损伤控制对不稳定骨盆骨折并四肢骨折患者凝血功能影响及疗效分析

目的 :回顾性分析骨科损伤控制理念对不稳定骨盆骨折合并四肢多发骨折患者凝血功能及治疗效果的影响。方法:选取2014年3月至2015年12月应用骨科损伤控制理念指导下治疗的40例不稳定骨盆骨折合并四肢多发骨折患者(治疗组),男22例,女18例;平均年龄(39.00±4.12)岁;ISS评分(25.36±10.81)分。2012年1月至2014年1月未应用骨科损伤控制理念指导下治疗的40例不稳定骨盆骨折合并四肢多发骨折患者(常规组)作为对照进行对比研究,常规组中,男25例,女15例;年龄(38.00±3.24)岁;ISS评分(26.56±11.44)分。术后按照Matta评价标准对复位进行评价,采用Majeed功能评分标准对术后功能进行评价。并观察患者治疗前及手术后7 d凝血功能改变情况。结果:所有患者获得随访,随访时间6~24个月。治疗后应用Matta评价标准对复位进行评价,治疗组(7.38±5.09)mm;常规组(10.11±6.53)mm(P0.05)。Majeed功能评分:治疗组(86.12±6.84)分;常规组(77.53±8.30)分(P0.05)。手术后第7天,治疗组的凝血酶原时间、血浆活化部分凝血酶时间、凝血酶时间明显高于常规组(P0.05);纤维蛋白原明显低于常规组(P0.05)。结论:对不稳定骨盆骨折合并四肢多发骨折患者应用骨科损伤控制理念治疗,能有效改善患者的凝血功能,有利于患者的功能恢复,提升患者的临床治疗效果。

Influence on coagulation function and the therapy effect of damage control orthopaedics for unstable pelvic fractures and multiple fractures of extremities

Objective: To retrospectively explore the effects of damage control orthopaedics concept on coagulation and curative effects in unstable pelvic fractures and multiple fractures of limbs.Methods: From March 2014 to December 2015,40 patients with unstable pelvic fractures and limbs multiple fractures in treatment group included 22 males and 18 females with an average age of(39.00±4.12)years old were treated with the damage control orthopaedics concept,the ISS score was(25.36±10.81)on average;Other 40 patients with the same trauma in conventional group included 25 males and 15 females with an average age of(38.00±3.24)years old were treated with conventional method from January 2012 to January 2014 served as control,the average ISS score was 26.56±11.44. Matta criteria and Majeed function standard were used respectively to evaluate the fracture reduction and therapeutic effects postoperatively. Coagulation function on the 7th day postoperatively was compared between two groups.Results: All patients were followed up for 6 to 24 months. According to Matta criteria,the fracture reduction of the treatment group and the conventional group were(7.38±5.09)mm and(10.11±6.53)mm,respectively(P<0.05). Majeed functional results of the treatment group and the conventional group were(86.12±6.84)points and(77.53±8.30)points,respectively(P<0.05). On the 7th day after surgery,PT,APTT,TT of the treatment group were significantly higher than that of the control group;and Fib of the treatment group was also significantly lower than that of the conventional group(P<0.05).Conclusion: The concept of damage control orthopaedics could effectively improve coagulation function of the patients with unstable pelvic fractures and limbs multiple fractures,thus are beneficial to the functional recovery as well as improve the curative effect postoperatively.