一例因高处作业坠落致严重多发伤的案例报告

A Case Report of Serious Multiple Injuries Caused by Falling from High Work

总结严重多发伤患者根据损伤控制理论完成救治的成功经验。收集我院救治的一例因高处作业坠落而导致的颈椎骨折并脊髓损伤、颅骨骨折并硬膜外及蛛网膜下腔出血、股骨远端开放性粉碎性骨折等严重多发伤的患者资料。患者损伤严重度评分55分,遵循伤害控制理论安排临床救治,包括急诊手术处理颅内出血和股骨开放性损伤,应用大剂量激素冲击治疗,二期手术解除脊髓压迫,重建颈椎稳定,固定股骨髌骨粉碎性骨折,恢复膝关节功能,术后半年患者由入院时的Frankel分级A级恢复至D级。在救治因高空坠落所导致的严重多发伤临床上,需要多学科协作,快速有效地解决危及患者生命的重要器官和组织产生的问题,同时需要防止继发性损伤尤其脊髓损伤,为二期治疗提供机会,才能获得最佳治疗效果。

To conclude the successful treatment for a patient with serious multiple injuries according to injury control theory.Clinical data were collected from a patient seriously injuried with cervical vertebral fracture, spinal cord injury, skull fracture,epidural and subarachnoid hemorrhage, open fracture of distal femur and other serious multiple injuries by falling. The injury severity score(ISS) was 55. According to the theory of injury control, the following clinical treatment was arranged emergency operation for intracranial hemorrhage, and external fixation for open fracture, and a high-dose hormone pulse therapy to reduce secondary injury of spinal cord, following by a second stage operation to decompress spinal cord injury and reconstruct cervical vertebra, and restore knee function with internal fixation for femur and patella fracture. An ideal outcome was obtained by timely, effective and correct treatment to rescue patient with severe multiple injuries, especially to prevent secondary spinal cord injury.