本文選題：骨科損傷控制 + 不穩(wěn)定骨盆骨折��； 參考：《鄭州大學》2015年碩士論文

【摘要】：背景和目的當今社會,隨著醫(yī)學的進步與變革,對創(chuàng)傷控制、尤其是多發(fā)傷的診治理念有了長足的進步,骨科損傷控制理念也應運而生:指創(chuàng)傷骨科用來控制病情進展的手段,不是立即實施確定性的創(chuàng)傷修復,當時提出這一理論彌補了美國廣泛使用槍支引起創(chuàng)傷救治的需要。20世紀80年代Stone等選擇17例嚴重多發(fā)傷患者實施早期簡化手術,重癥監(jiān)護病房復蘇,后期行確定性治療手術,獲得了良好的效果。創(chuàng)傷早期實施簡化控制手術進行控制損傷,挽救原來以為難以救治的危重患者,從而提出損傷控制外科(damage control surgery,DCS)的概念。近些年來損傷控制廣泛被使用于嚴重創(chuàng)傷及多發(fā)傷的救治,獲得了較大的進展。不穩(wěn)定骨盆骨折由高處墜落、擠壓、車禍等高能量損傷引起,往往伴有鄰近部位損傷,如膀胱、直腸、尿道等相應盆腔內(nèi)臟器損傷,可致大出血和休克,繼而引發(fā)低體溫、DIC和代謝性酸中毒,是致命性的骨折。因此在極端創(chuàng)傷狀態(tài)下引入骨科損傷控制是必要的。骨科損傷控制理念(damage control orthopedics,DCO)是指在圍手術期綜合應用多學科的方法,合理有效地改良一系列診療措施,如手術方式,最大限度地減少病人死亡率、術中應激、手術風險及并發(fā)癥,以達到加速患者功能恢復,提高康復質量的目的。骨科損傷控制理念核心內(nèi)涵是盡可能的減少甚至阻斷以手術操作為主的各種有創(chuàng)診療操作導致的機體應激反應。作為目前創(chuàng)傷醫(yī)學界最新的治療理念和原則之一,骨科損傷控制理念應用于臨床實踐即顯示出較傳統(tǒng)理念更為優(yōu)越的治療效果,同時在外科學的各個學科迅速傳播開來,逐步拓展到幾乎所有外科領域。但迄今為止仍骨科損傷控制主要應用于危重創(chuàng)傷,本文擬探討骨科損傷控制在不穩(wěn)定骨盆骨折中應用價值及前景。方法自2013年1月至2014年6月按照連續(xù)采樣的方法于鄭州大學第一附屬醫(yī)院急診外科收集以不穩(wěn)定骨盆骨折為診斷急診入院并采取手術治療的患者。按治療方案不同將納入研究的患者進行分組,并按照擬采取手術方式不同將每組患者隨機分為骨科損傷控制(damage control orthopedics,DCO)組和傳統(tǒng)手術(conservative treatment surgery,CTS)組。收集患者在院的相關生化指標及臨床指標。經(jīng)治的不穩(wěn)定骨盆骨折患者院外均獲隨訪,隨訪時間最短6個月,最長24個月,平均14個月。患者術后定期進行復查,進行Matta評分,然后比較組間上述指標的差異。統(tǒng)計處理采用spss17.0軟件進行統(tǒng)計處理,計量資料用x±s表示;計量資料采用t檢驗;重復測量資料采用單因素方差分析;組間率比較采用2c檢驗;等級資料采用秩和檢驗;P0.05認為差異有統(tǒng)計學意義。結果1.參與本研究的在院患者中DCO組2例(4%),CTS組6例(10%)因傷情較重,在治療期間死亡,成功隨訪99例,隨訪時間(14±4.9)月。隨訪中5例死亡病例(死因均與原發(fā)疾病無明顯相關)。2.患者入院PH值、BE、T、FDP、D-DT、WBC、ESR、PCT、CRP、組間性別構成,年齡相比差異無統(tǒng)計學意義(P0.01)。3.DCO組患者術后PH值、BE、T、FDP、D-DT、WBC、紅細胞沉降量、PCT、CRP等水平改善情況均較CTS組好,組間差異有統(tǒng)計學意義(P0.05)。4.DCO組術后患者胃腸功能恢復時間較短,術后床上功能鍛煉及護理開始時間較早,術后并發(fā)癥發(fā)生率較低,住院時間較短,住院費用較少,組間差異有統(tǒng)計學意義(P0.05)。5.組間術后WHO疼痛分級相比,DCO組術后疼痛分級較CTS組低,組間相比差異有統(tǒng)計學意義(P0.05)。6.DCO組術后優(yōu)良率較CTS組高,組間相比差異有統(tǒng)計學意義(P0.05)。結論骨科損傷控制理念在不穩(wěn)定骨盆骨折治療中的應用,能夠以簡化方式控制大出血,阻斷死亡三聯(lián)征的惡性循環(huán),減輕患者全身應激及炎癥反應。骨科損傷控制應用不穩(wěn)定骨盆骨折治療中能夠降低患者死亡率,減少術后并發(fā)癥的發(fā)生,減輕患者的經(jīng)濟負擔,提高患者術后肢體功能康復質量。
[Abstract]:Background and objective today's society, with the progress and change of medicine, the concept of diagnosis and treatment of trauma, especially multiple injuries has made great progress. The concept of injury control in Department of orthopedics has emerged as the times require: refers to the means that the traumatic Department of orthopedics is used to control the progress of the disease. It is not the immediate implementation of the definitive repair of trauma, and the theory made up the beauty at that time. The need for extensive use of firearms in the country was required for the treatment of trauma in the 80s.20 Stone and other 17 cases of severe multiple injuries. The early simplified operation was performed, the intensive care unit resuscitation, and the later period of deterministic treatment. The concept of damage control surgery (DCS) is put forward in critically ill patients. In recent years, damage control has been widely used in the treatment of severe trauma and multiple injuries, and great progress has been made. The injury of the corresponding pelvic viscera, such as the rectum and urethra, can cause massive hemorrhage and shock, and then cause hypothermia, DIC and metabolic acidosis, which are fatal fractures. Therefore, it is necessary to introduce the Department of orthopedics injury control under the extreme trauma condition. The concept of damage control orthopedics (DCO) is the comprehensive application of the comprehensive application in the perioperative period. The method of discipline, rational and effective improvement of a series of diagnosis and treatment measures, such as surgical methods, to minimize patient mortality, intraoperative stress, surgical risk and complications, in order to accelerate the recovery of the patient's function and improve the quality of rehabilitation. The connotation of the concept of the Department of orthopedics