Scannell Brian P, Waldrop Norman E, Sasser Howell C, Sing Ronald F, Bosse Michael J
Department of Orthopaedic Surgery, Dickson Institute of Health Studies, Carolinas Medical Center, Charlotte, North Carolina, USA.
J Trauma. 2010 Mar;68(3):633-40. doi: 10.1097/TA.0b013e3181cef471.
: Damage control with external fixation (DC-EF) of femoral shaft fractures in polytrauma patients is becoming standard treatment in many trauma centers. However, skeletal traction (ST) has long been used in the temporization of fractures. The purpose of this study was to compare the major physiologic clinical outcomes of provisional ST with DC-EF of femoral shaft fractures in severely injured patients.
: We retrospectively reviewed 205 patients sustaining blunt trauma, a femoral shaft fracture, and an Injury Severity Score > or =17 from 2001 to 2007 at a level I trauma center. Patients underwent definitive fixation in the first 24 hours with intramedullary nailing (IMN) (N = 126), initial DC-EF with delayed definitive treatment (N = 19), or initial ST with delayed definitive treatment (N = 60). Incidences of adult respiratory distress syndrome, multiple organ failure, sepsis, pneumonia, pulmonary embolism, and deep vein thrombosis were evaluated. Length of stay (LOS), intensive care unit LOS, days of mechanical ventilation, and mortality were also compared.
: There were no significant differences between ST and DC-EF groups in age, mechanism of injury, Injury Severity Score, Glasgow Coma Scale score on arrival, mean time to definitive fixation (4.1 days versus 5.0 days, respectively), or Abbreviated Injury Scale for chest. However, the ST group had a higher Abbreviated Injury Scale-head (2.5 versus 1.0, p = 0.0026). There were no significant differences in subsequent rates of adult respiratory distress syndrome, multiple organ failure, pulmonary embolism, deep vein thrombosis, pneumonia, mechanical ventilation days, intensive care unit LOS, and death. However, the ST group had a lower rate of sepsis (8.3% versus 31.6%, p = 0.0194) and a shorter LOS (26.5 days versus 36.2 days, p = 0.0237) than the EF group.
: DC-EF of femur fractures in severely injured patients offers no significant advantage in clinical outcomes compared with ST. Unless initially subjected to general anesthesia for life saving procedures, the use of ST as a temporization method remains a practical option.
在许多创伤中心，对多发伤患者的股骨干骨折采用外固定损伤控制（DC-EF）正成为标准治疗方法。然而，骨牵引（ST）长期以来一直用于骨折的临时处理。本研究的目的是比较严重受伤患者股骨干骨折临时ST与DC-EF的主要生理临床结果。
我们回顾性分析了2001年至2007年在一级创伤中心收治的205例钝性创伤、股骨干骨折且损伤严重度评分≥17分的患者。患者在最初24小时内接受了髓内钉固定（IMN）（N = 126）、初始DC-EF并延迟确定性治疗（N = 19）或初始ST并延迟确定性治疗（N = 60）。评估成人呼吸窘迫综合征、多器官功能衰竭、脓毒症、肺炎、肺栓塞和深静脉血栓形成的发生率。还比较了住院时间（LOS）、重症监护病房住院时间、机械通气天数和死亡率。
ST组和DC-EF组在年龄、损伤机制、损伤严重度评分、入院时格拉斯哥昏迷量表评分、确定性固定的平均时间（分别为4.1天和5.0天）或胸部简明损伤量表方面无显著差异。然而，ST组的简明损伤量表-头部评分更高（2.5比1.0，p = 0.0026）。在随后的成人呼吸窘迫综合征、多器官功能衰竭、肺栓塞、深静脉血栓形成、肺炎、机械通气天数、重症监护病房住院时间和死亡率方面无显著差异。然而，ST组的脓毒症发生率低于EF组（8.3%比31.6%，p = 0.0194），住院时间也更短（26.5天比36.2天，p = 0.0237）。
与ST相比，严重受伤患者股骨干骨折的DC-EF在临床结果方面无显著优势。除非最初因挽救生命的手术而接受全身麻醉，否则使用ST作为临时处理方法仍是一种实用的选择。
