严重多发骨关节损伤的标准及诊治(附58例报告)

The Standard Diagnosis and Treatment of Severe Multiple Bone and Joint Injury: A Report of 58 Cases

应用AIS≥3判定骨和关节损伤的严重度和利用≥2个蔡氏骨关节部位做为多发,并在此基础上分析58例严重多发骨关节损伤的诊断与治疗。58例中72个骨折采用手术固定治疗。结果58例的漏诊率是4.2％。1例发生多器官功能衰竭,3例发生骨筋膜室综合征,4个开放骨折术后感染,因严重颅内损伤死亡1例,死亡率1.7％。随访57例,结果表明早期手术固定的疗效优于保守治疗。严重多发骨关节损伤可以上述方法定义;仔细多次查体可减少漏诊率;早期手术固定有利于严重多发伤的治疗和骨关节功能的恢复。

We applied AIS≥3 to judge the severity of bone and joint injury, named≥2 parts of Cai' s standard bone or joint injuries as multiple. With above standard, we analysed the diagnosis and treatment of 58 such patients. Seventy-two fractures in 58 patients were treated by operative fixation. Results: The rate of missed diagnosis in 58 cases was 4.2%. One had MOF, 3 had compartment symptom, 4 open fracture were infected postoperatively. Only 1 patient died of severe intracranial trauma. Themotality rate was 1.7%. 57 cases were followed up. It revealed that the curative effect of operative fixation was better than conservative treatment. Conclusions: The standard of the injuries can be defined by above standard, The rate of missed diagnosis can be reduced by carefully physical examination. Early operative fixation have advantage to the treatment of severe multiple bone and joint injuries and restoration of the function.