Hammer R R, Rööser B, Lidman D, Smeds S
Department of Orthopaedic Surgery, University Hospital, Linkoping, Sweden.
J Orthop Trauma. 1996;10(8):545-54. doi: 10.1097/00005131-199611000-00007.
This study was undertaken to document whether a basic set of a new unilateral external fixation device could provide sufficient stability in complex musculoskeletal injuries involving upper and lower extremities and in patients with unstable pelvic ring disruptions. The initial clinical evaluation was performed in Sweden (stage 1) followed by field evaluation at the Swedish Field Hospital during the Mogadishu conflict in Somalia (stage 2). In stage 1, there were 90 patients with 116 acute limb injuries and six patients with an unstable pelvic ring disruption. Ninety limb injuries and all six pelvic fractures were primarily stabilized by the external fixation device. The other 26 fractures were managed at the index operation with intramedullary nailing, open reduction, and internal fixation or cast immobilization. Twelve patients had a local pedicle or free vascularized flap for soft tissue coverage. One multiply injured with an open Gustilo IIIB tibial shaft fracture had an early amputation. The basic set provided adequate stabilization for soft tissue recovery in 89 limb injuries (89 of 90), thereby providing optimal conditions for continued management to skeletal consolidation in 88 patients. Hemodynamic stabilization was achieved in all six patients with unstable pelvic fractures. In stage 2, there were 63 patients with war injuries and 33 patients injured in traffic accidents. All were managed under field conditions. The basic set was sufficient for soft tissue recovery in all 96 cases. It is concluded that the rigidity of this device is adequate for stabilization of severe musculoskeletal injuries requiring major surgical procedures. In addition, the simplicity of this device, which allows for only a limited number of possible configurations makes it suitable for inexperienced surgeons working under war or mass-casualty conditions to manage these complex musculoskeletal injuries.
本研究旨在记录一种新型单侧外固定装置的基本套件能否为涉及上肢和下肢的复杂肌肉骨骼损伤以及骨盆环不稳定破裂的患者提供足够的稳定性。初始临床评估在瑞典进行（第1阶段），随后在索马里摩加迪沙冲突期间于瑞典野战医院进行现场评估（第2阶段）。在第1阶段，有90例患者，共116处急性肢体损伤，6例骨盆环不稳定破裂。90处肢体损伤和所有6例骨盆骨折均首先通过外固定装置进行稳定处理。另外26处骨折在初次手术时采用髓内钉固定、切开复位内固定或石膏固定。12例患者采用局部带蒂或游离血管化皮瓣进行软组织覆盖。1例多处受伤且伴有开放性Gustilo IIIB型胫骨干骨折的患者早期行截肢手术。该基本套件为89处肢体损伤（90处中的89处）的软组织恢复提供了足够的稳定性，从而为88例患者持续治疗直至骨骼愈合提供了最佳条件。所有6例骨盆不稳定骨折患者均实现了血流动力学稳定。在第2阶段，有63例战争伤患者和33例交通事故伤患者。所有患者均在现场条件下进行处理。该基本套件对所有96例病例的软组织恢复均足够。结论是，该装置的刚度足以稳定需要进行大型外科手术的严重肌肉骨骼损伤。此外，该装置结构简单，可能的配置数量有限，适合在战争或大规模伤亡情况下工作的经验不足的外科医生处理这些复杂的肌肉骨骼损伤。
