目的探讨伤害控制骨科学（damage control orthopaedics，DCO）原则治疗骨科严重多发创伤的可行性和有效性。方法按照DCO原则收治严重多发创伤患者47例，男35例，女12例；年龄17-55岁，平均32．8岁；开放骨折28例，闭合骨折19例；颅脑损...目的探讨伤害控制骨科学（damage control orthopaedics，DCO）原则治疗骨科严重多发创伤的可行性和有效性。方法按照DCO原则收治严重多发创伤患者47例，男35例，女12例；年龄17-55岁，平均32．8岁；开放骨折28例，闭合骨折19例；颅脑损伤15例，胸部损伤20例，腹部损伤17例。患者术前损伤严重度评分平均33．4分，系统炎性反应评分平均2．9分，格拉斯哥昏迷评分平均11．4分。结果一期手术中骨科处理时间平均65min，术中出血量平均185ml；一期术后平均7d行骨折确定性手术，平均手术时间（142±29）min，术中出血量（420±70）ml。一期术后3例患者死亡，其中1例伴严重创伤性颅脑损伤，2例伴严重胸腹部损伤。术后3例出现腹腔内脓肿，经引流冲洗后治愈；2例发生外固定架针道浅表感染和1例深部感染，经治疗后愈合。无一例出现脂肪栓塞、深静脉血栓等其他并发症和与骨科治疗有关的其他系统病情的恶化。39例患者获得随访，随访时间3-14个月，平均9个月。骨折愈合时间5～14个月，未发现畸形愈合及远期并发症。结论运用DCO原则治疗骨科多发创伤，可减少患者二次打击程度，控制炎性反应水平的增加，降低手术治疗风险，临床结果较好。展开更多
目的分析老年多发性创伤骨折患者围术期下肢深静脉血栓形成(lower extremity deep venous thrombosis,LEDVT)的危险因素。方法收集2012年1月至2018年2月于本院行手术治疗的273例老年多发性创伤骨折患者的病历资料,根据患者围术期有无LED...目的分析老年多发性创伤骨折患者围术期下肢深静脉血栓形成(lower extremity deep venous thrombosis,LEDVT)的危险因素。方法收集2012年1月至2018年2月于本院行手术治疗的273例老年多发性创伤骨折患者的病历资料,根据患者围术期有无LEDVT,将其分为LEDVT组和非LEDVT组。统计所有患者的性别、年龄、格拉斯哥昏迷评分(Glasgow coma score,GCS)、病程、体质指数(body mass index,BMI)、创伤类型、骨折部位、骨折类型、手术时间、术中出血量、术后抗凝药物使用情况、术后卧床时间、合并症、吸烟史、饮酒史等资料。对以上资料进行单因素和非条件Logistic回归分析,筛选老年多发性创伤骨折患者围术期LEDVT形成的独立危险因素。结果 273例患者中,61例(25.95%)发生LEDVT。单因素分析结果显示:年龄、BMI、骨折类型、手术时间、术后是否使用抗凝药物、术后卧床时间、是否合并糖尿病、有无吸烟史均为老年多发性创伤骨折患者围术期LEDVT的影响因素(P_均<0.05)。非条件Logistic回归分析显示:年龄≥75岁、BMI> 30 kg/m^2、手术时间≥2 h、术后卧床时间≥5 d、合并糖尿病、有吸烟史均为老年多发性创伤骨折患者围术期LEDVT的独立危险因素(P_均<0.05)。结论老年多发性创伤骨折患者围术期LEDVT较为常见,临床上需根据患者年龄、BMI、手术时间、术后卧床时间、合并糖尿病及吸烟史等采取必要的干预措施,尽量避免LEDVT的发生。展开更多
Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful...Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. Methods: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200e10,000 mL, with an average volume of 2850 mL. Postoperative followup ranged from 6 months to 1.5 years. Results: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral ar展开更多
文摘目的探讨伤害控制骨科学（damage control orthopaedics，DCO）原则治疗骨科严重多发创伤的可行性和有效性。方法按照DCO原则收治严重多发创伤患者47例，男35例，女12例；年龄17-55岁，平均32．8岁；开放骨折28例，闭合骨折19例；颅脑损伤15例，胸部损伤20例，腹部损伤17例。患者术前损伤严重度评分平均33．4分，系统炎性反应评分平均2．9分，格拉斯哥昏迷评分平均11．4分。结果一期手术中骨科处理时间平均65min，术中出血量平均185ml；一期术后平均7d行骨折确定性手术，平均手术时间（142±29）min，术中出血量（420±70）ml。一期术后3例患者死亡，其中1例伴严重创伤性颅脑损伤，2例伴严重胸腹部损伤。术后3例出现腹腔内脓肿，经引流冲洗后治愈；2例发生外固定架针道浅表感染和1例深部感染，经治疗后愈合。无一例出现脂肪栓塞、深静脉血栓等其他并发症和与骨科治疗有关的其他系统病情的恶化。39例患者获得随访，随访时间3-14个月，平均9个月。骨折愈合时间5～14个月，未发现畸形愈合及远期并发症。结论运用DCO原则治疗骨科多发创伤，可减少患者二次打击程度，控制炎性反应水平的增加，降低手术治疗风险，临床结果较好。
文摘目的分析老年多发性创伤骨折患者围术期下肢深静脉血栓形成(lower extremity deep venous thrombosis,LEDVT)的危险因素。方法收集2012年1月至2018年2月于本院行手术治疗的273例老年多发性创伤骨折患者的病历资料,根据患者围术期有无LEDVT,将其分为LEDVT组和非LEDVT组。统计所有患者的性别、年龄、格拉斯哥昏迷评分(Glasgow coma score,GCS)、病程、体质指数(body mass index,BMI)、创伤类型、骨折部位、骨折类型、手术时间、术中出血量、术后抗凝药物使用情况、术后卧床时间、合并症、吸烟史、饮酒史等资料。对以上资料进行单因素和非条件Logistic回归分析,筛选老年多发性创伤骨折患者围术期LEDVT形成的独立危险因素。结果 273例患者中,61例(25.95%)发生LEDVT。单因素分析结果显示:年龄、BMI、骨折类型、手术时间、术后是否使用抗凝药物、术后卧床时间、是否合并糖尿病、有无吸烟史均为老年多发性创伤骨折患者围术期LEDVT的影响因素(P_均<0.05)。非条件Logistic回归分析显示:年龄≥75岁、BMI> 30 kg/m^2、手术时间≥2 h、术后卧床时间≥5 d、合并糖尿病、有吸烟史均为老年多发性创伤骨折患者围术期LEDVT的独立危险因素(P_均<0.05)。结论老年多发性创伤骨折患者围术期LEDVT较为常见,临床上需根据患者年龄、BMI、手术时间、术后卧床时间、合并糖尿病及吸烟史等采取必要的干预措施,尽量避免LEDVT的发生。
文摘Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. Methods: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200e10,000 mL, with an average volume of 2850 mL. Postoperative followup ranged from 6 months to 1.5 years. Results: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral ar
