中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
6期
473-476
,共4页
徐华%刘雅克%刘璠%王友华%陶然%曹毅%王洪%周振宇%祝勇%朱鸣镝
徐華%劉雅剋%劉璠%王友華%陶然%曹毅%王洪%週振宇%祝勇%硃鳴鏑
서화%류아극%류번%왕우화%도연%조의%왕홍%주진우%축용%주명적
多处损伤%骨折%外固定器
多處損傷%骨摺%外固定器
다처손상%골절%외고정기
Multiple trauma%Fracture%External fixators
目的 评价外固定支架在严重多发骨折早期损伤控制骨科(DCO)中的应用价值. 方法 自2006年1月至2010年6月应用外固定支架救治42例严重多发骨折患者,男29例,女13例；年龄21～ 62岁,平均39.2岁.其中28例合并其他脏器损伤,31例合并不同程度的失血或创伤性休克,创伤严重度评分平均为34分.在积极抗休克的同时,早期采用外固定支架固定骨折,然后进行复苏治疗,维持血流动力学稳定.病情稳定后再根据患者具体情况选择最终确定性手术方案. 结果 本组患者死亡2例,1例死于失血性休克,1例死于颅脑外伤,死亡率为4.8％.发生并发症4例:合并急性呼吸窘迫综合征l例,肺栓塞1例,下肢深部感染2例.除死亡2例外,4例失访,36例患者获得随访,时间8～36个月,平均16个月.最终骨折均获得愈合,平均愈合时间为22周. 结论 外固定支架在严重多发骨折早期DCO中具有操作简便迅速、创伤小、并发症少等特点,有效地降低了死亡率,有利于多发骨折的进一步治疗.
目的 評價外固定支架在嚴重多髮骨摺早期損傷控製骨科(DCO)中的應用價值. 方法 自2006年1月至2010年6月應用外固定支架救治42例嚴重多髮骨摺患者,男29例,女13例；年齡21～ 62歲,平均39.2歲.其中28例閤併其他髒器損傷,31例閤併不同程度的失血或創傷性休剋,創傷嚴重度評分平均為34分.在積極抗休剋的同時,早期採用外固定支架固定骨摺,然後進行複囌治療,維持血流動力學穩定.病情穩定後再根據患者具體情況選擇最終確定性手術方案. 結果 本組患者死亡2例,1例死于失血性休剋,1例死于顱腦外傷,死亡率為4.8％.髮生併髮癥4例:閤併急性呼吸窘迫綜閤徵l例,肺栓塞1例,下肢深部感染2例.除死亡2例外,4例失訪,36例患者穫得隨訪,時間8～36箇月,平均16箇月.最終骨摺均穫得愈閤,平均愈閤時間為22週. 結論 外固定支架在嚴重多髮骨摺早期DCO中具有操作簡便迅速、創傷小、併髮癥少等特點,有效地降低瞭死亡率,有利于多髮骨摺的進一步治療.
목적 평개외고정지가재엄중다발골절조기손상공제골과(DCO)중적응용개치. 방법 자2006년1월지2010년6월응용외고정지가구치42례엄중다발골절환자,남29례,녀13례；년령21～ 62세,평균39.2세.기중28례합병기타장기손상,31례합병불동정도적실혈혹창상성휴극,창상엄중도평분평균위34분.재적겁항휴극적동시,조기채용외고정지가고정골절,연후진행복소치료,유지혈류동역학은정.병정은정후재근거환자구체정황선택최종학정성수술방안. 결과 본조환자사망2례,1례사우실혈성휴극,1례사우로뇌외상,사망솔위4.8％.발생병발증4례:합병급성호흡군박종합정l례,폐전새1례,하지심부감염2례.제사망2예외,4례실방,36례환자획득수방,시간8～36개월,평균16개월.최종골절균획득유합,평균유합시간위22주. 결론 외고정지가재엄중다발골절조기DCO중구유조작간편신속、창상소、병발증소등특점,유효지강저료사망솔,유리우다발골절적진일보치료.
Objective To evaluate the role of external fixation in the early damage control of serious polyfractures.Methods From January 2006 to June 2010,42 cases of serious polyfractures were treated with external fixators in our department.They were 29 males and 13 females,with a mean age of 39.2 years (from 21 to 62 years).Among them,28 cases were complicated with injury to other organs and 31 cases with hemorrhagic or traumatic shock.Their average injury severity score(ISS) was 34 points.Active anti-shock interventions combined with external fixation were applied in the emergency phase.Then the patients were transferred to ICU for further resuscitation.Definitive treatments were based on the general conditions of specific patients.Results Two patients died,one due to hemorrhagic shock and the other brain trauma.The mortality rate was 4.8％.Acute respiratory distress syndrome occurred in one case,pulmonary embolism in one case and lower extremity deep infection in 2 cases.Altogether 36 patients obtained an average follow-up of 16 months (from 8 to 36 months).Follow-ups revealed fractures healing in all cases after a mean time of 22 weeks.Conclusion In the early damage control of severe polyfractures,external fixators play a very important role in effectively reducing the mortality rate and facilitating further treatment,because they are simple and non-invasive.
