在修复下肢骨科创伤中推广损伤控制理念。
Promotion of a damage control concept in repairing orthopedic lower limb trauma.
作者信息
Li Fubin, Gao Lecai, Zuo Jiangang, Liu Guanlei
机构信息
Department of Trauma Surgery, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine Cangzhou 061001, Hebei, China.
出版信息
Am J Transl Res. 2022 May 15;14(5):3278-3285. eCollection 2022.
OBJECTIVE
To explore the application value of the concept of damage control orthopaedics (DCO) in clinical treatment of lower limb fractures.
METHODS
In this retrospective analysis, 157 patients with lower extremity fracture, who received surgery in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine (Cangzhou Orthopaedic Hospital) during March 2019 and August 2020, were chosen as research subjects. Among them, 73 patients admitted from March to December 2019 were included in the control group, and the other 84 patients admitted from January to August 2020 were included in the observation group. The control group received conventional fracture treatment scheme, and the observation group was treated under the DCO concept. The operation time, postoperative hospital stay, fracture reduction quality, incidence of complications, and bone metabolism and bone healing pre- and post-treatment were compared between the groups.
RESULTS
The operation time, time to achieve stable vital signs and hospital stay of the observation group were apparently shorter than those of the control group (P<0.05). Visual analog score (VAS) of patients in both groups on postoperative day 3 and 7 were substantially lower than those on postoperative day 1 (P<0.05), and VAS scores of patients in the observation group were markedly lower than those in the control group (P<0.05). Serum Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups were significantly reduced on 14 day after surgery compared to those before surgery (P<0.05), and the indexes of observation group were lower than those of control group (P<0.05). Serum Osteocalcin (BGP), carboxyterminal of type I procollagen (PICP), alkaline phosphatase (ALP), Soluble intercellular adhesion molecule-1 (sICAM-1) and Insulin like growth factor-1 (IGF-1) in the two groups postoperative day 14 were obviously higher than those before operation (P<0.05), and the indicators in the observation group were higher than those of the control group (P<0.05). The incidence of complications in the control group was significantly higher than that in the observation group (P<0.05).
CONCLUSION
The application of the DCO concept in the clinical treatment of lower extremity trauma can effectively promote the rehabilitation of patients with lower extremity trauma, minimize their complications, improve the bone metabolism and bone healing degree, and reduce the degree of pain.
目的
探讨损伤控制骨科（DCO）理念在下肢骨折临床治疗中的应用价值。
方法
本回顾性分析选取2019年3月至2020年8月在沧州市中西医结合医院（沧州骨科医院）接受手术的157例下肢骨折患者作为研究对象。其中，2019年3月至12月收治的73例患者纳入对照组，2020年1月至8月收治的84例患者纳入观察组。对照组采用传统骨折治疗方案，观察组采用DCO理念进行治疗。比较两组的手术时间、术后住院时间、骨折复位质量、并发症发生率以及治疗前后的骨代谢和骨愈合情况。
结果
观察组的手术时间、生命体征稳定时间和住院时间明显短于对照组（P<0.05）。两组患者术后第3天和第7天的视觉模拟评分（VAS）均显著低于术后第1天（P<0.05），且观察组患者的VAS评分明显低于对照组（P<0.05）。与术前相比，两组患者术后14天的血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）显著降低（P<0.05），且观察组指标低于对照组（P<0.05）。两组患者术后14天的血清骨钙素（BGP）、I型前胶原羧基端（PICP）、碱性磷酸酶（ALP）、可溶性细胞间黏附分子-1（sICAM-1）和胰岛素样生长因子-1（IGF-1）明显高于术前（P<0.05），且观察组指标高于对照组（P<0.05）。对照组的并发症发生率明显高于观察组（P<0.05）。
结论
DCO理念应用于下肢创伤临床治疗可有效促进下肢创伤患者康复，减少并发症，提高骨代谢及骨愈合程度，减轻疼痛程度。
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