损伤控制骨科技术在严重多发伤合并骨折治疗中的应用

目的 探讨严重多发伤时损伤控制骨科(damage control orthopedics,DCO)技术应用的可行性、适应证和疗效.方法 对1998-2008年应用DCO方法救治的31例严重多发伤合并骨折患者的临床资料作回顾性分析.结果18例严重多发伤伴骨盆骨折大出血,早期双侧髂内动脉结扎17例,早期骨盆外固定支架使用12例.11例严重多发伤伴开放性股骨骨折初期仅作清创和简单外固定,后期确定性内固定手术.2例脊柱骨折伴脊髓压迫,早期经后路行简单椎板减压.ICU治疗时间为1～11 d,平均4.3 d.本组患者死亡1例,其余30例全部生存.结论DCO更符合外伤后患者的病理生理特点,早期针对性控制处理及后期的一体化治疗是提高严重多发伤生存率的关键.

Abstract：

Objective To probe the feasibility, indications and efficacy of damage control orthopedics (DCO) in treating severe multiple injuries combined with fractures. Methods A retrospective analysis was done on the clinical data of 31 patients with severe multiple injuries combined with fractures treated by DCO from 1998 to 2008. Results Of all patients, 18 patients were combined with pelvic fractures and hemorrhage. Bilateralis hypogastric artery ligation was performed early in 17 patients and nonage pelvis external fixation was performed in 12. Eleven multiple trauma patients combined with femoral fractures received primary debridement and temporal external fixation for further definitive internal fixation. Two patients with spinal fractures combined with spinal cord compression received primary simple decompression. All patients received resuscitation in ICU for average 4.3 days (1-11 days). There was one death due to hemorrhagic shock. Conclusions DCO well conforms to pathophysiological character of the wounded. Early DCO and later integrated treatment are key to enhancement of the survival rate of the multiple trauma patients.

Application of damage control orthopedics in treatment of severe multiple injuries combined with fractures

Objective To probe the feasibility, indications and efficacy of damage control orthopedics (DCO) in treating severe multiple injuries combined with fractures. Methods A retrospective analysis was done on the clinical data of 31 patients with severe multiple injuries combined with fractures treated by DCO from 1998 to 2008. Results Of all patients, 18 patients were combined with pelvic fractures and hemorrhage. Bilateralis hypogastric artery ligation was performed early in 17 patients and nonage pelvis external fixation was performed in 12. Eleven multiple trauma patients combined with femoral fractures received primary debridement and temporal external fixation for further definitive internal fixation. Two patients with spinal fractures combined with spinal cord compression received primary simple decompression. All patients received resuscitation in ICU for average 4.3 days (1-11 days). There was one death due to hemorrhagic shock. Conclusions DCO well conforms to pathophysiological character of the wounded. Early DCO and later integrated treatment are key to enhancement of the survival rate of the multiple trauma patients.