Department of Orthopaedic Surgery, Division of Trauma, University of Pittsburgh, Pittsburgh, USA.
Injury. 2011 Jul;42(7):650-4. doi: 10.1016/j.injury.2010.07.248. Epub 2010 Aug 10.
Early definitive stabilisation is usually the treatment of choice for major fractures in polytrauma patients. Modifications may be made when patients are in critical condition, or when associated injuries dictate the timing of surgery. The current study investigates whether the timing of fracture treatment is different in different trauma systems.
Consecutive patients treated a Level I trauma centre were documented (Group US) and a matched-pair group was gathered from the German Trauma Registry (Group GTR).
New Injury Severity Score (NISS)>16, >2 major fractures and >1 organ/soft tissue injury. The timing and type of surgery for major fractures was recorded, as were major complications.
114 patients were included, n=57 Group US (35.1% F, 64.9% M, mean age: 44.1 yrs±16.49, mean NISS: 27.4±8.65, mean ICU stay: 10±7.49) and n=57 Group GTR (36.8% F, 63.1% M, mean age: 41.2 yrs±15.35, mean NISS: 29.4±6.88, mean ICU stay: 15.6±18.25). 44 (57.1%) out of 77 fractures in Group US received primary definitive fracture fixation compared to 61 (65.5%) out of 93 fractures in Group GTR (n.s.). The average duration until definitive treatment was comparable in all major extremity fractures (pelvis: 5 days±2.8 Group US, 7.1 days±9.6 Group GTR (n.s.), femur: 7.9 days±8.3 Group US, 5.5 days±7.9 (n.s.), tibia: 6.2 days±5.6 Group US, 6.2 days±9.1 Group GTR (n.s.), humerus: 5 days±3.7 Group US, 6.6 days±6.1 Group GTR (n.s.), radius: 6 days±4.7 Group US, 6.1 days±8.7 Group GTR (n.s.).
The current matched-pair analysis demonstrates that the timing of initial definitive fixation of major fractures is comparable between the US and Europe. Certain fractures are stabilised internally in a staged fashion regardless the trauma system, thus discounting previous apparent contradictions.
对于多发创伤患者，早期确定性稳定通常是主要骨折的首选治疗方法。当患者处于危急状态时，或者当相关损伤决定手术时机时，可能会进行修改。本研究旨在探讨不同创伤系统中骨折治疗的时机是否不同。
连续记录在一级创伤中心治疗的患者（美国组），并从德国创伤登记处收集匹配对组（GTR 组）。
新损伤严重程度评分（NISS）>16、>2 处主要骨折和>1 处器官/软组织损伤。记录主要骨折的手术时机和类型，以及主要并发症。
共纳入 114 例患者，美国组 57 例（女性 35.1%，男性 64.9%，平均年龄 44.1 岁±16.49，平均 NISS 27.4±8.65，平均 ICU 住院时间 10±7.49），GTR 组 57 例（女性 36.8%，男性 63.1%，平均年龄 41.2 岁±15.35，平均 NISS 29.4±6.88，平均 ICU 住院时间 15.6±18.25）。美国组 77 处骨折中有 44 处（57.1%）接受了初次确定性骨折固定，而 GTR 组 93 处骨折中有 61 处（65.5%）（无统计学意义）。所有主要四肢骨折的确定性治疗平均时间相似（骨盆：美国组 5 天±2.8，GTR 组 7.1 天±9.6（无统计学意义），股骨：美国组 7.9 天±8.3，GTR 组 5.5 天±7.9（无统计学意义），胫骨：美国组 6.2 天±5.6，GTR 组 6.2 天±9.1（无统计学意义），肱骨：美国组 5 天±3.7，GTR 组 6.6 天±6.1（无统计学意义），桡骨：美国组 6 天±4.7，GTR 组 6.1 天±8.7（无统计学意义）。
目前的配对分析表明，美国和欧洲初始确定性固定主要骨折的时机相似。某些骨折无论创伤系统如何，都以分期方式进行内部稳定，从而消除了先前明显的矛盾。
