Pape Hans-Christoph, Giannoudis Peter, Krettek Christian
Department of Trauma Surgery, Hannover Medical School, Carl-Neubergstr. 1, 30625 Hannover, Germany.
Am J Surg. 2002 Jun;183(6):622-9. doi: 10.1016/s0002-9610(02)00865-6.
Information illustrating the benefits of fracture stabilization after multiple trauma has been gathering for almost a century. At the turn of the last century, the introduction of the Thomas splint clearly demonstrated the importance of skeletal stabilization in the management of these patients. The introduction of standardized surgical treatment for fractures in the early 1950s is considered today as the turning point in the care of the polytraumatized patient. With the knowledge acquired, the application of early operative fixation of fractures in severely injured patients in the 1980s has yielded to the concept of early total care of all fractures. Yet, in distinct patient subgroups with severe thoracic injuries and very high injury severity scores, this concept has been associated with adverse outcomes. Therefore, in a further era that began in the 1990s, a different approach has been favored for these subgroups. It recommends early (initial) temporary stabilization followed by secondary definitive osteosynthesis of major fractures in patients at high risk of developing systemic complications. In the last decade, attempts have been made to determine which patients benefit from early total care and which ones should undergo a secondary definitive approach. This manuscript provides a historical overview on the changing treatment of fractures and summarizes the evolution of "damage control orthopedic surgery."
关于多发伤后骨折稳定化益处的相关信息已积累了近一个世纪。在上个世纪之交，托马斯夹板的引入清楚地表明了骨骼稳定化在这类患者治疗中的重要性。20世纪50年代初标准化骨折手术治疗方法的引入，如今被视为多发伤患者护理的转折点。基于已掌握的知识，20世纪80年代在重伤患者中早期手术固定骨折的应用，已发展为对所有骨折进行早期全面治疗的理念。然而，在胸外伤严重且损伤严重程度评分极高的特定患者亚组中，这一理念却带来了不良后果。因此，在始于20世纪90年代的又一个时期，针对这些亚组采用了不同的方法。它建议对有发生全身并发症高风险的患者，先进行早期（初始）临时稳定化，随后对主要骨折进行二期确定性骨合成。在过去十年中，人们一直在尝试确定哪些患者能从早期全面治疗中获益，哪些患者应采用二期确定性方法。本文提供了骨折治疗变化的历史概述，并总结了“损伤控制骨科学手术”的发展历程。
