Taeger G, Ruchholtz S, Zettl R, Waydhas C, Nast-Kolb D
Klinik und Poliklinik für Unfallchirurgie, Universität Essen, Hufelandstrasse 55, 45122 Essen.
Unfallchirurg. 2002 Apr;105(4):315-21. doi: 10.1007/s001130100340.
It is the purpose of the current investigation to determine whether immediate external fixation of fractures, which is a simple and fast procedure, followed by secondary planned conversion represents a safe and reliable procedure without additional trauma in multiply injured patients (ISS > 15).
With a prospective protocol, all data of multiply injured patients with fractures which required immediate osteosynthesis were registrated. Demographic data, severity of injury (AIS and ISS), data of primary surgery and osteosyntheses, course of intensive care (organ failure, local/systemic complications, infectious protocol), secondary conversion (time, duration, osteosynthesis related complications) and further course were analysed.
Out of 679 mulitiply injured patients (ISS 22), 118 required immediate surgical procedures for intracranial injury and 175 for further indications. In 45 multiply injured patients (ISS 37), 83 external fixations were performed. According to 59 planned secondary conversions (13 days), one patient developed deep infection, no other local complication was registrated. The average time for conversion procedures lasted three times longer as in immediate external fixation (43 vs. 139 min).
Immediate external fixation in multiply injured patients is fast and poor of complications. It is a expedient procedure which is safe and careful for critically ill patients. The required conversion procedure shows no raised rate of complications.
本研究旨在确定对于多发伤患者（损伤严重度评分[ISS]>15），骨折即刻外固定（一种简单快速的操作）随后进行二期计划性内固定转换是否是一种安全可靠且不会带来额外创伤的操作。
采用前瞻性方案，记录所有需要即刻骨固定的多发伤骨折患者的数据。分析人口统计学数据、损伤严重程度（简明损伤定级标准[AIS]和ISS）、一期手术和骨固定的数据、重症监护过程（器官功能衰竭、局部/全身并发症、感染防控措施）、二期转换（时间、持续时间、与骨固定相关的并发症）及后续病程。
在679例多发伤患者（ISS为22）中，118例因颅内损伤需要即刻手术，175例因其他指征需要即刻手术。在45例多发伤患者（ISS为37）中，共进行了83次外固定。按照59例计划性二期转换（平均13天），1例患者发生深部感染，未记录到其他局部并发症。转换手术的平均时间是即刻外固定的3倍（43分钟对139分钟）。
多发伤患者的即刻外固定操作快速且并发症少。对于危重症患者而言，这是一种安全、谨慎且合适的操作。所需的转换手术并未显示出并发症发生率升高。
