多发性损伤伴骨折的急救与早期处理

目的:探讨多发性损伤伴骨折的急救与早期处理。方法:1992年10月～2001年5月我院救治的237例含四肢、骨盆骨折的多发性损伤病人,骨折916处,颅脑损伤159例,血气胸82例,腹腔内脏器伤42例,胸腹联合伤12例,休克202例,窒息8例,昏迷61例,开放伤92例,合并神经损伤32例,其中ISS评分大于16分者192例,分四个阶段根据不同病情进行不同的急救与早期处理。结果:82例伤后4～48h死亡。185例经住院治疗的病人5例死亡,130例获平均6个月随访,骨折均达到解剖或接近解剖复位,骨折延迟愈合5例,骨不连2例,钢板断裂4例,髓内钉断钉2例。结论:边抢救、边诊断,全面综合,争取时间,针对不同的病情全面综合考虑,选择最佳治疗方案,手术尽早进行,但不强求24h内进行,不排斥保守治疗,是防止并发症,提高成活率,降低致残率的关键。

First aid and Early Treatment in Multi- injuries Accompany with Fracture

Objective: To investigate the first aid and early treatments in multi-injuries accompany with fractures. Methods: We analysised 267 cases of multi-injuries accompany with fractures in limbs or pelvic. The cases included 916 places of fractures; 159 eases of brain injuries; 82 eases hemopeumo-thorax; 42 cases of intra-abdominal injuries; 12 cases of joint injuries of throax and abdominal; 202 cases of shock; 8 cases of asphysia; 61 eases of coma; 92 cases of open injury; ISS scores higher than 16 saw in 192 cases. We adopted 4 different stages of first aid and early treatment measures according to severity of the patients. Results: We had 82 patients died at senee. 5 of the 185 patients treated patients died. We succeeded in following up to 6 months in 130 cured cases which had anatomatic reduction. Delay healing in 4 cases; Steel-plant broken in 4 cases; Intramedullary pin broken in 2 cases. Conclusions: We should diagnosis when we treatment the patient. We should choose the ideal measures according to the patients' conditions. The operation should be done as soon as possible. All are the critical points of reducing complications, improving survival rate and reducing disabling rate.