“三位一体”多发骨创伤救治策略与临床应用评价  

A trinity strategy for the treatment of multiple orthopedic trauma and assessment of its clinical application

作　　者：陈晓 王光超 张浩 吕开阳 周启荣 牛云飞 胡衍 张元维 李祖浩 沈浩[1,2] 崔进 王思成 顾峥嵘 耿振[7] 王栋梁[1,2] 范哲皓 盛世豪 何崇儒 费军 陈云丰[9] 林浩东 刘国辉[11] 侯志勇[12] 苏佳灿 Chen Xiao;Wang Guangchao;Zhang Hao;Lyv Kaiyang;Zhou Qirong;Niu Yunfei;Hu Yan;Zhang Yuanwei;Li Zuhao;Shen Hao;Cui Jin;Wang Sicheng;Gu Zhengrong;Geng Zhen;Wang Dongliang;Fan Zhehao;Sheng Shihao;He Chongru;Fei Jun;Chen Yunfeng;Lin Haodong;Liu Guohui;Hou Zhiyong;Su Jiacan(Department of Orthopedics,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Orthopedic Trauma Center,Xinhua Hospital Affiliated to ShanghaiJiao Tong University School of Medicine,Shanghai 200092,China;Department of Plastic Surgery,XinhuaHospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Departmentof Orthopedics,First Affiliated Hospital of Navy Medical University,Shanghai 200433,China;Department ofOrthopedics,Shanghai Zhongye Hospital,Shanghai 200941,China;Department of Orthopedics,LuodianHospital of Baoshan District,Shanghai 201908,China;Institute of Translational Medicine of ShanghaiUniversity,Shanghai 200444,China;Department of Trauma and War Injury,Army Medical Center,ArmyMedical University,Chongqing 400042,China;Department of Orthopedics,Sixth People′s Hospital Affiliatedto Shanghai Jiao Tong University School of Medicine,Shanghai 201306,China;Department of Orthopedics,Shanghai First People′s Hospital,Shanghai 200080,China;Department of Orthopedics,Union HospitalAffiliated to Huazhong University of Science and Technology Tongji Medical College,Wuhan 430022,China;Department of Orthopedics,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]上海交通大学医学院附属新华医院骨科,上海200092 [2]上海交通大学医学院附属新华医院创伤骨科中心,上海200092 [3]上海交通大学医学院附属新华医院整形外科,上海200092 [4]海军军医大学第一附属医院骨科,上海200433 [5]上海中冶医院骨科,上海200941 [6]上海市宝山区罗店医院骨科,上海201908 [7]上海大学转化医学研究院,上海200444 [8]陆军军医大学陆军特色医学中心战创伤医学科,重庆400042 [9]上海交通大学医学院附属第六人民医院骨科,上海201306 [10]上海市第一人民医院骨科,上海200080 [11]华中科技大学同济医学院附属协和医院骨科,武汉430022 [12]河北医科大学第三医院骨科,石家庄050051

出　　处：《中华创伤杂志》2024年第10期888-896,共9页Chinese Journal of Trauma

基　　金：国家重点研发计划(2022YFB3804300)。

摘　　要：目的探讨“三位一体”策略在多发骨创伤救治中的临床价值。方法采用回顾性病例系列研究分析2013年6月至2023年5月上海交通大学医学院附属新华医院、海军军医大学第一附属医院收治的1267例多发骨创伤患者的临床资料,其中男862例,女405例;年龄18~93岁[(55.2±19.8)岁]。合并伤:失血性休克632例,创伤性湿肺274例,颅脑损伤135例,腹盆腔出血116例,气胸89例,尿道损伤13例,膀胱破裂8例。患者均采用“三位一体”多发骨创伤救治策略,将救治全程分为急救期、重建期和康复期。急救期以稳定症状、抢救生命为宗旨;重建期以恢复解剖、复位结构为核心;康复期以中西协同、功能重建为目标。统计所有患者术后30 d内全因病死率、骨折愈合时间;末次随访时Constant⁃Murley肩关节功能评分、Mayo肘关节功能评分、Gartland⁃Werley腕关节功能评分、Harris髋关节功能评分、美国特种外科医院(HSS)膝关节功能评分和美国足踝外科协会(AOFAS)踝⁃后足功能评分的优良率和所有关节功能评分的总优良率;术前及术后6个月36条目简明健康量表(SF⁃36)评分,包括生理机能、生理职能、躯体疼痛、一般健康、生命力、社会功能、情感职能和精神健康8个维度;术后并发症发生率。结果患者均获随访6~18个月[(10.2±4.2)个月]。急性期(术后30 d内)病死率为2.37%,其中失血性休克导致死亡12例,创伤性脑损伤导致死亡10例,多器官功能障碍综合征(MODS)导致死亡6例,肺部感染导致死亡2例。骨折愈合时间为3.8~18个月[(11.5±4.2)个月],其中89.49%的患者在术后12个月内获得骨性愈合,8.93%的患者在术后18个月内获得骨性愈合,1.58%的患者经历二次手术。内固定失效和骨不连患者骨折愈合时间分别延长至(10.2±2.2)个月和(13.7±3.3)个月。末次随访时所有患者Constant-Murley肩关节功能评分、Mayo肘关节功能评分、Gartland-Werley腕关�Objective To explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods A retrospective case series study was conducted to analyze the clinical data of 1267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023,including 862 males and 405 females,aged 18⁃93 years[(55.2±19.8)years].Associated injuries included hemorrhagic shock in 632 patients,traumatic wet lung in 274,cranial injuries in 135,abdominal and pelvic bleeding in 116,pneumothorax in 89,urinary injury in 13,and vesical rupture in 8.All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid,remodeling,and rehabilitation.The first aid phase focused on stabilizing symptoms and saving lives;the remodeling phase centered on restoring the anatomical structure and alignment;the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine.The all⁃cause mortality within 30 days after surgery and fracture healing time were calculated;the excellent and good rates of Constant⁃Murley shoulder score,Mayo elbow score,Gartland⁃Werley wrist score,Harris hip score,Hospital for Special Surgery(HSS)knee score and the American Orthopedic Foot&Ankle Society(AOFAS)ankle⁃hindfoot score at the last follow⁃up and the overall excellent and good rate of all joint function scores were measured.The short form health survey(SF⁃36)scores were collected preoperatively and at 6 months postoperatively,including 8 aspects such as physical functioning,physical role,bodily pain,general health,vitality,social functioning,emotional role,and mental health.The incidence of postoperative complications was recorded.Results All the patients were followed up for 6⁃18 months[(10.2±4.2)months].The mortality rate during the acute phase(within 30 days

关 键 词：多处创伤 急救 骨重建 康复 

分 类 号：R683[医药卫生—骨科学]