RESUMO
Objective: To explore the clinical efficacy of damage control orthopaedics in treatment of patients with severe traumatic brain injury combined with limb fracture. Methods: Total 149 patients with sTBI combined with limb fracture treated in Emergency Surgery Department of Shandong University Qilu Hospital from January, 2011 to December, 2018 were collected. Patients that were treated with immediate definitive fixation before March 31st, 2013 were included into the routine treatment group (group A, 47 cases), and that were treated with damage control orthopaedics (DCO) after April 1st, 2013 were included into the DCO group (group B, 102 cases). The clinical data during hospitalization and prognosis 3 months after injury was analyzed retrospectively. Then according to the risk of postoperative ICP increase, the two groups were divided into low risk subgroup and high risk subgroup. The postoperative ICP, length of stay and GOS score were statistically analyzed. Results: There were no statistically significant differences in sex, age, preoperative GCS score, imaging type of lesion and initial intraoperative ICP between the two groups. The postoperative ICP and incidence of coagulation dysfunction were significantly higher in group A [(17.1±4.6) mmHg, 29.8%] than that in group B[(15.0±4.3) mmHg, 13.7%] separately(P<0.05), and there was no significant difference of length of stay and GOS score between the two groups (P=0.475 and 0.097, respectively). As for the subgroup with low risk of postoperative ICP increase, there was no significant difference in postoperative ICP and GOS score between group A and B, and the length of stay of group B was significantly longer than that of group A (P<0.05). As for the subgroup with high risk of postoperative ICP increase, there was no significant difference in the length of stay between group A and B (P=0.667), and for group A the postoperative ICP was higher and GOS score was lower than that of group B (P<0.05). Conclusions: For patients with sTBI combined with limb fracture, the application of DCO should be based on the severity of traumatic brain injury. For patients with high risk of postoperative ICP increase, DCO can significantly improve the prognosis of patients.
