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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (06) : 339 -344. doi: 10.3877/cma.j.issn.2096-0263.2021.06.004

脊柱专题

损害控制联合早期整体治疗在老年胸腰椎骨折并多发伤患者中的应用
相瑞1, 黄倩1, 司晋瑄1, 徐静1, 孟晓东1, 许凤琴1,†()   
  1. 1. 222000　连云港市第一人民医院脊柱骨科
  • 收稿日期:2020-12-28 出版日期:2021-12-05
  • 通信作者: 许凤琴
  • 基金资助:
    连云港市卫生计生科技项目(201709)

Application of damage control combined with early total care in elderly patients with thoracolumbar fractures and multiple injuries

Rui Xiang1, Qian Huang1, Jinxuan Si1, Jing Xu1, Xiaodong Meng1, Fengqin Xu1,†()   

  1. 1. Department of Spine, the first people's Hospital of Lianyungang, Lianyungang 222000, China
  • Received:2020-12-28 Published:2021-12-05
  • Corresponding author: Fengqin Xu
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引用本文：

相瑞, 黄倩, 司晋瑄, 徐静, 孟晓东, 许凤琴. 损害控制联合早期整体治疗在老年胸腰椎骨折并多发伤患者中的应用[J]. 中华老年骨科与康复电子杂志, 2021, 07(06): 339-344.

Rui Xiang, Qian Huang, Jinxuan Si, Jing Xu, Xiaodong Meng, Fengqin Xu. Application of damage control combined with early total care in elderly patients with thoracolumbar fractures and multiple injuries[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(06): 339-344.

目的

探讨损害控制（DC）理念联合早期整体治疗（ETC）在老年胸腰椎骨折并多发伤患者中的效果。

方法

回顾性分析连云港市第一人民医院2015年5月至2020年6月老年胸腰椎骨折合并多发伤患者104例，男性63例，女性41例。其中年龄60~86岁，平均（72±11）岁。按照治疗理念分组，其中应用传统理念治疗者有30例将其记为TC组，应用DC理念治疗者有32例将其记为DC组，应用DC联合ETC理念治疗者有42例将其记为研究组。比较三组患者手术出血量、手术时间、住院时间，患者术前和术后1个月损伤严重程度评分（ISS），患者术前、术后1个月和术后6个月腰椎功能障碍指数（ODI）和并发症。

结果

所有患者均获得完整随访，随访时间（5.7±1.3）个月。研究组出血量少于DC组和TC组[（652±91）mL vs.（875±107）mL和（997±142）mL]，手术时间和住院时间均短于DC组和TC组，差异均有统计学意义、[（127±20）min vs.（154±25）min和（177±35）min、（12.8±1.9）d vs.（17.3±2.6）d和（22.5±4.2）d，P< 0.05]；研究组、DC组和TC组术后1个月ISS评分分别为（14.6±1.8）分、（14.9±2.8）分、（18.8±3.0）分，每组术后1个月ISS与术前比较均下降，且研究组和DC组术后1个月ISS评分均低于TC组，差异有统计学意义（P< 0.05）；研究组、DC组、TC组术后1个月ODI评分分别为（24.5±4.2）分（、25.6±4.2）分（、34.2±6.9）分，术后6个月分别为（16.5±2.8）分（、17.2±3.0）分（、17.2±3.3）分，术后1个月、术后6个月三组ODI评分均低于术前，术后6个月三组ODI评分均低于术后1个月，研究组和DC组术后1个月ODI评分均低于TC组，差异均有统计学意义（P<0.05）；研究组、DC组、TC组术后并发症发生率分别为2.50%、25.81%、53.57%，研究组低于其余两组，DC组低于TC组，差异有统计学意义（P<0.05）。

结论

DC联合ETC较单纯DC、传统理念可更有效减轻老年胸腰椎骨折并多发伤的损伤程度，减少并发症，且相较于传统理念可促进术后早期腰椎功能恢复。

关键词: 损害控制, 早期整体治疗, 胸腰椎骨折, 多发伤
Objective

To investigate the effect of damage control (DC) concept combined with early total care (ETC) in elderly patients with thoracolumbar fractures and multiple injuries.

Methods

The clinical data of 104 cases treated in the first people's Hospital of Lianyungang who were elderly patients with thoracolumbar fractures with multiple trauma from May 2015 to June 2020 were analyzed retrospectively, with 63 male cases and 41 female cases, from 60 to 86 years old, average age (72±11) years old. They were divided into 3 groups according to the treatment concept, and there were 30 cases treated with traditional concept as TC group, 32 cases treated with DC concept as DC group and 42 cases with DC combined with ETC concept as study group. The blood loss, operation time and hospitalization time, injury severity scores (ISS) before and after 1 month of operation, lumbar disability indexes (ODI) before operation, after 1 and 6 months of operation and complications were compared between the 2 groups.

