长骨干骨折合并胸部严重损伤分期治疗的回顾性研究

目的：探讨分期治疗在长骨干骨折合并胸部严重损伤救治中的应用价值。方法：自2005年1月至2009年10月在损伤控制理论指导下对分期救治的41例长骨干骨折合并胸部严重损伤的患者进行回顾性研究,其中男29例,女12例;年龄17～65岁,平均（37.2±6.1）岁。入院时损伤严重度评分（injury severity score,ISS）16分以上,平均27.4分。救治分3个阶段：第1阶段主要控制胸部症状,对骨折进行早期临时固定;第2阶段进行复苏和生理状态的优化;第3阶段待胸部情况允许后,做延期的骨折确定性手术。结果：本组无死亡病例。所有患者胸部症状在伤后5～23d缓解,伤后10～25d长骨干骨折得到最终的手术治疗,无严重术中及术后并发症发生。随访6～36个月,平均19.4个月,全部患者呼吸功能良好,38例长骨干骨折术后10～16周达临床愈合,1例闭合性骨折、2例开放性骨折发生骨不连,经植骨内固定后治愈。结论：在损伤控制理论指导下对长骨干骨折合并胸部损伤的患者进行分阶段的一体化救治,可有效提高救治质量,减少伤残率和病死率。

Retrospective study on staged treatment of long bone shaft fractures with severe thoracic trauma

Objective: To evaluate the feasibility and efficacy of staged treatment of patients with long bone shaft fractures and severe thoracic trauma. Methods: A retrospective study was performed on 41 patients with long bone shaft fractures and severe thoracic trauma who underwent staged treatment under the guidance of damage control orthopedics from January 2005 to October 2009 in our department. Among the patients,29 patients were male and 12 patients were female,with an average age of(37.2±6.1)years(ranged,17 to 65 years). On admission,the value of injury severity score(ISS) for these patients was above 16 and the average value was 27.4. The therapy process included three stages:first stage,controlling thoracic symptoms and provisionally fixing fracture;second stage,resuscitating and optimizing physiological condition in intensive care unit;third stage,operating for fractures when pathogenic condition was equable. Results: There was no dead case. Pathogenic condition of thorax in all patients regained equable in 5 d to 23 d and long bone shaft fractures were fixed in 10 d to 25 d after injury. There was no seriously operative or postoperative complication. All the patients were followed up,the duration ranged from 6 to 36 months,with an average of 19.4 months. Their respiratory functions were good. The long bone shaft fractures were healed in 10 to 16 weeks among 38 patients. The bone nonunion happened in 1 patient with closed fracture and 2 patients with opened fracture. Conclusion: Damage control orthopedics is a safe strategy for treatment of long bone shaft fractures with severe thoracic trauma. It is suggested that the surgeons should take a staged approach to perform damage control and definitive surgery.