damage control concept is to reduce or even block operation operation as possible. As one of the latest treatment concepts and principles in the field of trauma medicine, as one of the latest treatment concepts and principles in the field of trauma medicine, the concept of injury control in the Department of orthopedics is applied to clinical practice, which shows a more superior treatment effect than the traditional concept, and is spreading rapidly in various disciplines of the external science and gradually expanding to almost all of them. There is a surgical field. But to date, Department of orthopedics damage control is mainly used in critical trauma. This paper intends to explore the value and Prospect of the Department of orthopedics injury control in unstable pelvic fractures. Methods from January 2013 to June 2014, the unstable pelvic fractures were collected at the First Affiliated Hospital of Zhengzhou University in accordance with the continuous sampling method. Patients who were admitted to the hospital for the diagnosis of emergency hospitalization were divided into groups according to the different treatment schemes, and the patients in each group were randomly divided into the Department of orthopedics (damage control orthopedics, DCO) and the traditional surgery (conservative treatment surgery, CTS). The patients with unstable pelvic fractures were followed up, the shortest 6 months, the longest 24 months, an average of 14 months. The patients were reexamined after the operation, the Matta score was carried out, and then the differences between the above indexes were compared. Statistical processing was carried out with SPSS17.0 software for statistical processing and measurement. The material was expressed with x + s; the measurement data were tested by t test; the repeated measurement data were analyzed with single factor variance; the rate of inter group was compared with 2C test; the rank data was tested by rank sum test; P0.05 thought the difference was statistically significant. Results 1. in this study, 2 cases (4%) were involved in the hospital patients, and 6 cases (10%) in the CTS group were seriously injured and died during the treatment period. Follow up 99 cases, follow-up time (14 + 4.9) months. 5 cases of death in the follow-up (no significant correlation with the primary disease),.2. patients were hospitalized with pH, BE, T, FDP, D-DT, WBC, ESR, PCT, CRP, and there was no statistical difference between the groups (P0.01).3.DCO group. The improvement was better than that of the CTS group. The difference between the groups was statistically significant (P0.05) the recovery time of the gastrointestinal function in the group.4.DCO was shorter, the postoperative bed functional exercise and nursing began earlier, the incidence of postoperative complications was low, the hospitalization time was shorter, the hospitalization cost was less, and the difference between the groups was statistically significant (P0.05) WHO pain between the.5. group after the.5. group. The classification of pain in group DCO was lower than that of group CTS, and there was significant difference between groups (P0.05) compared with group.6.DCO (P0.05), there was a higher rate in group.6.DCO than that in group CTS, and there was a significant difference between groups (P0.05). Conclusion the application of the concept of injury control in the treatment of unstable pelvic fractures can control massive bleeding and block death by three In the treatment of unstable pelvic fracture, injury control in Department of orthopedics can reduce the mortality of the patients, reduce the incidence of postoperative complications, reduce the economic burden of the patients, and improve the rehabilitation quality of the postoperative limb function.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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