Results

All patients were followed up for (5.7±1.3) months. The blood loss in the study group was less than that in the DC group, and the operation time and hospitalization time were shorter than those in the DC group and TC group, with statistically significant differences [(652±91) mL vs (875±107) mL and (997±142) mL, (127±20) min vs (154±25) min and (176±35) min, (12.8±1.9) d vs (17.3±2.6) d and (22.5±4.2) d, P<0.05]. The ISS scores in the study group, DC group and TC group were (14.6±1.8), (14.9±2.8) and (18.8±3.0) scores after 1 month of operation, and the ISS scores in the three groups decreased after 1 month of operation, which in the study group and DC group after 1 month of operation were lower than that in the TC group, with statistically significant differences (P<0.05). The ODI scores in the study group, DC group and TC group after 1 month of operation were respectively (24.5±4.2), (25.6±4.2) and (34.2±6.9), which after 6 months of operation were respectively (16.5± 2.8), (17.2±3.0) and (17.2±3.3), and the scores in the three groups after 1 and 6 months of operation were lower than those before treatment, and those after 6 months of operation were lower than those after 1 month of operation, of which the study group and DC group after 1 month of operation were lower than that in the TC group, with statistically significant differences (P<0.05). The incidences of complications in the study group, DC group and TC group were 2.50%, 25.81% and 53.57%, which in the study group was lower than those in the other two groups, and the DC group was lower than that in the TC group, with statistically significant differences (P<0.05).

Conclusion

Compared with DC alone, DC combined with ETC can effectively reduce the damage degreeand complications in elderly thoracolumbar fractures and multiple injuries.

Key words: Damage control, Early total care, Thoracolumbar vertebral fractures, Multiple trauma
表1 三组老年胸腰椎骨折合并多发伤患者一般资料比较
组别 例数 性别（例） 年龄（岁，±s） ISS评分（分，±s） 骨折部位（例）
男 女 胸椎 腰椎
研究组 42 25（59.52） 17（40.48） 74±12 31±5 20（47.62） 22（52.38）
TC组 30 18（60.00） 12（40.00） 72±10 31±5 16（53.33） 14（46.67）
DC组 32 20（62.50） 12（37.50） 72±11 31±5 15（46.88） 17（53.13）
χ2/F值   0.712 0.360 1.024 0.563
P值   0.258 0.514 0.193 0.611
组别 例数 合并症[例（%）]
合并四肢骨折 腹部创伤 颅脑损伤 泌尿系统创伤 骨盆损伤 软组织撕裂
研究组 42 9（21.43） 12（28.57） 4（9.52） 5（11.90） 10（23.81） 15（35.71）
TC组 30 6（20.00） 9（30.00） 1（3.33） 4（13.33） 6（20.00） 14（46.67）
DC组 32 7（21.88） 10（31.25） 2（6.25） 3（9.38） 8（25.00） 12（37.50）
χ2值   0.128 0.245 0.186 0.117 0.769 0.263
P值   0.769 0.694 0.743 0.775 0.215 0.682
表2 三组老年胸腰椎骨折合并多发伤患者出血量、手术时间和住院时间比较（±s）
组别 例数 出血量（mL） 手术时间（min） 住院时间（d）
研究组 40 652±91*# 127±20*# 12.8±1.9*#
DC组 31 875±107* 154±25* 17.3±2.6*
TC组 28 997±142 176±35 22.5±4.2
F值   82.261 28.866 91.350
P值   0.000 0.000 0.000
表3 三组老年胸腰椎骨折合并多发伤患者ISS评分比较（分，±s）
组别 例数 术前 术后1个月 F值 P值
研究组 40 29.8±5.0 14.6±2.6* 17.130 <0.001
DC组 31 30.6±5.2 14.8±2.7* 15.104 <0.001
TC组 28 29.6±5.2 18.8±3.0 9.621 <0.001
F值   0.355 22.512    
P值   0.702 <0.001    
表4 三组患者术前、术后1个月和术后6个月ODI评分比较（分，±s）
组别 例数 术前 术后1个月 术后6个月 F值 P值
研究组 40 41.25±5.68 24.50±4.20&* 16.50±2.85&@ 24.208 <0.001
DC组 31 40.96±5.27 25.65±4.15&* 17.15±3.03&@ 23.369 <0.001
TC组 28 41.33±5.95 34.25±6.88& 17.25±3.26&@ 21.204 <0.001
F值   0.289 9.241 0.563    
P值   0.765 0.002 0.418    
图4 术后6个月影像学检查图片
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