伤害控制原则处理危重患者下肢骨折的临床研究

Damage Control Orthopedics in Treatment of Severe Polytrauma Patients with Lower Limb Fractures

目的探讨应用伤害控制的原则处理危重患者下肢骨折的意义和方法。方法自2003年3月～2008年9月收治合并有下肢骨折严重多发伤54例,对应用伤害控制原则处理下肢骨折的病例进行回顾性分析研究;全部患者常规抢救处理后,到手术室继行开颅、开胸或剖腹后,骨折均行简单固定,待全身情况平稳后行最终确定性手术。结果本组54例(105处骨折)中死亡5例,截肢1例;48例(93处骨折随访9～48个月,其中36处骨折更换为髓内固定,25处近关节的骨折根据不同骨折类型选择合适的内固定物进行内固定,6处由于外固定架针道渗液行皮牵引,平均10 d后更换内固定手术,20处骨折保留外固定架至治疗结束。79处愈合(愈合率84.9%),四种主要并发症经再次手术得到治愈。结论应用伤害控制的原则处理危重患者的下肢骨折可以在保证患者安全的情况下,最大程度地恢复患者的肢体功能。

Objective To investigate the significance and methods of damage control theory in low extremity fracture. Methods fifty- four low extremity fracture patients with multiple injuries undergoing the damage control from Mar. 2003 to Sep.2008 were retrospectively analyzed. All cases were treated with routine rescue procedures, simple fLxation followed by craniotomy, thoracotomy or laparotomy and secondly definited fixation after getting good general situation.Results One hundred and five fractures of all cases, except the 5 death and 1 amputated case were followed up from 9 to 48 months. The fLxing type of 36 fractures were changed by intramedullery nail, of 25 frac- tures nearby joint fractures were changed by different internal fixation according the type of fracture, of 6 fractures were changed internal fixation after 10 days percutaneous traction because of local infection and of 20 fractures continuously fixed by external fixation till bone healed.The fracture healing rate was 84.9 percent. Four major complications were cured by the re-operation.Conclusion Application of the principle of damage control to manage lower limb fracture patients with multiple injuries can ensure patient safety, also maximize the restoration of the patient＇s physical function.