内固定手术治疗合并中重型颅脑损伤下肢骨折的体会(1)
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[摘要] 目的：总结合并中重型颅脑损伤下肢骨折患者内固定术手术治疗的经验和体会。方法：回顾分析1998～2009年我院收治合并中重型颅脑损伤(GCS评分为5～12分)下肢骨折患者136例，其中，保守治疗76例(保守治疗组)，积极的手术方案内固定治疗60例(手术治疗组)。结果：采用积极手术内固定组在ICU时间、住院时间、卧床并发症、死亡率、均优于保守治疗组，且该组术后随访6～18个月，平均12.6个月，积极手术治疗组后期的康复在骨折畸形愈合，关节功能优良率方面均优于保守治疗组。结论：积极地行内固定手术治疗不但有利于患者脑外伤的康复，而且有利于患肢的功能恢复。
[关键词] 下肢骨折；中重型颅脑外伤；内固定术
[中图分类号] R683.42 [文献标识码]B[文章编号]1673-7210(2010)11(c)-163-02
Experience on internal fixation surgery in treatment lower limb fracture combination moderate and severe traumatic brain injury
LIU Wuyi, XU Wenxiang, NING Weiquan, LUO Nengjian, ZHOU Wei
(The second Hospital of Xiangtan City, Xiangtan 411100, China)
[Abstract] Objective: To summary the experience on internal fixation surgery in treatment lower limb fracture combination moderate and severe traumatic brain injury. Methods: A retrospective analysis of the merger in our hospital with severe head injury (GCS score of 5 to 12 minutes) 136 cases of patients with lower limb fracture from 1998 to 2009, 76 cases of conservative treatment for the conservative treatment group, aggressive surgical treatment of 60 cases of internal fixation options for the internal fixation group. Results: Internal fixation by an active group in the ICU and hospital stay, bed complications, mortality rates were better than the conservative treatment group. And the group was set up for 6 to 18 months, an average of 12.6 months, active treatment group recovered later in the fracture malunion, joint function was superior to conservative high rate of treatment group. Conclusion: Internal fixation surgery actively, which is not only beneficial to patients with traumatic brain injury rehabilitation, but also helps to restore limb function.
[Key words] Lower limb fractures; Severe traumatic brain injury; Internal fixation
随着交通建筑行业的发展，合并颅脑损伤的下肢骨折患者在临床中愈来愈常见，对于患者常规应本着生命第一的原则，先救治颅脑外伤。对于生命体征处于相对稳定或经抢救而颅内情况达到相对稳定时，怎样对下肢的骨折进行进一步处理有利于颅脑损伤及伤肢的康复成为主要考虑的问题。对1998～2009年我院收治的136例合并中重型颅脑损伤下肢骨折患者总结分析如下:
1 资料与方法
1.1 一般资料
回顾我院1998～2009年收治的合并中重型颅脑损伤的下肢骨折患者，并从中选取符合下列标准的病例136例，年龄18～65岁；颅脑损伤GCS评分为5～12分；CT显示有明显的脑挫伤，硬膜外(下)血肿或脑干损伤者；不合并其他的脏器损伤；无严重的心肺肾器质性功能疾病及糖尿病。将其分为两组，积极手术治疗组60例，保守治疗组76例；男66例，女70例；重型颅脑损伤50例(5～8分)，中型颅脑损伤86例(9～12分)；下肢骨折根据骨折的部位例数分类如下：股骨干骨折42例 ......
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