Orthopedic Trauma Service, Hadassah University Hospital, Jerusalem, Israel; Orthopedic Department, Hadassah University Hospital, Jerusalem, Israel; Orthopedic Department, Emek Medical Center, Afula, Israel.
Orthopedic Trauma Service, Hadassah University Hospital, Jerusalem, Israel; Orthopedic Department, Hadassah University Hospital, Jerusalem, Israel.
Injury. 2021 Jul;52(7):1886-1890. doi: 10.1016/j.injury.2021.04.031. Epub 2021 Apr 9.
Treatment of polytrauma patients with femoral shaft fracture has changed considerably during the past few decades. A transition from early total care (ETC) to "Damage Control" Orthopaedics (DCO) in selected patients was proposed in order to decrease mortality. The aim of the study was to investigate whether this policy change resulted in improved patient outcome.
We present a retrospective, comparative study, held in a Level I trauma center in Jerusalem, Israel. Polytrauma patients with Injury Severity Score higher than 16 with femoral shaft fracture were included. Data was extracted from our institute's electronic trauma registry. The study examines two time periods: Between the years 1996 and 2006 patients were treated according to the ETC protocol, with immediate intramedullary nailing (IMN) within 12 h. From 2007 until 2019 a DCO policy was adopted, implementing temporary external fixator for high risk patients, according to the "Hannover" criteria. Following resolution of the acute phase, these were converted to IMN. Patients eligible for DCO were matched to controls who received ETC during the earlier period.
A total of ninety-six patients were included (DCO n = 44, ETC n = 52). The groups were comparable in terms of age, gender, mechanism of injury, injury to surgery time and Injury severity score (DCO median 31.5, ETC median 29). No statistical difference was found between the groups in terms of mortality (P = 0.757), acute respiratory distress syndrome (P = 0.534), sepsis (P = 0.519) and hospital stay (DCO median 24 days, ETC median 21.5 days) or ICU stay (Median 7 days in both groups).
This pilot study did not demonstrate better outcome by implementing DCO concepts in the polytrauma patient.
III prognostic.
在过去几十年中，多发创伤合并股骨干骨折患者的治疗方法发生了很大变化。为了降低死亡率，有人提出在选择的患者中从早期全面治疗（ETC）过渡到“损伤控制骨科（DCO）”。本研究旨在探讨这一政策变化是否导致患者预后改善。
我们进行了一项回顾性、对照研究，研究地点为以色列耶路撒冷的一家一级创伤中心。纳入创伤严重程度评分（ISS）>16 分合并股骨干骨折的多发创伤患者。数据从我院电子创伤登记系统中提取。本研究考察了两个时间段：1996 年至 2006 年期间，患者根据 ETC 方案治疗，在 12 小时内进行髓内钉内固定（IMN）；2007 年至 2019 年期间，采用 DCO 方案，根据“汉诺威”标准对高危患者实施临时外固定架，待急性期缓解后转换为 IMN。符合 DCO 条件的患者与接受早期 ETC 的对照组患者相匹配。
共纳入 96 例患者（DCO 组 44 例，ETC 组 52 例）。两组在年龄、性别、损伤机制、损伤至手术时间和损伤严重程度评分（DCO 中位数 31.5，ETC 中位数 29）方面无统计学差异。两组在死亡率（P=0.757）、急性呼吸窘迫综合征（P=0.534）、脓毒症（P=0.519）和住院时间（DCO 中位数 24 天，ETC 中位数 21.5 天）或 ICU 住院时间（两组中位数均为 7 天）方面无统计学差异。
本初步研究结果表明，在多发创伤患者中实施 DCO 概念并未改善预后。
III 级预后研究。
