| 伤害控制论在肢体严重创伤保肢治疗中的应用 |
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Received:October 19, 2011
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| 作者 | Author | 单位 | Unit | E-Mail |
| 沈立锋 |
SHEN Li-feng |
浙江省立同德医院骨科，浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
hzshenlf@163.com |
| 张春 |
ZHANG Chun |
浙江省立同德医院骨科，浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 郭峭峰 |
GUO Qiao-feng |
浙江省立同德医院骨科，浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 张晓文 |
ZHANG Xiao-wen |
浙江省立同德医院骨科，浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 刘亦杨 |
LIU Yi-yang |
浙江省立同德医院骨科，浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 黄恺 |
HUANG Kai |
浙江省立同德医院骨科，浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 期刊信息：《中国骨伤》2012年25卷，第2期，第152-154页 |
| DOI：10.3969/j.issn.1003-0034.2012.02.017 |
| 基金项目:浙江省医药卫生科学研究基金(编号：2008B030),浙江省医药卫生平台骨干人才计划(编号：2011RCA006) |
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目的：探讨伤害控制论在肢体严重创伤保肢治疗中的重要性。
方法：对2007年6月至2009年12月在伤害控制论指导下分期治疗的14例肢体严重创伤患者进行回顾性分析，男13例，女1例；年龄6～62岁，平均38.4岁。根据Tscherne软组织损伤分类：开放性骨折Ⅲ级(Fr.OⅢ)10例，Ⅳ级(Fr.OⅣ)2例，闭合性骨折Ⅲ级(Fr.CⅢ)2例。所有患者在我院进行首次手术，先评估创伤情况，在伤害控制论指导下Ⅰ期彻底清创。存在动脉断裂者先吻合血管，骨折采用外固定支架固定，先VSD覆盖创面，Ⅱ期行软组织修复重建手术，骨折不稳定者改用钢板固定。
结果：所有患者获随访，时间6～19个月，均保肢成功，无一例发生骨髓炎，肢体功能良好。除1例Fr.OⅣ型骨折经历2次清创后行游离皮瓣移植外，其余均未超过2次手术，创面最终全部愈合。2例伤后9个月出现骨不连，再次清创植骨后骨折愈合。骨折愈合时间5～15个月。
结论：肢体严重创伤常因软组织损伤严重，感染以及肢残发生率高，应用伤害控制论分期治疗，最大限度减少软组织进一步损伤，有益于保肢治疗的成功。 |
| [关键词]:骨折 创伤和损伤 临床方案 |
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| Application of damage control in severe traumatic limb salvage |
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Abstract:
Objective: To investigate the importance of damage control in limb salvage in severe trauma.
Methods: A retrospective analysis of 14 patients with severe limb trauma was performed from June 2007 to December 2009. There are 13 males and 1 female,ranging in age from 6 to 62 years with an average of 38.4 years. According to the Tscherne's classification about soft tissue injury,10 cases were type Fr.OⅢ，2 cases were type Fr.OⅣ，and 2 cases were type Fr.CⅢ。 All the patients received the first operation in our hospital. In the first stage,all the patients received debridemen directed by damage control after the situation was evaluated. The broken arteries were anastomosed,bone fractures were fixed with external fixation,wound were covered with the application of VSD. In the second stage,the soft tissue defect was reconstructed,and the plate fixation of unstable fracture was performed.
Results: The patients were followed up,and the duration ranged from 6 to 19 months. All limbs were salvaged successfully with two-stage operations,except one Fr.O Ⅳ fracture reveived the third operation. No osteomyelitis occurred,and the functions of the salvaged limbs were satisfied. Two patients had non-union at 9 month later,and were cured after re-debridement and bone replantation. The time of fracture union ranged from 5 to 15 months.
Conclusion: Severe traumatic limbs always have high rate of infection and extremity disability because the severe injury of soft tissue. The application of damage control can reduce the further injury of soft tissue,which is better for the success of limb salvage. |
| KEYWORDS:Fractures Wounds and injuries Clinical protocols |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 沈立锋,张春,郭峭峰,张晓文,刘亦杨,黄恺.伤害控制论在肢体严重创伤保肢治疗中的应用[J].中国骨伤,2012,25(2):152~154 |
| 英文格式: | SHEN Li-feng,ZHANG Chun,GUO Qiao-feng,ZHANG Xiao-wen,LIU Yi-yang,HUANG Kai.Application of damage control in severe traumatic limb salvage[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(2):152~154 |
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