伤害控制骨科学—多发伤治疗最新观点

Damage control orthopaedics: state of the art management of polytrauma

挽救生命、减少伤残仍是多发伤救治的基本观点,治疗的形式和时机却在逐渐地变化、修正,伤害控制原则是一项新的多发伤治疗策略,其在创伤骨科的应用产生了伤害控制骨科学。伤害控制骨科学包括三步,第一步:早期临时固定不稳定性骨折、止血,如果需要,作颅内减压;第二步:在ICU内复苏病人使其各项生理指标达到理想状态;第三步:病人病情稳定后进行最终的正式手术固定骨折。伤害控制骨科学适应证:血液动力学不稳定及极度危重的多发伤病人应遵循伤害控制原则;对临界病人,仍可早期手术正式固定骨折,但如果手术过程中任何时间发生病情恶化,手术应该立即改为伤害控制。伤害控制骨科学是一项正在发展、完善的技术,将来研究需要进一步验证既有观点的有效性,以减少多发伤病人ARDS和MOF的发生。

While the basic concept of saving life and decreasing disability h as not changed in the management of polytrauma, the timing and strategies of tre atment have been gradually modified. Damage control is one of the new strategies , and its application in orthopedic traumatology is known as damage control orth opedics. Damage control orthopedics involves formalized three stages in the mana gement of fractures of long bones and pelvis. Stage 1 consists of temporary fixa tion of the unstable fractures and hemostasis. Stage 2 comprises resuscitation, warming, oxygen delivery and administration of coagulation factors to the patien t in the intensive care unit. In Stage 3 definitive fixation is done for the fra cture. Indications of damage control orthopedics: for patients with polytrauma w hose conditions are unstable or in extremis the damage control strategy is recom mended. For the borderline patients early total care may be applied, but the sur gery should be performed with great caution. It has to be converted to the damag e control strategy if conditions of the patient deteriorate during the operation . Since damage control orthopedics is an evolving practice, further work is need ed to enhance its effectiveness and to reduce the incidence of ARDS and MOF.