儿童严重骨盆骨折救治的损伤控制策略应用体会

Application of damage control orthopaedics strategy in children patients remedy with severe pelvic fracture

目的：探讨损伤控制骨科（damage control orthopaedics DCO）理论在儿童严重骨盆骨折救治中的应用。方法：按是否遵循DCO策略将本院自2001年1月-2013年6月收治的32例儿童严重骨盆骨折分为2组，对照组为前期未按DCO原则治疗的14例患者，观察组为后期采用DCO方法治疗的18例患者，总结DCO策略方法及临床效果。结果：观察组15例患者存活，3例死亡，其中1例死于失血性休克，2例死于多器官功能衰竭，远期Cole疗效评分为36．7分。对照组9例患者存活，5例死亡，3例死于失血性休克，其中1例死于弥漫性血管内凝血，1例死于严重感染，远期Cole疗效评分为30．6分，2组患者在死亡率、远期疗效方面差异均有统计学意义（P〈0．05）。结论：将DCO技术干预和骨科专科医生的早期介入提前到事故现场和急诊室阶段，并应用于儿童严重骨盆骨折的临床治疗，强调院前急救和院内处理并重，有利于对患儿进行迅速、有效、旨在抢救生命的整体治疗，能显著提高患儿的生存率，减少并发症的发生。

Objeetiv： To study the application of damage control orthopaedics theory in children patients remedy with severe pelvic fracture. Methods： Through retrospective analysis the clinical data had been collected of 32 cases children patient with severe pelvic frac- ture in our hospital from January 2001 to June 2013. The patients had been divided into 2 groups based on whether or not to follow the damage control orthopaedics theory. As the control group was not followed the DCO strategy in prophase, as the treatment group was adopt- ed the DCO strategy in anaphase. And the methods and clinical effect of DCO strategy had been Summarized. Results： In the treatment group there were 15 eases survival, and 3 cases death. As 1 case succumbed to hemorrhagic shock, 2 cases succumbed to multiple organ failure. The long - tern Cole curative effect score was 36.7. In the control group there were 9 cases survival, and 5 cases death. As 3 ca- ses succumbed to hemorrhagic shock, 1 case succumbed to diffuse intravascular coagulation, 1 case succumbed to severity infection. The long - tern Cole curative effect score was 30.6. Te death rate and long - tern Cole curative score were statistical significance between two groups （ p 〈 0.05 ）. Conclusion： Application of the DCO strategy and the orthopedics specialist earlier period intervention in children patients remedy with severe pelvic fracture, as a part of integrated treatment, might be beneficial for rapid rescue, improve survival rate, and decreasing complications.