Jamjoom Bakur A, Jamjoom Abdulhakim B
Trauma and Orthopedics Department, Kettering General Hospital, Kettering, Northamptonshire, UK.
Neurosciences (Riyadh). 2012 Apr;17(2):111-4.
We present a review of the published evidence on the optimal timing for long bone fracture fixation in severe traumatic brain injury (TBI); a matter that remains under debate. Fifteen retrospective articles (level II-3 evidence) were considered suitable for the review. We conclude that the published evidence does not provide a definitive answer to the optimal timing of long bone fracture surgery in severe TBI, and a randomized controlled trial is required. We recommend a safe strategy that combines damage control surgery with a period of monitoring of intracranial pressure, cerebral perfusion pressure, and if available brain tissue oxygen until the patient is considered fit for the fracture fixation.
我们对已发表的关于严重创伤性脑损伤（TBI）中长骨骨折固定最佳时机的证据进行了综述；这一问题仍存在争议。十五篇回顾性文章（二级3类证据）被认为适合该综述。我们得出结论，已发表的证据并未为严重TBI中长骨骨折手术的最佳时机提供明确答案，因此需要进行一项随机对照试验。我们推荐一种安全策略，即结合损伤控制手术以及一段时间的颅内压、脑灌注压监测，若条件允许还需监测脑组织氧含量，直至患者被认为适合进行骨折固定。
