早期外固定术在重型颅脑创伤合并四肢骨折中的应用  

Early fracture external fixation in treatment of severe traumatic brain injury combined with extremity fracture

作　　者：侯立军[1] 金海[1] 潘承光[1] 欧阳跃平[1] 卢亦成[1] 李波[1] 王慧[1] 

机构地区：[1]第二军医大学附属长征医院神经外科,上海200003

出　　处：《中华创伤杂志》2009年第3期196-198,共3页Chinese Journal of Trauma

基　　金：基金项目：国家自然科学基金资助项目（30672148）;全军医学科学技术研究“十一五”计划课题资助项目（06MB217）;上海市科学技术委员会基础研究重点课题资助项目（07JC14071）;军队“十一五”科技攻关课题资助项目（08a063,06G54）

摘　　要：目的探讨早期（〈48h）骨折外固定术在重型颅脑创伤（GCS≤8）合并四肢骨折患者中的临床应用效果。方法统计重型颅脑创伤合并四肢骨折年龄、性别、颅脑创伤情况、骨折部位分布及其他全身情况等差异均无统计学意义的患者，根据骨折的早期（〈48h）治疗方法不同，将重型顷脑创伤患者分为两组。A组：早期骨折外固定组（40例）；B组：早期骨牵引、石膏固定等保守治疗组（57例）。对比分析两组患者褥疮、肺炎、下肢静脉血栓形成等并发症发生情况，ICU时间、住院时间、骨折愈合时间、病死率等指标。结果A组在感染率、褥疮、肺炎、下肢静脉血栓发生率方面明显低于B组（P〈0．05）。A组的ICU时间、住院时间、骨折愈合时间短于B组（P〈0．05）。A组的病死率低于B组，差异有统计学意义（P〈0．05）。结论针对重型颅脑创伤合并四肢骨折的患者，开展早期骨折外固定法与原有早期骨牵引、石膏固定等保守治疗方法相比，减少了并发症，缩短了恢复时间，降低了病死率。Objective To discuss clinical effects of early （ 〈 48 hours after injury） fracture external fixation in treatment of severe traumatic brain injury （TBI） combined with extremity fracture. Methods The study involved patients with no statistical difference in aspects of age, sex, GCS, fracture distribution and general condition. According to different treatment methods at early stage （ 〈 48 hours） , the patients with TBI were divided into Group A （ early extremity fracture external fixation） and Group B （ early extremity fracture traction or cast immobilization）. A comparative observation was done on complications including bedsore, pneumonia and deep venous thrombosis and on duration in ICU, hospitalization, time for fracture healing and mortality in two groups. Results Incidence rate of bedsore, pneumonia, deep venous thrombosis and mortality in Group A was lower than that in Group B （ P 〈 0.05 ）, and Group A had shorter time for ICU, hospitalization and fracture healing （P 〈 0.05）. Conclusion For patients with severe TBI combined with extremity fracture, early fracture external fixation is more effective to reduce complications, shorten the recovery time and reduce mortality, compared with conservative methods.

关 键 词：脑损伤 骨折  四肢 骨折固定术 外 

分 类 号：R651.15[医药卫生—外科学] R683.41[医药卫生—临床医学]