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多发伤中肢体损伤处理的最新进展

Current updates in management of extremity injuries in polytrauma.

作者信息

Devendra A, Nishith P Gupta, Dilip Chand Raja S, Dheenadhayalan J, Rajasekaran S

机构信息

Dept of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641 043, Tamil Nadu, India.

出版信息

J Clin Orthop Trauma. 2021 Jan;12(1):113-122. doi: 10.1016/j.jcot.2020.09.031. Epub 2020 Sep 24.

Abstract

Injury-related morbidity and mortality have been one of the most common causes of loss in productivity across all geographic distributions. It remains to be a global concern despite a continual improvement in regional and national safety policies. The establishment of trauma care systems and advancements in diagnostics and management have improved the overall survival of severely injured. A better understanding of the physiopathological and immunological responses to injury led to a significant shift in trauma care from "Early Total Care" to "Damage Control Orthopedics." While most of these algorithms were tailored to the philosophy of "life before limb," the impact of improper fracture management on disability and societal loss is increasingly being recognized. Recently, "Early Appropriate Care" of extremities has gained importance; however, its implementation is influenced by regional health care policies, available resources, and expertise and varies between low and high-income countries. A review of the literature was performed using PubMed, Embase, Web of Science, and Scopus databases on articles published from 1990 to 2020 using the Mesh terms "Polytrauma," "Multiple Trauma," and "Fractures." This review aims to consolidate on guidelines and available evidence in the management of extremity injuries in a polytraumatized patient to achieve better clinical outcomes of these severely injured.

摘要

与损伤相关的发病率和死亡率一直是所有地理区域生产力损失的最常见原因之一。尽管区域和国家安全政策不断改进,但它仍然是一个全球关注的问题。创伤护理系统的建立以及诊断和管理方面的进步提高了重伤患者的总体生存率。对损伤的生理病理和免疫反应的更好理解导致创伤护理从“早期全面护理”向“损伤控制骨科”发生了重大转变。虽然这些算法大多是根据“生命优先于肢体”的理念制定的,但骨折处理不当对残疾和社会损失的影响越来越受到认可。最近,四肢的“早期适当护理”变得越来越重要;然而,其实施受到区域卫生保健政策、可用资源和专业知识的影响,在低收入和高收入国家之间存在差异。使用PubMed、Embase、科学网和Scopus数据库,以1990年至2020年发表的文章为对象,使用医学主题词“多发伤”、“多处创伤”和“骨折”进行了文献综述。本综述旨在整合多发伤患者四肢损伤管理的指南和现有证据,以实现这些重伤患者更好地临床结局。

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