Clinical effect of damage-control orthopedics in the treatment of severe pelvic fracture

目的探讨骨科损伤控制(dCO)治疗严重骨盆骨折的临床效果。方法回顾性分析本院2010年1月~2014年1月收治的201例严重骨盆骨折患者临床资料,其中采用dCO治疗的患者为试验组(n=104),未采用dCO治疗的患者为对照组(n=97),观察两组的院内死亡率、手术时间、术中失血量、术中输液总量、术后并发症发生率和6 H乳酸清除率。结果试验组、对照组分别有7例(6.7%)和22例(22.7%)死亡,死亡原因均为失血性休克和多器官功能不全综合征,两组院内死亡率比较差异有统计学意义(P=0.003)。试验组的手术时间显著短于对照组[(55.7±11.2)MIn VS(121.5±21.3)MIn,P=0.012);试验组的术中出血量、术中输液总量均显著少于对照组[(250.3±54.3)Ml VS(612.5±56.7)Ml,(4613.9±1135.4)Ml VS(8821.3±2030.4)Ml,P=0.008、0.006)]。试验组、对照组术后并发症发生率分别为17.3%和24.7%,两组比较,差异无统计学意义(P=0.262)。试验组的急性呼吸窘迫综合征发生率显著低于对照组(P=0.038)。试验组、对照组术后6 H乳酸清除率分别为21.3%和11.2%,两组比较,差异有统计学意义(P=0.004)。结论 dCO有助于提高严重骨盆骨折患者的生存率、降低急性呼吸窘迫综合征发生率。Objective To explore the clinical effect of damage-control orthopedics(DCO) in the treatment of severe pelvic fracture.Methods Clinical data from 201 patients with severe pelvic fracture from January 2010 to January 2014 were retrospectively analyzed.Patients applied DCO was classified into experimental group(n=104),and those who didn′t were categorized into control group(n=97).The hospital mortality,operative time,intraoperative amount of bleeding,intraoperative amount of transfusion,incidence rate of postoperative complication,and lactate clearance rate of 6-hour in two groups was observed respectively.Results There were 7(6.7%) and 22(22.7%) dead cases in experimental group and control group And the causes of death were hemorrhagic shock and multiple organ dysfunction syndrome.The hospital mortality between two groups displayed a statistical difference(P =0.003).The operative time in experimental group[(55.7±11.2) min] was obviously shorter than that in control group [(121.5±21.3) min](P=0.012).In experimental group,the intraoperative amount of bleeding and amount of transfusion during surgery [(250.3 ±54.3) ml and(4613.9±1135.4)ml] in control group,and it was(612.5±56.7) ml and(8821.3±2030.4) ml respectively.After comparison,the two indexes in experimental group was obviously less than that in control group(P=0.00,0.006).The incidence rate of postoperative complication in experimental group and control group was 17.3% and 24.7% respectively,which didn′t display a statistical difference(P=0.262).The incidence rate of acute respiratory distress syndrome(ARDS) in experimental group was obviously lower than that in control group(P=0.038).The lactate clearance rate of 6-hour after surgery was 21.3% and11.2% in the experimental group and control group with a statistical difference(P=0.004).Conclusion DCO is beneficial to improve the survival rate of patients with severe pelvic fracture and reduce the incidence of ARDS