损伤控制骨科理论在地震致骨盆骨折救治中的应用
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摘要
目的探讨损伤控制骨科理论在汶川地震致骨盆骨折救治中的作用及效果。方法对28例地震致骨盆骨折患者应用损伤控制骨科理论救治进行回顾性总结分析,所有患者一期行抗休克治疗及骨盆外固定支架临时固定,二期进入ICU复苏治疗,经ICU复苏后,如骨折不稳定再三期进行骨盆的确定性骨折固定手术及合并伤确定性手术。结果经过损伤控制的分期处理,本组28例患者全部存活,经3个月的随访,所有患者生命体征稳定,骨折固定好,疗效满意。结论损伤控制骨科理论应用于骨盆骨折救治可明显提高患者的生存率,降低并发症的发生率。
Objective To discuss the effect of damage control orthopaedics(DOC) on 28 cases of pelvic fracture which had been caused by the 5.12 Sichuan Wenchuan earthquake in 2008. Methods A retrospective study was conducted to evaluate the effect of DOC for the 28 cases of pelvic fracture.All patients was managed with anti-shock measures and temporal fixation of fracture in the first stage, resuscitation in intensive care unit in the second stage, If the pelvis still remain instability after temporal fixation of fracture in the first stage,do determinacy operation on the pelvis(open reduction and internal fixation) and associated injury also do determinacy operation at the same time in the third stage. Results After three-stage damage control,all the 28 cases survied. follow up 3 months,All patients obtained stable vital signs,satisfactory reduction and internal fixation with no complications.therapeutic effect satisfactory.Conclusion DOC for pelvic fracture can significantly prove the survival of patients and decrease their complications.
Objective To discuss the effect of damage control orthopaedics(DOC) on 28 cases of pelvic fracture which had been caused by the 5.12 Sichuan Wenchuan earthquake in 2008. Methods A retrospective study was conducted to evaluate the effect of DOC for the 28 cases of pelvic fracture.All patients was managed with anti-shock measures and temporal fixation of fracture in the first stage, resuscitation in intensive care unit in the second stage, If the pelvis still remain instability after temporal fixation of fracture in the first stage,do determinacy operation on the pelvis(open reduction and internal fixation) and associated injury also do determinacy operation at the same time in the third stage. Results After three-stage damage control,all the 28 cases survied. follow up 3 months,All patients obtained stable vital signs,satisfactory reduction and internal fixation with no complications.therapeutic effect satisfactory.Conclusion DOC for pelvic fracture can significantly prove the survival of patients and decrease their complications.
引文
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12Harwood PJ,Giannoudis PV,van Griensven M,et al.Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients[J].J Trauma,2005,58:446-452.
13van Vugt AB,van Kampen A.An unstable pelvic ring.The killing fracture[J].J Bone Joint Surg Br,2006,88:427-433.
14Stawicki SP,Brooks A,Bilski T,et al.The concept of damage control:extending the paradigm to emergency general surgery[J].Injury,2008,39:93-101.
15周贤杰,罗从风.地震伤骨盆骨折的损害控制处理(附一例报告)[J].中华创伤骨科杂志,2008,10:551-554.
16王爱民,孙红振,杜全印,等.损害控制外科技术救治地震严重多发伤[J].中华创伤骨科杂志,2008,10:507-509.
17Giannoudis PV.Aspects of current management[J].J Bone Joint Surg,2003,85:478-483.
18李世和.损伤控制理论在创伤骨科中的指导作用[J].中华创伤骨科杂志,2008,6(3):285-288.
19石汉平.损害控制外科的基本内容[J].中华创伤杂志,2001,17(1):249-250.
2Hildebrand F,Giannoudis P,Kretteck C,et al.Damage control:extremi-ties[J].Injury,2004,35:678-689.
3Pape HC,Grimme K,Van Griensven M,et al.Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoin-flammatory parameters:prospective randomized analysis by the EPOFF Study Group[J].J Trauma,2003,55:7-13.
4TileM.Pelvic ring fractures:should they be fixed[J].J Bone Joint Surg Br,1988,70:1-12.
5Taeger G,Ruchholtz S,Waydhas C,et al.Damage control orthopedics in patients with multiple injuries is effective,time saving,and safe[J].JTrauma,2005,59:409-416.
6Giannoudis PV,Pape HC.Damage control orthopaedics in unstable pel-vic ring injuries[J].Injury,2004,35:671-677.
7孙以华,陈涛,高峰,等.急诊床旁骨盆外固定术救治严重骨盆骨折(附21例报告)[J].中医正骨,2008,20:44-45.
8Rotondo MF,Schwab CW,McGonigal MD,et al.Damage control:an ap-proach for improved survival in exsanguinating penetrating abdominal in-jury[J].J Trauma,1993,35:375-382.
9Surface ship survivability.Washington DC.Department of Defence[J].Naval War Publication,1996:20-31.
10Matta JM,Tornetta P3rd.Internal fixation of unstable pelvic ring inju-ries[J].Clin Orthop Relat Res,1996,329:129-140.
11Stone HH,Strom PR,Mullins RJ.Management of the major coagulopa-thy with onset during laparotomy[J].Ann Surg,1983,197:532-535.
12Harwood PJ,Giannoudis PV,van Griensven M,et al.Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients[J].J Trauma,2005,58:446-452.
13van Vugt AB,van Kampen A.An unstable pelvic ring.The killing fracture[J].J Bone Joint Surg Br,2006,88:427-433.
14Stawicki SP,Brooks A,Bilski T,et al.The concept of damage control:extending the paradigm to emergency general surgery[J].Injury,2008,39:93-101.
15周贤杰,罗从风.地震伤骨盆骨折的损害控制处理(附一例报告)[J].中华创伤骨科杂志,2008,10:551-554.
16王爱民,孙红振,杜全印,等.损害控制外科技术救治地震严重多发伤[J].中华创伤骨科杂志,2008,10:507-509.
17Giannoudis PV.Aspects of current management[J].J Bone Joint Surg,2003,85:478-483.
18李世和.损伤控制理论在创伤骨科中的指导作用[J].中华创伤骨科杂志,2008,6(3):285-288.
19石汉平.损害控制外科的基本内容[J].中华创伤杂志,2001,17(1):249-250.
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