From the Department of Orthopedic Surgery, McMaster University, Hamilton General Hospital, Hamilton, Ontario (Oitment, Thornley, and Pahuta), the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network (Jentzsch) and Department of Surgery, University of Toronto (Jentzsch), Toronto, Ontario, Canada, and the Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland (Jentzsch).
J Am Acad Orthop Surg. 2021 Dec 15;29(24):e1291-e1302. doi: 10.5435/JAAOS-D-21-00312.
There has been a shift in the management of the polytrauma patients from early total care to damage control orthopaedics (DCO), whereby patients with borderline hemodynamic stability may be temporized with the use of external fixators, traction, or splinting with delayed osteosynthesis of fractures. Recently, there has been an increasing trend toward a middle ground approach of Early Appropriate Care for polytrauma patients. The concepts of DCO for the spine are less clear, and the management of trauma patients with combined pelvic ring and spinal fractures or patients with noncontiguous spinal injuries present unique challenges to the surgeon in prioritization of patient needs. This review outlines the concept of DCO and Early Appropriate Care in the spine, prioritizing patient needs from the emergency department to the operating room. Concepts include the timing of surgery, minimally invasive versus open techniques, and the prioritization of spinal injuries in the setting of other orthopaedic and nonorthopaedic injuries. Contiguous and noncontiguous spinal injuries are considered in construct planning, and the principles are discussed.
创伤患者的治疗模式已从早期全面治疗转变为损伤控制性骨科（damage control orthopedics，DCO），对于血流动力学临界稳定的患者，可使用外固定架、牵引或夹板临时固定，延迟骨折的切开复位内固定。最近，创伤患者的早期适当治疗已成为一种新的治疗趋势。脊柱 DCO 的概念尚不清楚，对于合并骨盆环和脊柱骨折的创伤患者或非连续脊柱损伤的患者，如何在优先考虑患者需求方面对外科医生提出了独特的挑战。本文概述了脊柱 DCO 和早期适当治疗的概念，从急诊科到手术室，按患者需求的优先级对其进行排序。这些概念包括手术时机、微创与开放技术以及在其他骨科和非骨科损伤背景下脊柱损伤的优先排序。在构建计划中考虑了连续和非连续脊柱损伤，并讨论了相关原则。
