外固定支架在严重多发伤合并肢体骨折损伤控制中的应用

目的介绍应用外支架治疗严重多发伤合并肢体骨折的方法并评价疗效。方法2009年1月至2012年12月，作者应用外支架对28例严重多发伤合并肢体骨折进行早期临时固定，心肺复苏、ICU监护和Ⅱ期确定性手术治疗，患者中男19例，女9例；年龄25～61岁，平均40．5岁。骨折部位：骨盆骨折5例，骨盆合并四肢骨折3例，四肢骨折15例，脊柱骨折3例，脊柱合并四肢骨折2例。闭合性骨折16例，开放性骨折12例。28例患者均合并其他多部位损伤，创伤严重程度评分平均35分。结果本组患者治愈26例（92％），死亡2例（8％），其中1例死于多器官功能衰竭，1例死于颅脑外伤，ICU治疗平均5．6d。发生各种并发症共7例。25例患者获得随访，时间8—36个月，平均16个月。22例骨折正常愈合，平均愈合时间18．4周。2例发生骨折延迟愈合，1例发生骨不连，经二期手术并植骨后愈合。结论外支架可用于严重多发伤合并肢体骨折的早期损伤控制，具有操作简单、效果可靠、并发症少等优点，可有效提高严重多发伤合并肢体骨折的救治效果，值得临床推荐使用。

The Use of External Fixator in Damage Control for the Patients with Polyfractures

Objective To introduce the use of external fixation in the early damage control of serious multiple injury pa- tients and evaluate the clinical results. Methods From January 20（0 to December 2012, a total of 28 cases with multiple inju- ries were treated with using of externa fixation in the early damage control, cardiopumonary resuscitation, ICU recovery and definitive treatment on phase H. There were 19 males and 9 females,with average age of 40.5 years （25 - 61 years）. There were 5 cases of pelvic fractures ,3 of pelvic and extremities, 15 of extremities ,3 of spine and 2 of spine and extremities. There were 16 closed fractures and 12 open fractures. The average ISS score was 35. Results Two patients died, one for MOF and the other brain trauma. The mean time of ICU was 5.6 days. 7 cases were suffered with complications. 25 cases were followed up for a mean of 16 months （range,8 to 36 months）. 22 patients healed evenly with the mean time of 18.4 weeks. Delayed bone union was found on 2 cases and nonunion on 1 case, and healed after two - stage operation and bone grafting. Conclusion In the early damage control of severe multiple injuries, external fixation can be used to improve the treatment results and should be recommend,with the advantages of simple operation, good results and few complications.