Perioperative effect comparison of simultaneous fixation and staging fixation in polytrauma patients combined with spine injury and long bone fracture
10.3760/cma.j.issn.1001-8050.2018.12.011
- VernacularTitle:脊柱损伤合并长骨骨折多发伤患者不同期手术围术期效果比较
- Author:
Qianli MA
1
;
Jiongjiong GUO
;
Minrui WU
;
Hong ZHENG
;
Yuyun ZHENG
;
Hui LIU
Author Information
1. 厦门大学附属福州第二医院骨科
- Keywords:
Fracture fixation;
Spinal fractures;
Multiple trauma;
Postoperative complications
- From:
Chinese Journal of Trauma
2018;34(12):1120-1126
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the perioperative effects of simultaneous fixation and staging fixation in polytrauma patients combined with spine injury and long bone fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 41 severe polytrauma patients with unstable spine combined with long bone fracture admitted from June 2009 to June 2015.There were 30 males and 11 females,aged 21-66 years [(41.2 ± 12.2)years].The injured spinal segments included cervical vertebrae in 11 patients,thoracic vertebrae in 15,lumbar vertebrae in 23,sacrococcygeal vertebrae in two,as well as injuries at two or more different segments in 10 patients.The long bone fracture segments included humerus in six patients,radius and ulna in 14,femur in 15,tibia and fibula in 14,as well as injuries at two or more different segments in eight patients.The injury severity score (ISS) were all ≥ 15 points.According to the timing of operation,the patients were divided into the simultaneous operation group (20 patients) and the staging operation group (21 patients).In the simultaneous operation group,there were 16 males and four females,aged (43.1 ± 12.6)years,and internal or external fixations of spine and long bone were performed at stage Ⅰ.In the staging operation group,there were 14 males and seven females,aged (40.1 ± 11.9)years.Spine fixation surgery was performed first,and then surgery for long bone fracture was performed after the conditions were stabilized.Spinal surgery methods included anterior subtotal vertebral resection,bone graft plate internal fixation,posterior laminectomy and decompression,and lateral mass screw or pedicle screw internal fixation.Plate and interlocking nail were used for internal fixation of long bone fracture,and single arm bracket for external fixation.The preoperative hospitalization time,operation time,operative blood loss (intraoperative hemorrhage and postoperative drainage),postoperative complications,hospitalization time and Frankel score of spinal cord injury before and after operation were compared between the two groups.Results The preoperative hospital stay was (9.3 ± 6.7) days in the simultaneous operation group and (5.6 ± 5.0) days in the staging operation group (P ＞ 0.05).The simultaneous operation group had significantly longer operation time [(4.9 ± 2.0) hours] than the staging operation group [(3.2 ± 1.2) hours] (P ＜ 0.01),more operative blood loss [(1 322.6 ± 507.1) ml] than the staging operation group [(1 036.7 ± 233.9) ml] (P＜0.05),and shorter hospitalization stay [(22.8 ± 12.6)days] than the staging operation group [(33.0 ± 15.4) days] (P ＜ 0.05).The complication incidence of the simultaneous operation group [45％ (9/20)] was significantly lower than that of the staging operation group [86％ (18/21)] (P ＜ 0.01).No significant difference was found in Frankel score between the simultaneous operation group [(3.3 ±1.7)points] and the staging operation group [(3.1 ± 1.5)points] (P ＞0.05).Conclusion For polytrauma patients combined with spine injury and long bone fracture,simultaneous operation can reduce hospitalization time and complication incidence compared with staging operation.
