摘要
目的探讨单臂外固定架在严重多发创伤患者骨折早期固定中的安全性和有效性。方法2005年1月～2007年1月，按伤害控制骨科学（DCO）原则治疗伴有主要骨折的多发创伤患者34例，ISS评分平均29．4分，GCS评分平均12．5分；单发骨折24例，多发骨折10例，其中股骨骨折17处，胫腓骨14处，肱骨7处，前臂6处，复杂骨盆骨折3处。人院后均予以快速复苏，按照伤害控制性手术方案实施单臂外固定架临时固定骨折，完成复苏后行确定性的骨折内固定。结果开放性骨折平均每处骨折清创、外固定手术时间65min（30～140min），出血量185mL（70～250mL）；闭合性骨折平均每处手术时间45．8min（31～65min），出血量30mL（10～50mL）。平均间隔14．2d（5～45d）更换内固定，确定性骨折固定每处平均手术时间142min（60。171min），出血量420mL（200～490mL）。2例复苏期间死亡，1例针道感染，1例深部感染。余32例出院后均得到随访，平均随访18个月（8～32个月），骨折均获得愈合。未出现急性呼吸功能障碍、脂肪栓塞、多器官功能衰竭等严重并发症。结论单臂外固定架是一种安全、简便、有效的早期骨折固定的方法，正确运用可以控制手术规模和减少手术时间，为确定性手术创造了必备的条件。
Objective To study safety and efficacy of early external fixation in the treatment of multiple injuries. Methods A cohort of 34 patients with multiple injuries plus major fractures requiring immediate stabilization were admitted to our institute from January 2005 to January 2007. Their mean ISS （Injury Severity Score） was 29.4 and mean GCS （Glasgow Coma Score） 12. 5. In all the patients, immediate resuscitation was performed after hospitalization. Open fractures were immobilized with temporary primary external fixation according to the damage control orthopaedics （DCO） protocol. After organ functions became stable, secondary definitive internal osteosynthesis was executed at the earliest possible time. The time spent, blood loss and complications were record for evaluation. Results Thirty-two cases were followed up for a mean time of 18 months （8-32 months）. For open fractures, the mean time of primary procedure was 65 min （30-140 min）, and blood loss attributed to DCO was 185 mL （70-250 mL）; for closed fractures, the two were 45.8 min （31-65 min） and 30 mL （10-50 mL） respectively. The mean interval between the primary procedure and the secondary definitive osteosynthesis was 14.2 days （5-45） . The mean operation time for the secondary definitive osteosynthesis was 142 min （60-171 min）, and the blood loss was 420 mL （200-490 mL） . Severe complications, such as pulmonary failure, fat embolism and multiple organ failure, were not found after the primary procedure. Two patients with severe traumatic brain injury died after internal fixation. One superficial pin hole infection and one local deep infection occurred after surgery. The fractures had a satisfactory healing. Conclusions The early external fixation is safe and effective. It helps reduce the resuscitation time and blood loss in the primary treatment of severely injured patients, and facilitates the secondary definitive osteosynthesis.
出处
《中华创伤骨科杂志》
CAS
CSCD
2007年第12期1127-1130,共4页
Chinese Journal of Orthopaedic Trauma
关键词
外固定器
多发伤
伤害控制骨科学
骨折
External fixators
Multiple injuries
Damage control orthopaedics （DCO）
Fracture
