improved ROM outcomes (P = .013). Although VJT provides a reliable option for autologous reconstruction in posttraumatic joints, it is limited by impaired postoperative ROM. Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes.
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  • 文章类型: Journal Article
    3D printing is increasingly used in many fields of medicine. The broadening of knowledge in this field and the cooperation of doctors and engineers increase the interest in this technology and results in attempts to implement it at every stage of the treatment.
    The review aims to summarize the current literature on the use of 3D printing technology in the treatment of post-trauma patients.
    A review of available scientific publications in PubMed regarding 3D printing and its application in the context of posttraumatic procedures was carried out. Clinical Trials and Reviews from the period 2014-2019 (6-year period) were taken into consideration. The database was searched for \"Printing\", \"ThreeDimensional\" [MAJR] [MeSH Term]. Finally, 48 studies have been included in our review article.
    3D printing technology has a number of applications in patients who have suffered injuries. 3D printing has found application in the preparation of procedures, accurate visualization of occurring injuries and complications, education of doctors and patients, prototyping, creation of synthetic scaffolding, production and implementation of target implants and rehabilitation.
    3D printing is increasingly used in providing for posttraumatic patients. It is necessary to conduct further research in this area and to provide development opportunities regarding biopolymers and bioprinting. It is also necessary to improve cooperation between doctors and engineers and to create new centres that can comprehensively use 3D printing - from imaging diagnostics to the production of implants and their surgical use.
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  • 文章类型: Journal Article
    目的:创伤是踝关节骨性关节炎的主要原因,这与显著的发病率有关。这篇综述重点介绍了当前的文献,目的是使读者了解创伤后踝关节炎的最新管理,描述治疗功效,适应症,禁忌症,和并发症。
    结果:最近对骨关节炎的研究表明,在创伤后骨关节炎的发病机制和发展速度方面,解剖部位之间存在差异。这归因于新发现的每个关节固有的生物学差异。关于创伤后踝关节炎的手术治疗,同种异体骨软骨移植,和踝上截骨术已证明有希望的结果。此外,门诊设置被认为是适当的管理疼痛后,全踝关节置换术,与低并发症发生率和无再入院相关。创伤后踝关节炎的治疗通常是进行性的。初始治疗需要非药物选择,手术保留用于保守治疗难治性创伤性踝关节关节炎。在制定管理策略时,应仔细考虑患者的人口统计和生活方式,因为结果取决于每组相应标准的满意度。最终,创伤后踝关节炎的管理应个性化,以满足需求和愿望,这是每个病人特有的。
    OBJECTIVE: Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications.
    RESULTS: Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.
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  • 文章类型: Journal Article
    Post-traumatic long bone osteomyelitis (PTOM) is a relatively frequent occurrence in patients with severe open fractures and requires treatment to prevent limb-threatening complications. The Masquelet technique represents a length-independent, two-staged reconstruction that involves the induction of a periosteal membrane and use of an antibiotic-impregnated cement spacer for the treatment of segmental bone loss that result from bone infection. In this review, we summarize recent developments regarding the diagnosis and treatment of long bone PTOM, with a special emphasis on the use of the Masquelet technique for reconstruction of wide diaphyseal defects.
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