摘要
对严重创伤患者的救治观念正在从早期全面救治向损伤控制治疗转变,其原因为严重创伤可引发机体全身炎症反应,以白细胞介素6、血清降钙素原为代表与炎症反应有关的标记物在血液中浓度升高,可导致患者体温降低、酸中毒和凝血机制异常,进而引起急性呼吸窘迫综合征和多器官功能衰竭。长时间的手术治疗可视为二次打击,加重患者的病情。对于严重创伤患者的股骨干骨折急性期以外固定治疗为宜;骨盆骨折以外固定架固定为主,对难控制骨盆部出血的患者可行直接手术止血、骨盆动脉造影和栓塞、骨盆填塞止血;脊柱骨折早期治疗的目的是保持脊柱的稳定性,避免脊髓的二次损伤,开放性脊柱损伤要注意相邻重要脏器损伤的治疗,同时要预防感染的发生。早期手术治疗对不完全脊髓损伤患者的治疗效果好。
The treatment of severely traumatic patients was changing from total care treament to the damage control surgery, as a result in the inflammatory reaction caused by trauma,in which the inflammatory marks, such as interleukin-6 and serum procalcitonin in the blood increased,and caused hypothermia,acidosis ,and disturbance of blood coagulation,and resuited in the acute respiratory distress syndrome and multiple organs failure. A long-term operation as the second hit made the disease worse. In the patients ,the femoral fracture was treated with external fixator;the pelvic fracture was treated with external fixator, and the uncontrolled haemorrhage in the pelvis was treated through direct hemostasis, angiography and embolism of arteries, and the tamponade of pelvis;the purpose of treatment of spinal fracture was keeping the stability of spine, avoiding the secondary injury on the spinal cord. It must pay attention to the injury of the adjacent organs and infection in the opening spinal injury. The result of operation was better in the incomplete spinal cord injury.
出处
《中国骨伤》
CAS
2009年第7期563-566,共4页
China Journal of Orthopaedics and Traumatology
关键词
损伤控制理论
骨折
股骨
骨盆
脊柱
Damage control theory
Fractures
Femur
Pelvis
Spine
