Clinical effects of damage control surgery in treatment of severe craniocerebral injury combined with multiple extremity fractures / 中华创伤杂志

ABSTRACT

Objective To investigate the effects of damage control surgery (DCS) in the treatment of severe craniocerebral injury patients combined with multiple extremity fractures.Methods The clinical data of 128 patients with severe craniocerebral injury[Glasgow coma scale (GCS) scored 3-8] combined with multiple extremity fractures admitted from May 2011 to August 2015 were retrospectively analyzed by case-control study.There were 81 males and 47 females,with an average age of 37.3 years (range,19-77 years).The patients were treated with intracranial pressure monitoring in addition to the common administration.The patients were subdivided into two groups:87 patients treated with DCS concept as damage control group and 41 patients treated with non-DCS routine concept as control group.The DCS group received craniotomy and fracture fixation operation in stage Ⅰ with selective operation of open reduction and internal fixation.The control group received craniotomy and open reduction and internal fixation in stage Ⅰ.The postoperative intracranial pressure,operation duration,intraoperative blood loss,hospital stay and prognosis [Glasgow outcome scale (GOS)] were analyzed statistically.Results No intracranial infection was found in all patients during the treatment process.In damage control group,the postoperative intracranial pressure was normal in 44 cases (51％),which was significantly better than that in control group [8 cases (20％)] (P ＜ 0.05).In damage control group,operation duration [(150.1 ± 12.4)minutes],intraoperative blood loss [(270.6 ± 15.3)ml],and hospital stay [(29.7 ± 9.3) days] were significantly shortened compared with control group,whose operation duration,intraoperative blood loss and hospital stay were (270.6 ± 9.8) minutes,(460.2 ± 17.5) ml,and (34.4 ± 6.2) days,respectively (P ＜ 0.05).The GOS rating of damage control group (70％) was notably higher than that in control group (42％) (P ＜ 0.05).Conclusion For severe craniocerebral injury patients combined with multiple extremity fractures,the application of DCS contributes to control of postoperative intracranial pressure,which can also shorten the duration of hospitalization and improve prognosis.