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Fixed manner and timing of processing multiple injuries and long bone injury

Author: Anonymous From: www.yourpaper.net Posted: 2010-05-11 11:54:31 Read:
Author: Tian Lihua, Hu ?Z, Zhao Hong,
[Abstract] the purpose of analysis of severe multiple injuries and long bone injuries in the relationship between to explore fracture fixation and processing timing. Method randomly collected 357 cases of multi-hair injury and patients with long bone injury according to its characteristics of long bone injury, fixation and processing time packet retrospective analysis using AIS serious the ISS and TRISSRTS law the degree of the trauma of the three-level measure assessed to between the control group and group comparability and statistical analysis. Full-head of the bone injury maximum AIS (MAIS) = 3.28 1.15, complicated by other parts of the injury MAIS = 4.45 1.69, ISS = 35.57 19.64, Ps = 0.67 0.29. Wounded to survive the dangerous and long bone injury and concurrent site of injury or organ, combination or mixture of fixed patients with the site of injury and long bone complex injuries, post-fixed patients delayed fracture fixation factors. Conclusion The concept of damage control, based on injury the classification treatment helps weigh the fracture treatment of the pros and cons and make a reasonable choice or phased implementation.
the [Key words] multi-trauma; long bone fractures; internal fixation
Abstract: Objective To analyze the relationship of treatment between severe multiple injuries and long bone fractures and discuss the methods and optimal time to deal with them.Methods A total of 357 cases were classified by injury feature, fixation methods and treatment time for long bone fractures in patients with multiple trauma.Injury severity was assessed in 3 different levels with AIS, ISS and TRISSRTS, to control the comparability and statistical analysis in and among groups of patients with multiple trauma.Results MAIS = 3.28 1.15 for long bone fractures, MAIS = 4.45 1.69 for incorporated injuries, ISS = 35.57 19.64 and Ps = 0.67 0.29 for the whole group.Survival risk for patients was related with long bone fractures combined with site of or organs, patients with fixation of combination or mixing way had a great number of injury positions and long bone fractures and complicated traumatic condition.There were more factors to exert an influence on patients with postponed fracture fixation. Conclusion The concept of damage control should be used to treat patients according to different injury classifications, which helps to make reasonable choices of bone fracture treatment or implement by stages.
Key words: multiple trauma; long bone fractures; internal fixation
Long bone injury is serious and more hair injury is more common merged injury, type of injury is also compared with complex and diverse, despite the progress of fracture fixation so that multiple injuries in the long bone injury of the therapeutic effect can be to improve significantly, but select the proper fixation and processing timing is still more difficult. Especially severe multiple trauma treatment the most important issue is to save lives, fracture injury treatment strategies are still subject to the general condition and in stable condition constraints or limitations, so the subject of today's orthopedic trauma still need to explore. Materials and Methods
object of study and choice
The object of this study are in line with the diagnostic criteria of multiple trauma [1], associated with various types of long-bone injury 357 cases, male 213, female 144 cases; aged 17 to 69 years old. Average length of stay (25.57 17.65) days. Femoral fracture 148 cases, 155 cases of tibial fractures, fibula 124 cases, humerus fracture 102 cases, 63 cases of fracture of the ulna, radial fracture 75 cases. In addition, combined with 112 cases of fracture of the clavicle, hand or foot long bone fractures in 65 cases. (Nearly) 301, bone and joint injury cases, the need to repair the blood vessels and nerves in 72 cases. Craniocerebral injury in 221 cases, face and neck injury in 105 cases, chest wound 173 cases, the abdominal injury 137 cases; 5 died. The general situation in the sub-groups, multiple injuries principal part of a treatment time, and past history of rating no significant difference, comparable.
injury assessment and methods
The multiple trauma severity measured by the three-level assessment, the patient's overall injury comprehensive evaluation of tissue injury at the injury severity score (ISS) method of quantitative evaluation in accordance with the trauma and injury severity score (TRISSRTS) , anatomical injury by abbreviated injury scale the standard (AIS98) the district grading and find the AIS survival hazard ratio (AISSRR) [2] and score data are derived from the hospital for medical treatment of the wounded collected a variety of data and clinical records.
