Leipzig University, Department of Orthopaedic Surgery, Spine Unit, Liebigstrasse 20, 04103 Leipzig, Germany.
World J Emerg Surg. 2009 Mar 3;4:9. doi: 10.1186/1749-7922-4-9.
Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS(R) polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS(R) protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient.
大量炎症紊乱在多发创伤患者的创伤后病程中被发现，这在创伤的实验模型和体外环境中得到了证实。因此，损伤控制外科（DCS）的原则在过去二十年中得到了发展，并已成功应用于严重创伤患者的治疗。损伤控制外科和矫形（DCO）的目的是在严重损伤后的脆弱阶段限制额外的医源性创伤。考虑到创伤性脑损伤和急性肺损伤，已经开发并广泛使用了快速稳定的植入物，如外固定器，以及具有最小潜在额外手术相关损害患者免疫状态的决定手术方法。很明显，在多发创伤患者的脊柱创伤中也应该采取类似的方法。然而，到目前为止，关于多发伤中脊柱损伤的损伤控制脊柱手术的数据很少，缺乏对照试验，在广泛使用的 ATLS(R)多发伤算法中，脊柱损伤仅被次要提及。本文综述了多发伤中脊柱创伤评估和治疗的文献，就如何根据 ATLS(R)方案评估脊柱创伤患者以及多发伤患者脊柱损伤的治疗策略提出了建议。
