损害控制外科治疗重型颅脑损伤合并多发四肢骨折的疗效

Clinical effects of damage control surgery in treatment of severe craniocerebral injury combined with multiple extremity fractures

目的探讨损害控制外科（DCS）技术治疗重型颅脑损伤合并多发四肢骨折的效果。方法采用回顾性病例对照研究分析2011年5月-2015年8月收治的128例重型颅脑损伤合并多发四肢骨折患者临床资料，其中男81例，女47例；年龄19～77岁，平均37．3岁。格拉斯哥昏迷评分（GCS）3～8分。所有患者除常规处理外，行颅内压监测。患者根据救治方法分为两组：损害控制组（87例，DCS治疗方法），Ⅰ期只行开颅手术并固定骨折部位，择期行骨折切开复位内固定术；对照组（41例，传统常规方法救治），Ⅰ期行开颅手术及骨折切开复位内固定术。比较两组术后颅内压、手术时间、手术出血量、住院时间、预后情况[格拉斯哥预后评分（GOS）]等指标。结果患者在治疗过程中均未出现颅内感染。损害控制组术后颅内压控制正常44例（51％），明显优于对照组的8例（20％）（P〈0．05）。损害控制组手术时间、手术出血量、住院时间分别为（150．1±12．4）min、（270．6±15．3）ml、（29．7±9．3）d，较对照组明显缩短[（270．6±9．8）min、（460．2±17．5）ml、（34．4±6．2）d]（P〈0．05）。损害控制组伤后6个月良好率为70％，明显高于对照组的42％（P〈0．05）。结论对于重型颅脑损伤合并多发四肢骨折患者，DCS的应用有利于控制术后颅内压，显著缩短住院时间并改善患者的预后。

Objective To investigate the effects of damage control surgery （DCS） in the treatment of severe craniocerebral injury patients combined with multiple extremity fractures. Methods The clinical data of 128 patients with severe craniocerebral injury[ Glasgow coma scale （GCS） scored 3-8] combined with multiple extremity fractures admitted from May 2011 to August 2015 were retrospectively analyzed by case-control study. There were 81 males and 47 females, with an average age of 37.3 years （range, 19-77 years）. The patients were treated with intracranial pressure monitoring in addition to the common administration. The patients were subdivided into two groups： 87 patients treated with DCS concept as damage control group and 41 patients treated with non-DCS routine concept as control group. The DCS group received craniotomy and fracture fixation operation in stage I with selective operation of open reduction and internal fixation. The control group received craniotomy and open reduction and internal fixation in stage I. The postoperative intracranial pressure, operation duration, intraoperative blood loss, hospital stay and prognosis [ Glasgow outcome scale （ GOS ） ] were analyzed statistically. Results No intracranial infection was found in all patients during the treatment process. In damage control group, the postoperative intracranial pressure was normal in 44 cases （51% ） , which was significantly better than that in control group [ 8 cases （ 20% ） ] （ P 〈 0.05 ）. In damage control group, operation duration [ （ 150.1 ± 12.4 ） minutes ], intraoperative blood loss [ （270.6 ± 15.3 ） ml ],and hospital stay [ （29.7 ± 9.3 ） days ] were significantly shortened compared with control group, whose operation duration, intraoperative blood loss and hospital stay were （ 270.6 ±9.8 ） minutes, （ 460.2 ± 17.5） ml, and （ 34.4 ± 6.2） days, respectively （ P 〈 0.05 ）. The GOS rating of damage control group （70%） was notably higher than that in control group （42%） （ P 〈 0.05 ）. Conclusion For severe craniocerebral injury patients combined with multiple extremity fractures, the application of DCS contributes to control of postoperative intracranial pressure, which can also shorten the duration of hospitalization and improve prognosis.