CAJ | 학술논문

目的探讨损伤控制性手术在边界型严重多发性骨折治疗中的疗效.方法选择2009年1月-2010年6月应用外科手术救治的严重多发性骨折37例患者(ISS 16～42分,Pape 分型为边界型).全部患者按损伤控制原则实施分期手术治疗,第一阶段予以止血、清创和骨折的临时固定,第二阶段主要为抗休克、抗凝血功能异常、抗低温和抗感染等治疗,在生理情况允许后再尽早行第三阶段的骨折确定性手术.结果所有患者经第一和第二阶段治疗后均实现了有效的清创、固定和抗休克治疗,未发生医源性二次损伤.确定性手术后患者恢复良好,术后随访6～14个月,总致残率为16％.结论采用损伤控制理念分期手术治疗边界型严重多发性骨折安全有效.
목적 탐토손상공제성수술재변계형엄중다발성골절치료중적료효.방법 선택2009년1월-2010년6월응용외과수술구치적엄중다발성골절37례환자(ISS 16～42분,Pape 분형위변계형).전부환자안손상공제원칙실시분기수술치료,제일계단여이지혈、청창화골절적림시고정,제이계단주요위항휴극、항응혈공능이상、항저온화항감염등치료,재생리정황윤허후재진조행제삼계단적골절학정성수술.결과 소유환자경제일화제이계단치료후균실현료유효적청창、고정화항휴극치료,미발생의원성이차손상.학정성수술후환자회복량호,술후수방6～14개월,총치잔솔위16％.결론 채용손상공제이념분기수술치료변계형엄중다발성골절안전유효.
Objective To investigate the curative effects of damage control surgery in treatment of borderline severe multiple fractures.Methods The study involved 37 patients with severe multiple fractures(ISS of 16-42,Pape classification of borderline type)surgically treated from January 2009 to June 2010.All patients underwent staged surgeries according to damage control principles:hemostasis,debridement and provisional fixation were given in the first stage;antishock,anti-coagulation dysfunction,anti-hypothermy,anti-infection were performed in the second stage;definitive operations for fractures were performed as soon as possible in the third stage,provided that their physiological condition was permitted.Results All the patients received effective treatments such as debridement,provisional fixation and antishock in the first and second stages,with no iatrogenic secondary injury.The patients had significant recovery in the 6-14 months of follow-up,with total disability rate of 16％.Conclusion The staged operations according to damage control principles are effective and safe in treatment of borderline severe multiple fractures.