四肢骨折合并颅脑损伤手术治疗专家共识  

Expert consensus on surgical treatment of limb fracture combined with traumatic brain injury

作　　者：万中元 高杰 林宜磒 柴伟 李绍光 李运军 何红英 王晔来 韩力 郭艳辉 史纪 张熔基 田坤 宋芳 侯颖 张建政 张志成 唐佩福 孙天胜 WAN Zhong-yuan;GAO Jie;LIN Yi-yun;CHAI Wei;LI Shao-guang;LI Yun-jun;HE Hong-ying;WANG Ye-lai;HAN Li;GUO Yan-hui;SHI Ji;ZHANG Rong-ji;TIAN Kun;SONG Fang;HOU Ying;ZHANG Jian-zheng;ZHANG Zhi-cheng;TANG Pei-fu;SUN Tian-sheng(National Center of Orthopaedics and Exercise Rehabilitation,Senior Department of Orthopedics,The Fourth Medical Center of Chinese PLA General Hospital,Beijing,100853,China)

机构地区：[1]国家骨科与运动康复临床医学研究中心,北京100853 [2]中国人民解放军总医院第四医学中心骨科学部,北京100048 [3]中国人民解放军总医院第一医学中心神经外科学部,北京100039 [4]中国人民解放军总医院第七医学中心骨科,北京100070 [5]中铁建设集团有限公司,北京100040 [6]中国人民解放军火箭军特色医学中心口腔科,北京100088

出　　处：《中国骨与关节杂志》2024年第9期698-709,共12页Chinese Journal of Bone and Joint

基　　金：军队后勤重大科研项目(ALB23J002);军队装备科学研究项目(LB2022B020200);解放军总医院新技术项目(2023102);北京市自然科学项目(7232165);河南省重点研发专项(231111310100)。

摘　　要：一、制定背景创伤是目前世界范围内死亡和残疾的主要原因之一,2020年全球因创伤导致的死亡人数达到了840万,其中以多发伤多见[1]。多发伤大多由高能量损伤所致,四肢骨折的发生率很高,占到了全部伤情的近60.0%,其中上肢骨折占21.8%,下肢骨折占19.0%,17.7%的患者同时有上、下肢骨折[2]。多发伤患者中有65.0%存在颅脑损伤[3],其中39.2%为重型颅脑损伤[4]。当四肢骨折的患者同时合并严重的颅脑损伤时,往往伤情危重,预后较差,病死率高达21.8%,相比之下,严重躯干或四肢损伤导致的病死率仅为12.9%,单纯的颅脑损伤病死率为17.8%[5-6]。The incidence of limb fracture is very high in patients with multiple injuries.In addition to limb fracture,some patients have traumatic brain injury as well.When severe traumatic brain injury is combined with limb fracture,the injury is often critical and complicated,with high mortality and poor prognosis.The final treatment outcomes of patients depend on injury evaluation and resuscitation,operation time,anesthesia mode,perioperative pain management,blood transfusion,nutrition and other perioperative issues.It is of great significance to master the correct evaluation method,choose the appropriate treatment strategy and reduce the risk of second-hit to the brain for the treatment of limb fracture complicated with traumatic brain injury.At present,there is no clinical guideline or expert consensus on the surgical treatment of limb fractures combined with traumatic brain injury.In view of this,the National Orthopaedic and Sports Rehabilitation Clinical Research Center launches the Expert Consensus on the Surgical Treatment of Limb Fractures combined with Craniocerebra Injury.Seven clinical problems that orthopaedic surgeons most concern about are selected,and relevant recommendations are finally formed,aiming at summarizing relevant treatment experience,guiding further clinical practice,and improving the treatment effect of limb fracture patients combined with traumatic brain injury.

关 键 词：颅脑损伤 骨折 四肢 多处创伤 矫形外科手术 

分 类 号：R683.4[医药卫生—骨科学]