多发伤并长骨损伤的固定方式与处理时机_临床医学论文.docVIP

多发伤并长骨损伤的固定方式与处理时机_临床医学论文 多发伤并长骨损伤的固定方式与处理时机_临床医学论文 作者：田利华，胡 耑，赵 鸿， 【摘要】 目的 分析严重多发伤与长骨损伤的救治关系，探讨骨折固定方式与处理时机。方法 对随机采集的357例多发伤并长骨损伤患者按其长骨损伤特征、固定方式以及处理时间分组进行回顾性分析，采用AIS、ISS和TRISSRTS法对创伤的严重程度进行3个层次衡量评定，以控制组内和组间的可比性与统计学分析。结果 全组长骨损伤AIS最大值(MAIS)=3.28±1.15，并发其他部位伤MAIS=4.45±1.69，ISS=35.57±19.64,Ps=0.67±0.29。伤员生存危险与长骨损伤状况及所并发损伤的部位或器官有关，组合或混合方式固定患者并发损伤部位和长骨数多而伤情复杂，后期固定患者多存在延迟骨折固定的影响因素。结论 建立损害控制的概念，依据伤情进行分类救治有助于权衡骨折治疗利弊并做合理选择或分期实施。 【关键词】 多发伤;长骨骨折;内固定 Abstract： Objective To analyze the relationship of treatment between severe multiple injuries and long bone fractures and discuss the methods and optimal time to deal with them.Methods A total of 357 cases were classified by injury feature,fixation methods and treatment time for long bone fractures in patients with multiple trauma.Injury severity was assessed in 3 different levels with AIS,ISS and TRISSRTS,to control the comparability and statistical analysis in and among groups of patients with multiple trauma.Results MAIS=3.28±1.15 for long bone fractures,MAIS=4.45±1.69 for incorporated injuries,ISS=35.57±19.64 and Ps=0.67±0.29 for the whole group.Survival risk for patients was related with long bone fractures combined with site of or organs,patients with fixation of combination or mixing way had a great number of injury positions and long bone fractures and complicated traumatic condition.There were more factors to exert an influence on patients with postponed fracture fixation.Conclusion The concept of damage control should be used to treat patients according to different injury classifications,which helps to make reasonable choices of bone fracture treatment or implement by stages. 　　Key words:multiple trauma;long bone fractures;internal fixation 　　长骨损伤是严重多发伤较为常见的合并伤，损伤类型也较复杂而多样，尽管骨折内固定物的进展使多发伤中长骨损伤的治疗效果得以大幅提高，但选择恰当的固定方式和处理时机仍然较为困难。尤其是严重多发伤救治的首要问题是挽救生命，其骨折损伤的治疗策略仍受到全身状况和病情稳定的制约或限制，以致是当今创伤骨科仍需探讨的课题。资料与方法 　　1 研究对象及选择 　　本组研究对象均符合多发性创伤诊断标准[1]，同时合并有各类长骨损伤者357例，男性213例，女性144例;年龄为17～69岁。平均住院时间(25.57±17.65)天。股骨骨折148例次，胫骨骨折155例次，腓骨骨折1