Damage control resuscitation of severe multiple trauma in the pelvic fractures / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the clinical effects of damage control resuscitation (DCR) in treating severe multiple trauma in the pelvic fractures.</p><p><b>METHODS</b>From March 2009 to September 2013, a restrospective analysis was conducted on the clinical data of 28 patients with multiple trauma in the pelvic fractures, including 19 males and 9 females, ranging in age from 21 to 51 years old with an average of 32.5 years old. According to Tile classification of pelvic fractures, 16 cases were type B and 12 cases were type C. Injury severity score (ISS) averaged 32.0±3.4. All cases were treated with damage contral orthopaedics and DCR strategy, namely that used immediately with small capacity of balanced salt solution on admission so as to maintain the blood pressure between 80 to 90 mmHg. At the same time, emergency phase I simple debridement plus external fixator or bundled with fixed pelvic was done, and the chest or abdomen combined injury was treated at first. And limbs fracture was temporary dealing with bone traction or plaster external fixation, etc. After bleeding was controlled by operation, fluid resuscitation was done as fast as possible and the plasma was transfused early according to the proportion of plasma and red cell suspension (2 U:1 U-3 U:2 U). Dosage of balanced salt solution and blood before remedy shock was recorded, and the removal of time of lactic acid and coagulation were observed.</p><p><b>RESULTS</b>Five cases were died after 4 to 15 hours into hospital (3 cases died for severe trauma-hemorrhagic shock and 2 cases for acute respiratory distress syndrome). Twenty-three cases were remedy shock at 1.6 to 4.3 hours after injury with an average of 2.4 hours. Period I operation duration was (78.2±10.3) minutes. Dosage of balanced salt solution was (3,798±340) ml and red cell suspension was 14 to 18 U, fresh frozen plasma (FFP) was (1,267±58) ml (1U FFP=100 ml), blood platelet was 8 to 12 U for 9 patients. The removal time of lactic acid and PT-APTT was (11.4±2.1) hours and (4.3±0.8) hours. Measures were taken to correct electrolyte and acid-base imbalance was normal. The success rat of recovery was 82.2% (23/28).</p><p><b>CONCLUSION</b>Damage control resuscitation (DCR) integrates the main links such as damage control operation and allowable low blood pressure (or limited liquid resuscitation) and hemostatic control resuscitation, was early effective treatment measures for the patients with severe multiple trauma in the pelvic fractures.</p>

Clinical observation of damage control resuscitation in rescue multiple fracture with hemorrhagic shock / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects of damage contral resuscitation (DCR) in rescue multiple fracture with hemorrhagic shock.</p><p><b>METHODS</b>From January 2009 to May 2013, clinical data of 24 patients suffered from multiple fracture with hemorrhagic shock were retrospectively reviewed. Among them, 18 cases were male and 6 cases were female, aged from 21 to 48 years old with an average of (32.5 +/- 4.5). Small capacity of balanced salt solution were used to maintain systolic, pressure (80-90) mmHg before operation. After control of bleeding with operation, sufficient amount of liquid were rapidly use, and plasma were supplied according to proportion of plasma and red cell suspension (1 U:2 U-1 U:1 U). After remedy of shock, fluid infusion were sustained negative balance slightly and keep acid-base equilibrium of electrolyte. Dosage of balanced salt solution and blood transfusion before remedy shock were recorded, removal time of lactic acid, coagulation function, incidence and case fatality of DIC were observed.</p><p><b>RESULTS</b>Four patients were died after 6-18 h into hospital (2 cases died for acute respiratory distress syndrome and 2 cases for irreversible shock). Twenty patients with shock were corrected at 2-6 h after injury. Dosage of balanced salt solution was(4,259 +/- 268) ml,red cell suspension was (14 +/- 2) U, fresh frozen plasma was (800-1,600) ml (FFP: 1 U = 100 ml) averaged (900 + 300) ml, blood platelet was 4-6 U. Coagulation function and electrolyte were normal. Lactic acid was less than 2 mmol/L within 24 h,the success rate of recovery was 83.3% (20/24).</p><p><b>CONCLUSION</b>Performing DCR can obvious improve success rate of remedy serious fracture combined with uncontrolled hemorrhagic shock. Supplementing FFP when correcting coagulation function should be carry out promptly in fluid resuscitation.</p>

