Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, Aachen, Germany.
Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany.
Eur Surg Res. 2024;65(1):115-122. doi: 10.1159/000541399. Epub 2024 Sep 30.
Coagulopathic disorders (CDs) complicate treatment in polytraumatised patients. Against this background, operative strategies for fracture management are controversial in this cohort. This study therefore investigated the effects of two established operative concepts, early total care (ETC) and damage control orthopaedics (DCO), on CD in a large-animal polytrauma (PT) model.
Twenty-two animals (Sus scrofa domesticus) sustained PT involving blunt-chest trauma, liver laceration, bilateral femur fracture, and pressure-controlled haemorrhagic shock. After resuscitation, animals were allocated to ETC (n = 8), DCO (n = 8), or served as a non-traumatised control group (CG, n = 6). Animals were ventilated and monitored under ICU standards for 72 h. Blood samples were collected at baseline and post-trauma after 1.5, 2.5, 24, 48, and 72 h. Plasminogen activator inhibitor-1 (PAI-1) and thrombin-antithrombin (TAT) complex concentrations were determined by ELISA.
Compared to the CG, ETC and DCO subjects had significantly increased plasma concentrations of PAI-1 after 2.5 h (CG vs. ETC: p = 0.0050, CG vs. DCO: p = 0.0016). Furthermore, the ETC group showed significantly increased plasma PAI-1 concentrations after 24 h compared to the CG and DCO groups (CG vs. ETC: p = 0.0002, DCO vs. ETC: p = 0.0004). During the later clinical course, concentrations of TAT were significantly increased in the ETC group compared to the CG and DCO group after 72 h (CG vs. ETC: p = 0.0290, DCO vs. ETC: p = 0.0322).
PT is strongly associated with CD in the early post-traumatic course. In comparison to DCO, ETC appeared to be negatively associated with CD. Future studies must investigate this impact, especially in those patients admitted with trauma-induced coagulopathy, to improve outcomes.
凝血功能障碍（CDs）使多发创伤患者的治疗复杂化。在此背景下，此类患者骨折管理的手术策略存在争议。因此，本研究在大型动物多发创伤（PT）模型中调查了两种既定手术概念，即早期全面护理（ETC）和损伤控制骨科（DCO），对 CDs 的影响。
22 只动物（Sus scrofa domesticus）经历了钝性胸部创伤、肝脏裂伤、双侧股骨骨折和压力控制失血性休克。复苏后，动物被分配到 ETC（n = 8）、DCO（n = 8）或作为未受伤对照组（CG，n = 6）。动物在 ICU 标准下通气和监测 72 小时。在基线和创伤后 1.5、2.5、24、48 和 72 小时采集血样。通过 ELISA 测定纤溶酶原激活物抑制剂-1（PAI-1）和凝血酶-抗凝血酶（TAT）复合物浓度。
与 CG 相比，ETC 和 DCO 组在 2.5 小时后血浆 PAI-1 浓度显著升高（CG 与 ETC：p = 0.0050，CG 与 DCO：p = 0.0016）。此外，与 CG 和 DCO 组相比，ETC 组在 24 小时后血浆 PAI-1 浓度显著升高（CG 与 ETC：p = 0.0002，DCO 与 ETC：p = 0.0004）。在后期临床过程中，与 CG 和 DCO 组相比，ETC 组在 72 小时后 TAT 浓度显著升高（CG 与 ETC：p = 0.0290，DCO 与 ETC：p = 0.0322）。
PT 在创伤后早期与 CD 密切相关。与 DCO 相比，ETC 似乎与 CD 呈负相关。未来的研究必须调查这种影响，特别是在那些因创伤引起的凝血功能障碍而入院的患者中，以改善结局。
