Rommens P M, Broos P L, Delooz H H
Department of Emergency Medicine, University Hospitals of Leuven, Belgium.
Acta Chir Belg. 1990 Jan-Feb;90(1):32-8.
The first and principal aim of the preclinical care of polytraumatized patients is preserving life through the restoration of respiration and circulation. Following this, the external hemorrhages should be treated. Early reduction of closed and open fractures relieves the pressure on the skin and surrounding soft tissues and prevents secondary transport-damage. Immobilization of the fractures, together with the proximal and the distal joints in a pneumatic splint, is carried out before transport. During the clinical phase, the operative stabilization of the fractures follows reanimation and life-saving operations. Primary treatment is performed as far as possible, because it reduces late death due to sepsis and multiorgan failure. In case of several fractures, an order of treatment is set up: fractures with an arterial lesion, second or third-degree open fractures and fractures with an impending compartment syndrome are the most urgent. The principles of fracture treatment in elective surgery are also valid for emergency osteosynthesis, but the choice of the fixation-device can be different. The external fixation is the first-choice treatment for fractures of the lower leg, while plate osteosynthesis is preferred for femur and humerus.
多发伤患者院前急救的首要目标是通过恢复呼吸和循环来维持生命。在此之后，应处理外出血情况。早期复位闭合性和开放性骨折可减轻皮肤及周围软组织的压力，防止继发性转运损伤。在转运前，使用气动夹板对骨折部位以及近端和远端关节进行固定。在临床阶段，骨折的手术固定在复苏和挽救生命的手术之后进行。尽可能进行一期治疗，因为这可降低因败血症和多器官功能衰竭导致的晚期死亡率。对于多处骨折，需确定治疗顺序：伴有动脉损伤的骨折、二度或三度开放性骨折以及伴有即将发生骨筋膜室综合征的骨折最为紧急。择期手术中骨折治疗的原则同样适用于急诊骨固定术，但固定器械的选择可能有所不同。外固定是小腿骨折的首选治疗方法，而钢板内固定则更适用于股骨和肱骨骨折。
