胸腰椎爆裂骨折合并严重多发伤的损伤控制

目的：探讨损伤控制骨科（damage control orthopaedics，DCO）技术救治胸腰椎爆裂骨折合并严重多发伤的临床疗效。方法：胸腰椎爆裂骨折合并严重多发伤患者21例，男15例，女6例；年龄20～60岁，平均40岁。脊髓神经功能按Frankel分级：A级3例，B级3例，C级9例，D级6例。立即进行液体复苏、急诊简易手术控制出血和污染。其中剖腹探查10例，胸腔闭式引流6例，肺破裂修补2例，术中同时行四肢骨折外固定架固定9例，骨牵引或石膏托外固定5例。急诊术后均进入SICU进一步纠正低体温、酸中毒及凝血功能紊乱。病情稳定后5～7d行胸腰椎骨折手术。结果：21例中18例休克迅速纠正，4～26h死亡3例，存活率约85．7％（18／21）。18例均获随访，时间6～14个月，脊髓损伤按Frankel分级：A级3例，B级2例，C级3例，D级3例，E级7例，优良率（D级，E级）55．6％（10／18）。结论：及时应用DCO技术，尽早解除脊髓压迫重建脊柱稳定性，可以显著提高脊柱脊髓型严重多发伤的救治成功率，降低伤残率。

Damage control orthopaedics of thoracolumbar burst fracture complicated with severe polytrauma

Objective: To investigate the therapeautic effect of damage contral orthopaedics(DCO) applicated to thoracolumbar burst fracture complicated with severe polytrauma. Methods: Twenty-one patients with severe polytrama including 15 males and 6 females with an average age of 40 years old ranging from 20 to 60 years,were treated by immediate fluid resuscitation and emergency simple operation so as to contral the bleeding and contamination. According to Frankel grade of spinal nerves function,3 cases were grade A,3 were grade B,9 were grade C,6 were grade D. Ten cases were performed to open abdominal operation,6 cases underwent closed negative pressure drainage thorough chest,2 cases with lung rupture were treated by repairing operation. During operation,9 cases were treated with by external fixation and 5 cases were skeletal traction or external fixation with plaster support for extremities fractures. After emergency operation,the patients were transported into surgical intensive care unite (SICU),and corrected the hypothermia,acidosis and coagulation. The definitive thoracolumbar operation was performed between 5 to 7 days as soon as the vital signs became stable. Results: Among 21 cases,trauma hemorrhagic shock was corrected rapidly in 18 cases and 3 cases died in 4 to 26 hours. The survival rate was about 85.7%(18/21). Eighteen patients were followed up for 6 to 14 months with an average of 10 months. According to Frankel grading,3 cases were grade A,2 cases were grade B,3 cases were grade C,3 cases were grade D,7 cases were grade E. Conclusion: It may increase the therapy achievement rate excellently and decrease the disabled rate that performing damage contral orthopaedics(DCO) timly,relifing the compression on the spinal cord and re-establishing the stability of spinal column as early as possible.