损伤控制理念在严重四肢骨折伴多发伤中的应用

Application of damage control concept in severe limbs fractures combining with multiple trauma

目的 ：探讨损伤控制理念在严重四肢骨折伴多发伤治疗中的应用和临床效果。方法 ：回顾性分析2009年7月至2012年7月应用损伤控制理念指导下治疗严重四肢骨折伴多发伤患者30例（损伤控制组）,男20例,女10例;年龄20~60岁,平均（34.03±12.81）岁;损伤严重程度评分（ISS）26~54分,平均（35.00±12.81）分。以2006年6月至2009年6月间采用传统手术方式（早期全面处理原则）治疗严重四肢骨折伴多发伤患者30例为对照组,男23例,女7例;年龄18~65岁,平均（34.23±11.04）岁;ISS评分26~51分,平均（35.56±11.04）分。分别对两组年龄、性别、ISS评分、Gustilo分级、手术时间、手术出血量、输血量、术后并发症及死亡率等进行对比分析。结果：损伤控制组中存活28例,死亡2例（6.7%）,术后发生并发症6例（成人呼吸窘迫综合征2例,多器官功能衰竭1例,弥撒性血管内凝血1例,伤口感染2例）。对照组中存活22例,死亡8例（26.7%）,术后发生并发症13例（成人呼吸窘迫综合征4例,多器官功能衰竭2例,弥撒性血管内凝血2例,术后感染3例）。对两组年龄、性别、ISS评分、Gustilo分级、并发症比较差异无统计学意义（P〉0.05）,两组死亡率、手术时间、手术出血量、输血量比较差异有统计学意义（P〈0.05）。结论：损伤控制理念用于治疗严重四肢骨折伴多发伤患者,有利于对患者进行迅速有效的救治,可提高生存率,减少并发症,临床疗效显著。

Objective：To discuss the application and clinical effect of damage control concept in the treatment of severe limbs fractures combining with multiple trauma. Methods ： From July 2009 to July 2012,30 patients with severe limbs fractures combining with multiple trauma were treated with the damage control concept,included 20 males and 10 females with an average age of（34.03±12.81） years old ranging from 20 to 60 years old;the ISS averaged（35.00±12.81） points（ranged from 26 to54 points）. And the control group also contained 30 patients with severe limbs fractures combining with multiple trauma treated by the traditional operation from June 2006 to June 2009,there were 23 males and 7 females with an average age of（34.23±11.04） years old ranging from 18 to 65 years old. The ISS averaged（35.56±11.04） points（ranged from 26 to 51 points）. The age,gender,ISS,Gustilo classification,operation time,intraoperative blood loss,blood transfusion,postoperative complications and mortality rate were observed and compared. Results：In the damage control concept group,there were 28 cases surviving and 2 cases（6.7%） death; 6 cases of postoperative complication included 2 cases of adult respiratory distress syndrome,1 case of multiple organ failure,1 case of disseminated intravascular coagulation and 2 cases of wound infection. In the control group,there were 22 cases surviving and 8 cases death（26.7%）;13 cases of postoperative complication included 4 cases of adult respiratory distress syndrome,2 cases of multiple organ failure,2 cases of disseminated intravascular coagulation and 3 cases of wound infection. There were no statistically significant differences between two groups in age,gender,ISS,Gustilo classfication and complication（P〉0.05）,however there were statistically significant differences in mortality rate,operation time,blodd loss,blodd transfusion between two groups（P〈0.05）. Conclusion：Damage control concept is used to treat severe limbs fractures combining with multiple trauma which has the rapid and effective therapy,can improve survival rate and reduce complication.