摘要
四肢和脊柱是交通伤中最常见的致伤部位之一。交通伤的院前救治是我国交通伤救治中最薄弱的环节,为此,应该逐步增设院前急救网点,建立院前—院内一体化创伤救治服务体系,加强院前急救员的培养训练工作。在四肢脊柱交通伤的救治中,首先应抢救危及生命的严重创伤,但同时也要兼顾骨折的及时处理。详细了解致伤机制和全面查体是防止交通伤漏诊的重要方法。在四肢交通伤骨折的救治中,特别是对多发伤伤员的急救,外固定器技术具有明显的优越性。带锁髓内钉技术治疗四肢长管状骨骨折也可取得满意疗效。骨盆骨折的早期可采用外固定器稳定骨折,同时采用髂内动脉栓塞等技术积极处理骨盆骨折所导致的大出血。在脊柱交通伤的治疗中,应考虑到脊柱的稳定性和迟发性截瘫等因素,适当确定手术适应证。椎管环形减压术可充分地解除对脊髓的压迫。颈椎骨折常可采用颈椎前路钢板螺钉固定颈椎融合手术。胸腰椎骨折脱位可实施经椎弓根后路短节段内固定手术治疗。
Of all the traffic injuries, injuries of extremities and spi ne have a very high incidence. Since the pre-hospital treatment is the weakest point in the management of traffic trauma in our country, first aid network shou ld be established and improved so as to integrate the pre-hospital and hospital care into an effective and consistent system, and thus a great many first aid w orkers should be sufficiently trained to meet the needs. The priority in traffic injury emergency is to treat serious concurrent injuries and life-threatening complications. The extremities and spine injury should be treated actively on th e spot in time. A thorough understanding of injury mechanism and complete examin ation play an important role in prevention of overlooked diagnosis. To treat vic tims of limb fractures, especially those with multiple injuries, application of external fixator is a good consideration. And application of locking intramedull ary nail to treat long tubular bone fractures has proved very satisfactory. For pelvis fractures caused by traffic accidents, external fixation can be used init ially and massive hemorrhage resulting from the injury can be treated by artery embolism. In the treatment of spine and spinal cord injury, the indication of su rgery can be determined after a careful consideration of stability of spine and the possibility of delayed paraplegia. The operation of circular decompress can release the spinal cord compression satisfactorily. In most cases, anterior cerv ical fixation and fusion with steel plate and screw is advisable for treatment o f fractures of cervical spine, while posterior immobilization with screw through pedicle of vertebra is usually suggested for treatment of fracture-dislocation of thoracolumbar vertebrae.
出处
《中华创伤骨科杂志》
CAS
CSCD
2004年第1期12-15,共4页
Chinese Journal of Orthopaedic Trauma
