Lebel Ehud, Blumberg Nehemia, Gill Amit, Merin Ofer, Gelfond Reuven, Bar-On Elhanan
Israeli Defense Forces, Medical Corps, Israel.
J Trauma. 2011 Dec;71(6):E128-31. doi: 10.1097/TA.0b013e3182147654.
An earthquake occurred in Haiti on January 12, 2010. The center of earthquake and the most extensive damage occurred near the capital Port-au-Prince. There were an estimated 230,000 deaths with more than 250,000 others injured. The Israeli Defense Forces Field Hospital (IDF hospital) is a military unit composed of army-recruited (volunteer) medical personnel that was sent to Haiti to serve as a stand-alone center for early response until larger medical missions could become functional and take on the task of more sophisticated and long-lasting medical support. This study describes the use of external fixator frames for orthopedic damage control whereby bone stabilization in conjunction with soft tissue care serves as a stopgap until more comprehensive therapy is forthcoming.
Data were collected from patients' files (generated at the IDF hospital) regarding the use and immediate outcome of limbs stabilized by external fixator frames.
During the 10 days of the IDF hospital's activity, a total of 1,111 patients were admitted; 244 surgical procedures were performed under general or regional anesthesia and of these, the orthopedists performed 221 (90%) surgical procedures. Seventy-three fractures were stabilized operatively by application of an external fixator. Most of the frames were applied on fractures (closed and open) of the lower limbs (48 on femur and 24 on tibia/fibula). All procedures were performed in a field-style operating room. Sterile technique was possible only for elements actually inserted into the patient. Limb alignment was based on manual palpation: intraoperative fluoroscopy was not available; soft tissue care followed bone stabilization. No patient died. All patients completed urgent stabilization at the IDF hospital and were transferred to other facilities or discharged for home care.
We describe "orthopedic damage control" using external fixator frames for bone stabilization and soft tissue care as a viable approach in the context of a mass casualty scenario. Technical aspects are described in detail in addition to the advantages and limitations of this approach, which could serve as guidelines for future military and civilian scenarios where large-scale orthopedic damage control would be practiced.
2010年1月12日海地发生地震。震中及破坏最严重的地区位于首都太子港附近。据估计，地震造成23万人死亡，25万多人受伤。以色列国防军野战医院（IDF医院）是一个由军队招募（志愿）医务人员组成的军事单位，被派往海地作为早期应对的独立中心，直至更大规模的医疗任务能够运作并承担更复杂、更持久的医疗支持任务。本研究描述了使用外固定架进行骨科损伤控制的情况，即通过骨骼固定结合软组织护理作为权宜之计，直至更全面的治疗到来。
从患者病历（由IDF医院生成）中收集有关使用外固定架稳定肢体的情况及即时结果的数据。
在IDF医院开展活动的10天里，共收治1111名患者；在全身或区域麻醉下进行了244例外科手术，其中骨科医生实施了221例（90%）外科手术。通过应用外固定架对73处骨折进行了手术固定。大多数外固定架用于下肢骨折（闭合性和开放性）（股骨48处，胫腓骨24处）。所有手术均在野战式手术室进行。仅对实际插入患者体内的部件可采用无菌技术。肢体对线基于手动触诊：术中无法进行透视检查；在骨骼固定后进行软组织护理。无患者死亡。所有患者在IDF医院完成紧急固定后被转至其他机构或出院接受家庭护理。
我们描述了使用外固定架进行骨骼固定和软组织护理的“骨科损伤控制”，这是在大规模伤亡情况下的一种可行方法。除了该方法的优点和局限性外，还详细描述了技术方面，可为未来实施大规模骨科损伤控制的军事和民用场景提供指导。
