Kalb D C, Ney A L, Rodriguez J L, Jacobs D M, Van Camp J M, Zera R T, Rockswold G L, West M A
Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis 55415, USA.
Surgery. 1998 Oct;124(4):739-44; discussion 744-5. doi: 10.1067/msy.1998.91395.
It has been suggested that early fixation of a fracture is deleterious to eventual neurologic outcome. We undertook this study to determine whether the timing of fracture fixation is correlated to neurologic outcome.
We retrospectively reviewed patients with severe head and orthopedic injuries requiring fracture fixation. Patients were divided into two groups: early fracture fixation (< 24 hours after injury) and late fracture fixation (> 24 hours after injury).
One hundred twenty-three patients met entry criteria. During fracture fixation, the early group had a significant 2-, 3-, and 2-fold increase in crystalloid, blood infusion, and blood loss, respectively. There was no difference in oxygen saturation and systolic blood pressure or episodes of cranial hypertension or hypoperfusion. There was no difference in outcomes as measured by in-hospital complications, stay in the intensive care unit or hospital, mortality rates, hospital discharge or follow-up Glasgow Coma Scores, or long-term orthopedic or neurologic results.
Patients undergoing fracture fixation with severe head injury mandate monitoring of intracranial pressure and perfusion and tailored fluid resuscitation to meet specific organ end points. Integrating end organ perfusion and pressure with meticulous fluid status during the definitive repair phase may reduce the exposure to secondary brain injury in patients undergoing early fracture fixation.
有人提出，骨折早期固定对最终的神经功能结局有害。我们进行这项研究以确定骨折固定时机是否与神经功能结局相关。
我们回顾性分析了需要进行骨折固定的重度颅脑和骨科损伤患者。患者分为两组：早期骨折固定（伤后<24小时）和晚期骨折固定（伤后>24小时）。
123例患者符合纳入标准。在骨折固定期间，早期组的晶体液输注量、输血量和失血量分别显著增加了2倍、3倍和2倍。氧饱和度、收缩压、颅内高压或灌注不足发作次数无差异。根据院内并发症、重症监护病房或医院住院时间、死亡率、出院时或随访时的格拉斯哥昏迷评分、长期骨科或神经功能结果衡量，结局无差异。
重度颅脑损伤患者进行骨折固定时，必须监测颅内压和灌注情况，并进行针对性的液体复苏以达到特定器官的终点指标。在确定性修复阶段，将终末器官灌注和压力与细致的液体状态相结合，可能会减少早期骨折固定患者发生继发性脑损伤的风险。
