Mrozek S, Gaussiat F, Geeraerts T
Department of Anesthesiology and Intensive care, University Hospital of Toulouse, Équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », University Paul-Sabatier Toulouse 3, Hopital Purpan, 1, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
Ann Fr Anesth Reanim. 2013 Jul-Aug;32(7-8):510-5. doi: 10.1016/j.annfar.2013.07.010. Epub 2013 Jul 30.
The aim of this article is to describe the management of femoral shaft fractures in patients with severe traumatic brain injury (TBI). This is a major problem and two questions remain currently of interest: When and how to perform orthopedic surgery in severe TBI patients? The main point of perioperative management remains the prevention of secondary brain insults and the monitoring of intracranial pressure is essential especially in patients with intracranial lesions on the CT-scan. The "double hit" concept, suggesting that surgery by itself might increase the preexisting systemic inflammatory response, gives argument for very early or delayed surgery. Early definitive femoral osteosynthesis, if requires lengthy surgical procedure, does not seem appropriate in this context and "damage-control orthopedics" with external fixation seems to be a good alternative.
本文旨在描述重度创伤性脑损伤（TBI）患者股骨干骨折的处理。这是一个重大问题，目前仍有两个问题备受关注：重度TBI患者何时以及如何进行骨科手术？围手术期管理的要点仍然是预防继发性脑损伤，尤其是对于CT扫描显示有颅内病变的患者，监测颅内压至关重要。“二次打击”概念表明手术本身可能会加剧已有的全身炎症反应，这为极早期或延迟手术提供了依据。在这种情况下，如果早期确定性股骨干骨固定需要冗长的手术过程，似乎并不合适，而采用外固定的“损伤控制骨科”似乎是一个不错的选择。
