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

doi:10.3877/cma.j.issn.2096-0263.2021.06.004

Abstract

Abstract:

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

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.

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Figures/Tables 5

References 21

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组别	例数	性别（例）		年龄（岁，±s）	ISS评分（分，±s）	骨折部位（例）
组别	例数	男	女	年龄（岁，±s）	ISS评分（分，±s）	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（%）]
组别	例数	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

组别	例数	性别（例）		年龄（岁，±s）	ISS评分（分，±s）	骨折部位（例）
组别	例数	男	女	年龄（岁，±s）	ISS评分（分，±s）	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（%）]
组别	例数	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

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

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

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

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