摘要
[目的]探讨损伤控制骨科理论在骨盆骨折院前院内救治中的应用效果。[方法]回顾性分析本院自2001年1月～2012年6月收治的骨盆骨折患者105例,按是否遵循损伤控制骨科(damage control orthopaedics DCO)理论治疗,分为两组:治疗组为2006年3月～2012年6月在DCO原则指导下治疗的骨盆骨折,共58例,其中男37例,女21例,平均38.3岁,骨折按Tile分型A型11例,B型29例,C型18例,术前损伤严重度评分(ISS)为平均36.3分;对照组为2001年1月～2006年2月收治的未按DCO原则治疗的骨盆骨折47例,其中男31例,女16例,平均年龄37.1岁。骨折按Tile分型A型8例,B型24例,C型15例,术前损伤严重度评分为平均36.5分。并对死亡率、并发症发生率、骨折复位情况和远期疗效进行比较,评估两组的治疗效果。[结果]治疗组死亡3例(5.2%),发生严重并发症7例(12.1%),骨折复位优良率为82.4%,存活病例平均随访19.1个月(6～31个月),远期Cole疗效评分为35.6分;对照组死亡9例(19.1%)例,发生严重并发症13例(27.7%)例,骨折复位优良率为77.1%,存活病例平均随访20.4个月(13～32个月),远期Cole疗效评分为30.3分。两组患者在死亡率、并发症发生率、骨折复位优良率及远期疗效方面差异均有统计学意义(P<0.05)。[结论]在DCO理论指导下,强调院前急救和院内处理并重,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,规范急救流程,多学科协作,能减少骨盆骨折死亡率,提高救治成功率及远期疗效。
[ Objective] To investigate the application of the damage control orthopedics（DCO） strategyin the treatment of pelvic fractures in the pre-hospital and hospital settings. [ Method] This study was a retrospective analysis of pelvic fractures in our hospital between January 2001and June 2012. The patients were divided into 2 groups based on the type of treatment re-ceived for the pelvic fracture. The treatment group（ n = 58 ） consisted of 37 men and 21 women （mean age, 38.3 years）, with 11 Type A,29 Type B, and 18 Type C pelvic fractures （based on the Tile classification system） and a mean injury severity score （ISS） of 36.3 points;these patients received the 3 staged treatment following the principles of the DCO strategy in the pre-hos- pital and hospital settings. The control group （n=47） consisted of 31 men and 16 women （mean age,37.1 years） ,with 8 Type A ,24 Type B, and 15 Type C pelvic fractures （based on the Tile classification system） and a mean ISS of 36.5 points;these pa-tients underwent a single stage open reduction with internal fixation. The effect of treatment in the 2 groups was evaluated based on mortality,incidence of complications, fracture reduction, and long-term efficacy. [ Result ] In the treatment group, there were 3 deaths （5.2%）, and 7 （12.1% ） cases with serious complications. Additionally, in this group, the excellence result rate of frac-ture treatment was 82.4% ,the mean follow-up period of the survivors was 19.1 months （6-31 months）, and the mean long-term Cole score was 35.6 points. In the control group,there were 9 deaths （ 19.1% ） and 13（27.7% ） cases with serious com- plications. Additionally, in this group, the excellence result rate was 77.1%, the mean follow-up period of the survivors was 20. 4 months result （13 - 32 months）, and the mean long-term Cole score was 30.3 points. The mortality, incidence of complica-tions, excellence rate of fracture treatment, and Cole score were significantly different between the 2 groups （ P 〈 0.05 ）. [ Con-clusion] By following the principles of the DCO strategy that emphasize treating the patient in the pre-hospital and hospital set- tings,providing early intervention by the DCO technical and orthopedic specialist at the scene of the accident and in the emer-gency room, and employing the standard first aid process and a muhidisciplinary collaboration, the success rate of pelvic fracture treatment can be improved, and this can have a positive impact on the long-term outcome.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第20期2019-2024,共6页
Orthopedic Journal of China
关键词
骨盆
骨折
急救
损伤控制
pelvis, fracture, first aid, damage control
