儿童四肢骨折合并重度颅脑外伤手术时机探讨  

Investigation on operation timing of limb fractures combined with severe craniocerebral trauma in children

作　　者：蒋欣[1] 索朗 刘利君[1] 彭明惺[1] 唐学阳[1] 杨晓东[1] 王道喜[1] 

机构地区：[1]四川大学华西医院小儿外科,四川成都610041 [2]西藏自治区藏医院骨科,西藏拉萨850000

出　　处：《中国骨伤》2014年第6期486-490,共5页China Journal of Orthopaedics and Traumatology

基　　金：四川省应用基础研究计划资助项目(编号:2012JY0086)~~

摘　　要：目的：探讨合并重度颅脑外伤的儿童四肢骨折的手术时机及手术方案的选择。方法：自2005年1月至2012年7月,共收治合并严重颅脑外伤的儿童四肢骨折患儿36例,其中男24例,女12例;年龄1-13岁,平均（6.1±3.0）岁。受伤至入院平均（18.0±15.0）h;Glasgow昏迷评分≤8分,平均（6.4±1.3）分;AIS-ISS标准损伤严重度评分平均（25.9±8.1）分。开放性骨折13例,闭合23例。将患儿分为两组,立即手术组21例,入院后24 h内接受骨折固定,平均时间（15.0±7.4）h;延迟手术组15例,手术时间距入院平均（165.4±114.6）h。所有患儿接受骨折切开复位手术处理,33例内固定,3例外固定。观察并评价两组患儿的手术时间、术中出血量、骨折愈合时间及颅脑外伤、肢体外伤术后康复情况。结果：36例患儿术后伤口均Ⅰ期愈合,术中无死亡、昏迷加重、呼吸循环障碍等并发症发生。立即手术组手术时间（44.5±25.3）min,术中出血量（47.1±36.5）ml,骨愈合时间（2.7±0.5）个月,明显优于延迟手术组（87.0±40.0）min,（112.7±67.5）ml,（3.8±1.2）个月,两组比较差异有统计学意义（P〈0.05）。立即手术组Glasgow结局量表（4.7±0.6）分,延迟手术组（4.7±0.5）分,两组比较差异无统计学意义（t=0.23,P〉0.05）。立即手术组Fugl-Meyer运动功能评分（97.9±2.7）分,延迟手术组（97.7±3.9）分,两组比较差异无统计学意义（t=0.11,P〉0.05）。结论：合并重度颅脑外伤的儿童四肢骨折患者病情危重,在临床上应根据每个病例的具体情况来选择适宜的手术时机,在生命体征基本稳定的情况下尽早手术治疗四肢骨折。Objective： To investigate the best choice of operation opportunity and operation plan for limb fractures combined with severe craniocerebral trauma in children. Methods ：From January 2005 to July 2012,36 patients with limb fractures and severe craniocerebral trauma were received,including 24 males and 12 females aged from 1 to 13 years old （mean, 6.1±3.0）. The time from injury to hospital was（18.0±15.0） h. Glasgow coma score were less than 8 with an average of 6.4±1.3. AIS-ISS score were 25.9±8.1. Thirteen patients were open fracture, 23 were closed fracture. Patients were divided into immediate operation group （21 patients） received fracture fixation with 24 h, the average time was （15.0±7.4） h, and delayed oper- ation group （15 patients） received fracture fixation after 24 h, the average time was （165.4±114.6） h. All patients were treated by open reduction, and 33 cases by internal fixation, 3 cases were external fixation. Operative time, blood loss, fracture healing time and brain trauma, physical trauma, postoperative rehabilitation situation were observed and evaluated. Results：All pa- tients were healed at stage I , and no dead, aggravating of coma, disorders of breathing and circulation occurred during opera- tion. Operative time, blood loss, healing time in immediate operation group was （44.5＋25.3） rain, （47.1 ＋36.5） ml, （2.7＋0.5） months, respectively; while in delayed operation group was （87.0＋40.0） min, （112.7_＋67.5） ml, （3.8_＋1.2） months, respective- ly; and there were obvious differences between two groups. There was no siginificant meaning in Glasgow coma score and Fugl- Meyer motor function between immediate operation group （4.7_＋0.6,97.9_＋2.7） and delayed operation group （4.7＋0.5,97.7_＋ 3.9 ） （t=0.23, P〉0.05 ; t=0.11, P〉0.05 ）. Conclusion： The condition of limb fractures combined with severe craniocerebral trauma in children is seriously, comfortable surgical opportunity should according to particular

关 键 词：四肢 骨折 颅脑损伤 儿童 

分 类 号：R651.15[医药卫生—外科学]