损伤控制技术在严重多发骨折治疗中的应用

目的 :探讨损伤控制技术在严重多发骨折治疗中的应用效果。方法 :回顾性分析2014年1月至2016年12月应用损伤控制骨科技术(DCO组)进行治疗的23例严重多发骨折患者,男14例,女9例;年龄28~60(41.57±8.29)岁;NISS评分18~40(27.70±5.44)分。2007年1月至2009年12月应用早期确定性治疗技术(ETC组)的27例严重多发骨折患者,男16例,女11例;年龄19~55(38.33±9.99)岁;NISS评分20~43(31.07±6.46)分。比较两组的总手术时间、ICU复苏时间、输血量、住院时间、死亡率及并发症情况。结果:DCO组患者存活22例,死亡1例,术后发生并发症3例(2例急性呼吸窘迫综合征,1例术后钉道感染)。ETC组患者存活25例,死亡2例,术后发生并发症10例(4例急性呼吸窘迫综合征,3例术后钉道感染,1例术后伤口感染,2例发生多器官功能衰竭)。DCO组的术中输血量、ICU恢复时间、术后并发症等指标与ETC组相比差异有统计学意义(P0.05);两组的总手术时间、住院时间及死亡情况差异无统计学意义(P0.05)。结论:对于严重多发骨折的患者,应用损伤控制技术可明显降低患者术后并发症,缩小ICU恢复时间,减少术中输血量,为临床治疗此类患者提供一定的依据。

Application of damage control orthopedics for the treatment of severe multiple fractures

Objective: To investigate the application effect of damage control orthopedics for the treatment of severe multiple fractures.Methods: From January 2014 to December 2016,23 patients with severe multiple fractures were treated with the damage control orthopedics (DCO),included 14 males and 9 females with an average age of (41.57±8.29) years old ranging from 28 to 60 years old; the NISS averaged(27.70±5.44) points ranging from 18 to 40 points. As the control group,27 patients with severe multiple fractures were treated by the early total care(ETC) technology from Jan. 2007 to Dec. 2019,included 16 males and 11 females with an average age of (38.33±9.99) years old ranging from 19 to 55 years old,the NISS averaged (31.07±6.46) points ranging from 20 to 43 points. The ICU recovery time,blood transfusion,total operation time,mortality,complication and length of hospital stay were observed and compared between two groups.Results: In the DCO group,there were 22 cases surviving and 1 case death,3 cases of postoperative complication contained 2 cases of adult respiratory distress syndrome,1 case pin of infection in external fixation. In ETC group,there were 25 cases surviving and 2 cases death,10 cases of postoperative complication contained 4 cases of adult respiratory distress syndrome and 3 cases of pin infection in external fixation,1 case of wound infection and 2 cases of multiple organ failure. There was statistically significant difference between two groups in blood transfusion in operation,the ICU recovery time,and complications(P<0.05). There was no statistically significant difference in total operation time,length of hospital stay and mortality between two groups(P>0.05).Conclusion: For patients with severe multiple fractures,application of damage control orthopedics can significantly reduce the postoperative complications,ICU recovery time and intraoperative blood transfusion,provide a certain basis for clinical treatment of such patients.