The Application Of Damage Control Theory During The Open Pelvic Fracture

Background:Open pelvic fracture (open pelvic fracture.) Is a severe, fatal injuries, such damage is usually caused by trauma due to heavy bleeding and severe infection and death, the mortality rate as high as50%. Treatment of such injury is more emphasis on the rapid control of massive bleeding, the restoration of effective blood volume, timely and thorough debridement, prevention of infection, these are the key to life-saving; deal with pelvic fractures and associated injuries and local wound crucial. Damage control theory of damage control orthopedics,(DCO), the prototype began in the late19th century liver injury tamponade; the beginning of the1980s, some surgeons noted that patients with severe trauma, massive blood loss surgical staging and early laparotomy thatcompletion of definitive surgery, the former can significantly improve the survival rate; the Rotondo official presentation of the damage control (damage control, DC) concept in1993, and recommended a treatment program. Damage control surgery damage control surgery (DCS) in the beginning of treatment for critically ill dying of abdominal trauma, the past two decades has gradually expanded the range of applications, involving almost all fields of surgery, and even covers of Obstetrics and Gynecology, Ophthalmology Otolaryngology and pediatrics specialist treatment of critically ill patients; but not limited to trauma, is also used in the surgical treatment of some severe diseases.Purpose:1.Explore the open pelvic fractures in patients with clinical features and counter-measures;2.Investigated the damage control theory (DCO) the feasibility and efficacy ofthe application of open pelvic fractures;3.Summarizes our hospital in recent years, admissions for treatment of open pelvic fractures in patients with damage control theory to guide treatment and to further explore the importance and necessity of the theory of damage control for treatment of open pelvic fractures.Methods:Collection2001.11-2011.10Shandong Provincial Hospital trauma orthopedics in37patients were treated with DCO method of treatment of open pelvic fractures in patients with the clinical data were retrospectively analyzed, admitted to the same period,29cases of non-DCO guidance pelvic fracture as the control group, ie non-DCO group. DCO patients are open pelvic fracture, application of the DCO theory strategy to guide treatment, all patients with initial surgery are not the ultimate certainty oftreatment, medical treatment are three-stage treatment, first for emergency treatment for life-threatening situation, the purposes of the initial injury controllingtreatment, mainly temporary fixed and abdominal aortic cross-clamping of theexternal fixator, and then such as the ICU for fluid resuscitation, the lastre-deterministic internal fixation. Non- DCO patients also are open pelvic fractures, the use of the first operation is the uncer-tainty of internal fixation, the composition of cases no significant difference between the DCO group.Quantitative analysis by age, ISS score, intraoperative blood loss, operation time, the second timing of surgery, hospital stay, and matta ratings and other indicatorsto assess the overall efficacy of the patients.Results:DCO group of37cases of open pelvic fracture patients, male26cases, accounting for70.27%, female11cases; age of17to65years old, average age35.56years; by traf-fic accident in19cases, falling injuries in11cases, heavy objects to drop injury in five cases, the machine strangulation injury in two cases.Tile method of classification [3]:A type3cases,12cases of B-type (some unstable), C-type (unstable)22cases (stable).17cases with hemorrhagic shock are abdominal aortic balloon occlusion technique,29cases of early pelvic external fixator.10patients with open femoral fractures initially received only a simple debridement and external fixation. Postoperative admission to the ICU resuscitation, and then to be the stability of the physiological conditions do un-certainty and internal fixation. All patients mortality rate was5.4%(2/37), injury severity score (ISS) of the death group average of41.4points, mainly died of hemorrha-gic shock shock, merge hurt with MODS. There were complications in10cases,3cases of partial flap necrosis, two cases of acute respiratory distress syndrome (ARDS),2cases of com-mon iliac artery thrombosis,2cases of abdominal infection, one case of acute renal fai-lure; nine cases cured; one cases of death.1. Two groups of patients, the age composition of showing a statistically signi- ficant difference (DCO patients, the average age of35.56years old, non-DCO patients the average age of44.07years), no significant differences in other admission indicators shows in the injury situation at the same time young people are often subjected to more violence, more severe disease, suggesting the need to DCO implementation of the strategy.2. Two groups of patients, the mean total blood volume of the composition, while not showing a statistically significant difference, P=0.054, and the DCO group the ave-rage amount of bleeding1527.03ml and non-DCO group, the average amount of bleed-ing1022.41ml compared to ensure are quite different, suggesting two points, the appli-cation of the theory of DCO does not reduce the overall open pelvic fractures in patients with bleeding, and doctors choose to use DCO strategy may be more inclined to the large amount of bleeding in patients.3. Two groups of patients the hospital stay were not statistically significant diffe-rence (DCO group (36.71days), non-DCO group of36.2days, F=0.024, P=.486), the DCO group before the second surgery has been recovering in the ICUfor some time, so for the internal fixation of the quadratic, the DCO implementation of the strategy in patients with internal fixation for shorter stay in hospital on the postoperative rehabilita-tion may improve the efficiency.4. Two sets of results show the Tile type Matta score is generally driven with A, B, and C typing were lower, Tile pelvic genotyping of guiding significance for the progno-sis of patients.5. Tile type, two sets of results show the Matta score of ISS score overall driven with basically the same, the ISS score of guiding significance for the prognosis of pati- ents.6. And non-DCO group compared to the DCO group, patients with the final score Matta’s excellent higher rate.Conclusions:1.Rapid and accurate diagnosis and integrated treatment is to improve the key tosevere multiple trauma survival rate, reasonable application of the DCT can bequickly and effectively to save the patient’s life and improve the survival, stability, fracture, and reduce the incidence of complications, is safe and effective method.2.Acute renal failure is the cause of death in patients with one of the reasons. Should pay much more attention to the deep venous thrombosis, multiple organfailure (MODS) and systemic complications of severe inflammatory response syndrome (SI-RS).3. Patients with open pelvic fractures, doctors seem to be more inclined to guide treatment for those younger or blood loss greater for patients with orthopedic damage control.4. ISS score of open pelvic fractures with the further prognosis significance.The Tile’s typing help predict the efficacy of treatment.