摘要
[目的]探讨骨科损伤控制(damage control orthopedics,DCO)技术在严重多发伤合并股骨骨折治疗中的可行性及疗效。[方法]回顾性分析2012年1月~2015年6月诊治的多发伤合并股骨骨折患者,选取损伤严重度评分(injury severity score,ISS)≥16,存活期>24 h的47例患者为研究对象。根据不同时期手术方式不同分为两组,27例应用DCO技术进行治疗作为DCO组,20例应用早期全面处理(early total care,ETC)技术进行治疗作为ETC组。其中,DCO组中7例股骨骨折以外支架作为终极手术治疗,20例一期行外支架治疗,待患者一般情况稳定后二期采用闭合或有限切开复位方法治疗;ETC组中所有病例均采用一期闭合或有限切开复位内固定方法进行治疗。统计所有患者的ISS评分、术中失血量、手术时间、机械通气时间和并发症等指标。[结果]与ETC组相比较,DCO组患者的术中失血量、手术时间、机械通气时间和并发症等指标均明显改善。[结论]将DCO技术应用于严重多发伤合并股骨骨折的治疗,能降低创伤后的二次打击,减少并发症的发生。
[Objective] To investigate the feasibility and clinical outcomes of damage control orthopedics （DCO） in the treatment of severe muhiple injuries associated with femoral fractures. [Methods] A retrospective analysis was performed in 47 cases of severe muhiple injuries associated with femoral fractures who were diagnosed and treated from January 2012 to June 2015. The inclusion criteria was the Injury Severity Score （ISS） equal to or greater than 16, and survival time longer than 24 hours. The patients were divided into two groups based on different operative methods at different times. Twenty-seven patients who were treated with DCO were selected as DCO group, and 20 patients who were treated with early total care （ETC） were selected as ETC gruup. In the DCO group, 7 patients underwent external fixation as the definitive treatment; 20 patients were treated with external fixation at the first stage, and then treated with closed reduction internal fixation （CRIF） or limited open reduction with internal fixation （ORIF） after the patients＇ conditions were stable. In ETC group, all the patients were treated with CRIF or ORIF at the first stage. The ISS score, blood loss in operation, time of operation, mechanical ventilation time, and complications were statistically analyzed. [Results] The DCO group had significant intprovemeuts in blood loss in operation, time of operation, mechanical ventilation time, and complications compared with the ETC group. [ Conclusions] The application of DCO can reduce second hit and complications in the treatment of severe multiple injuries associated with femoral fractures.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第2期119-122,共4页
Orthopedic Journal of China
关键词
骨科损伤控制
股骨骨折
严重多发伤
damage control orthopedics, femoral fracture, severe multiple injuries
