创伤后多重损伤患者。是等待,是操作,还是使用损伤控制骨科模板?病例报告

Osama Al-Odat, M. M. Odat, S. Luca, M. Fotea, Andrei Nicolae Avădanei, M. Zarzecki
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摘要

抽象的目的。损伤控制矫形术(DCO)是一种用于重伤患者康复的外科概念。考虑到创伤患者死亡的主要原因仍然是不受控制的出血,DCO强调预防酸中毒、凝血功能障碍和体温过低的“致命三合一”,而不是立即纠正解剖结构。因此,我们提出了在严重创伤病例中使用这种技术的重要性。方法。一名23岁女性因多重创伤被送入急诊室。根据高级创伤生命支持方案,全面暴露检查显示双侧前臂和股骨畸形,双侧开放股骨骨折,左踝关节畸形和盆腔淤斑。x光片证实肋骨骨折,双侧肺挫伤,左踝关节骨折,双侧耻骨上、下支骨折,双侧股骨骨折,右腿双侧骨中轴骨折。立即进行DCO,在骨折处放置外固定架,同时夹板固定前臂。在重症监护室(ICU) 11天后,患者接受了最终手术。结果。首先以DCO方案管理患者,而不是匆忙进行最终的外科手术,结果是适当的稳定。经过两年的随访,患者完全康复,恢复正常生活。结论。对严重受伤的病人进行决定性的手术会产生有害的影响,可能会降低预期寿命。短期生理恢复应优先于最终管理,并应进行DCO,以便取得最佳结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Post Traumatic Multi-Injured patients. To wait, to operate or to use Damage Control Orthopedic template? A case report
Abstract Purpose. Damage Control Orthopedics (DCO) is a surgical concept used in the recovery of seriously injured patients. Given that the leading cause of death among trauma patients remains uncontrolled hemorrhage, DCO emphasizes on preventing the "lethal triad” of acidosis, coagulopathy and hypothermia, rather than correcting the anatomy immediately. Thereby, we are presenting the crucial importance of using this technique in severe trauma cases. Methods. A 23-year-old female was admitted in the Emergency Room as a multi-trauma patient. Following the Advanced Trauma Life Support protocol, fully exposure examination showed bilateral forearm and femur deformities, with bilateral open femur fracture, left ankle deformity and pelvic ecchymosis. X-rays confirmed fractures of the ribs, bilateral pulmonary contusion, fracture of the left ankle fracture, bilateral superior and inferior pubic ramus, and bilateral femur fractures with both bone midshaft fracture on the right leg. DCO was proceeded immediately, during which external fixators were placed on the fractures, while splinting both forearms. After 11 days in the Intensive Care Unit (ICU), the patient underwent the definitive surgeries. Results. Managing the patient with the DCO protocol first and not rushing with the definitive surgical procedures resulted in a proper stabilization. After two years follow up, the patient fully recovered and returned to a normal life style. Conclusion. Performing a definitive operation on severely injured patients results in deleterious effects that could lower life expectancy. Short-term physiological recovery should be prioritized over definitive management and DCO should be proceeded in order for the best outcomes to be achieved.
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