Damage control orthopaedics of thoracolumbar burst fracture complicated with severe polytrauma / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the therapeautic effect of damage control orthopaedics (DCO) applicated to thoracolumbar burst fracture complicated with severe polytrauma.</p><p><b>METHODS</b>Twenty-one patients with severe polytrama including 15 males and 6 females with an average age of 40-years-old ranging from 20 to 60 years, were treated by immediate fluid resuscitation and emergency simple operation so as to control the bleeding and contamination. According to Frankel grade of spinal nerves function, 3 cases were grade A, 3 were grade B, 9 were grade C, 6 were grade D. Ten cases were performed to open abdominal operation, 6 cases underwent closed negative pressure drainage thorough chest, 2 cases with lung rupture were treated by repairing operation. During operation, 9 cases were treated with by external fixation and 5 cases were skeletal traction or external fixation with plaster support for extremities fractures. After emergency operation, the patients were transported into surgical intensive care unit (SICU), and corrected the hypothermia, acidosis and coagulation. The definitive thoracolumbar operation was performed between 5 to 7 days as soon as the vital signs became stable.</p><p><b>RESULTS</b>Among 21 cases, trauma hemorrhagic shock was corrected rapidly in 18 cases and 3 cases died in 4 to 26 hours. The survival rate was about 85.7% (18/21). Eighteen patients were followed up for 6 to 14 months with an average of 10 months. According to Frankel grading, 3 cases were grade A, 2 cases were grade B, 3 cases were grade C, 3 cases were grade D, 7 cases were grade E.</p><p><b>CONCLUSION</b>It may increase the therapy achievement rate excellently and decrease the disabled rate that performing damage control orthopaedics (DCO) timely, relifing the compression on the spinal cord and re-establishing the stability of spinal column as early as possible.</p>

Locking compressing plate combined with bone-grafting in medullary cavity for treatment of the distal fractures of tibia at delayed stage / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of delayed open reduction and locking compressing plate (LCP) plus bone-grafting in medullary cavity for the distal comminuted fractures of tibia.</p><p><b>METHODS</b>Twenty-nine patients with the distal comminuted fractures of tibia were treated between March 2006 and September 2008, including 19 males and 10 females, ranging in age from 27 to 58 years with an average of 42.5 years. From wounded to hospital, the time was from 2 to 4 hours. According to AO classification, type 43-A1 were in 3 cases, type A5 in 12 cases, type A3 in 9 cases and type 43-C1 in 5 cases. Among them, there were 11 cases with open fracture (type Gustilo I in 5 cases, type Gustilo II in 6 cases) and 18 cases with closed fracture. Calcaneal traction was done in earlier stage (plaster external fixation in 5 cases), keeping the nagative liquid balance and electrolyte balance and improving the microcirculation. After the swolen limbs relieved markedly in 8 to 12 days,operating was done by open reduction and LCP internal fixation plus bone-grafting with own ilium in medullary cavity. Functional exercise was undergone in earlier stage and the wounded limbs loading weight on 10 to12 weeks after operation when the X-ray revealed the callus formed markedly.</p><p><b>RESULTS</b>The incision healed well without severe complication. All patients were followed up for from 6 to 14 months with an average of 12 months. All cases obtained bone union. According to the Mazur's evaluation standard, the results were excellent in 25 cases, good in 3 cases, and fair in 1 case.</p><p><b>CONCLUSION</b>The above treatment can reduce the damage of periosteum and medullary cavity, shorten the time of bone healing and decrease the rate of bone nounion markedly. The internal fixation was reliable and less complacation after surgery, but it is very important for the right preoperation assessment to soft tissue injuries and the good operation timing choice.</p>

Treatment for crush syndrome of extremities with antioxidants / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical therapeutic effect of antioxidants assistant treatment of extremities crush syndrome (CS)in order to find new therapy.</p><p><b>METHODS</b>Twenty-one male patients (aged from 24 to 48 years, mean 36 years) were treated with the next antioxidants in early stage: (1) 20% Mannitol 250 ml intravenous drip in 30 minutes (one time per 6 to 8 h). (2) Sodium aescinate 20 mg, Salvia Miltiorrhiza 20 ml were dissolved respectively in isotonic saline or 5% glucose 200 ml and dripped by intravenous drip (50 to 60 drips per minute). The drugs were used for 5 to 7 days (one time per day). Basifying urine, keeping the nagative liquid banlance and electrolyte banlance, preventing infection and hold out treatment were done. When the pressure of muscular osteofascial compartment was more than 30 mmHg, deep fasia was cut to decompress timely and the above-mentioned drugs were continuously applied for patients.</p><p><b>RESULTS</b>Myoglobin urine of 21 cases died out after 2 to 3 days, of them, 13 cases were performed to decompress. After open decompression, 2 cases suffered from amputation because of long time of ischemia, 2 cases took place slight dysfunction of lower limbs, one hand had ischemia muscular contracture in 1 case and one foot down-vertical in 1 case. After followed-up of 8 months to 1 year, according to the function standard, the result were excellent in 8 cases, good in 7 cases, fair in 2 cases, poor in 4 cases. The excellent and good rate was about 71.4% (15/21).</p><p><b>CONCLUSION</b>After extremities crushed for long time, application of antioxidents as early as possible can decrease significantly the incidence and invalidity rate of CS.</p>