3 clinical classification and standards
Multiple injuries long bone injury characteristics to its divided into: only a single onset of fracture, the same part of the multi-stage fracture, multiple fractures of more than two parts as well as multiple combined multi-stage fracture type 4; their fracture fixed manner are divided into: only a single implementation inside or outside the fixed mode, the same parts in different ways to different mixed fixed combination of fixed and multiple sites; based on fixed timing of the implementation of the definitive therapy is divided into four: fixed early (<7 days) extension fixed (7 to 21 days), elective fixed (> 21 days), fixed installments (multiple fractures graded phased implementation). According to the Gustilo [3] method can be open long bone injury divided into three categories and their subtypes.
statistical methods
Detection data obtained are expressed as mean standard deviation, using SAS software for statistical analysis, two samples were compared using t test, multiple of the mean were compared using analysis of variance, multiple of the mean number of pairwise comparisons using q test, correlation analysis between the Student of Newman in Keuls law, damage grouping with trauma score using Spearman Yi law. P <0.05 was considered statistically significant. Results
1 head of the bone injury maximum AIS (MAIS) = 3.28 1.15, complicated by other parts of the injury MAIS = 4.45 1.69, significant difference (P <0.01) between the two; Among them, high-risk injuries (ISS 40) 147 cases, non-high-risk injuries (ISS <40) of the 210 cases, long bone injury number and MAIS between the two groups showed no significant difference (P> 0.05), but the correlation between the two groups with the probability of survival (Ps) more significant difference (P <0.01). The set of concurrent injury survival hazard ratio (AISSRR) MAIS is shown in table 1.
2 whole group ISS = 35.57 19.64, the number of the site of injury (4.27 1.85), number of bone damage long as (2.73 1.36) months; unilateral upper extremity or lower extremity long bone injury 119 cases of upper limb or lower extremity long bone fractures 97 cases, unilateral or bilateral lower extremity injury in 141 cases; damage in fixed differences between the ISS group there was no significant difference (P> 0.05), are shown in Table 2.
3 Ps (Triss) = 0.67 0.29, closed fractures of the group 242 cases, the average fixed time (7.36 6.95) days, open fractures 115 cases, the average fixed time (15.29 14.73) days, both more significant difference (P <0.01). Of a Gustilo classification wound: class I, class II 28 cases, III class 42 cases (III b and III C23 cases); 36 cases with two or more sub-type wound. The bone of the head of the fixed period of time and factors of comparative analysis in Table 3. AIS table a set of concurrent other parts of the injury the survival hazard ratio with MAIS comparison with the single fracture and multi-stage nature fracture group comparison: * P <0.01, P <0.05 Table 2 head of the bone fixed way with the injury situation of comparative analysis hybrid approach group: P <0.05; compared with the external fixation group: * P <0.01, ** P <0.05 Table 3 the head of the bone fixation period and factors of comparative analysis of early fixation group comparison: * P <0.01, P <0.05 discussion
Long bone injury in the process of multiple injuries caused by damage to the body has a smaller impact on the risk of survival, treatment can be delayed, but the long bone fractures fixed to stabilize the injury, effective care, early recovery and prevent complications or reduce the rate of disability is still to crucial. However, the treatment of multiple injuries the most important issue is to save lives, stabilize injuries, complications of concurrent serious injury or the secondary impact of long bone fractures has become a common cause of the exact fixed, so that by dealing with the manner and timing of the overall injury serious constraints and local conditions, especially with the multiple fracture there is often not only the handling of the conflict, and the entire complex fixed also prone to the trade-off contradictions. Therefore, multiple trauma treatment of orthopedic trauma 3 one of the most challenging issues [4]. This group of high-risk injury injury treatment more likely than non-high-risk injury by long bone injuries occur number and MAIS, and related to the combined injury parts or organs, which in the chest and head wounds AISSRR most significantly (P <0.05 or P <0.01). Involving long bone injury, the more dangerous the more obvious correlation with patient survival, its handling more difficult. Especially in patients survival can not be sure, severe ischemic hypoxia or loss of consciousness, multiple fracture often directly affect the integrity and continuity of the treatment and recovery of critically ill injury, and thus constitute a continuation of the life of the injured one of the unstable factors. Coupled with the skin tissue necrosis or wound infection extended treatment time, affect the recovery of limb function, can cause severe physical disability. This is not only the overall risk of injury treatment in patients with long bone damage, and also shows its long bone fracture fixation and processing of the importance of timing. Obviously, a single to concurrent injury treatment or long bones of early fixation of division in terms of dealing with such injuries is often difficult to get the desired effect, early control in critical injury, to reduce upfront complications, early and orderly treatment of long bone fixed combination It is the best choice to guide the class classification treatment of the wounded.
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