Applying Damage Control Orthopedic In 60 Cases With Severe Polytrauma Who Have Mainly Sustained Pelvic Trauma

BackgroundSevere polytrauma is a high-energy trauma, has complicated associated injuries with massive hemorrhage, and always leads to high mortality and the rate of disability.At the same time the interaction and cooperation of various damages influence the doctor to make correct diagnoses and treatments in time.Reviewed the documents, there are commonly severe polytrauma who have mainly sustained pelvic trauma, chest injuries and abdominal injuries. Severe polytrauma who have mainly sustained pelvic trauma are dangerous and complicated for the department of orthopedics.It often combines with many other parts and organ injuries, having massive hemorrhage, high shock rates and fierce conditions,make life in danger. Wang has proposed the definitions of severe polytrauma who have mainly sustained Orthopaedic Trauma and spinal cord trauma. According to the classification, we proposed the conception of severe polytrauma who have mainly sustained pelvic trauma to normalize diagnosis and treatment procedure.ObjectiveTo collect the cases of severe polytrauma who have mainly sustained pelvic trauma,analyze and summarize the feature of its pathogenetic condition, then provide initial evidence for applying Damage Control Orthopedic in severe polytrauma who have mainly sustained pelvic trauma.MethodsRetrospective study was adopted from 60 severe polytrauma who have mainly sustained pelvic trauma patients in our division between January,2000 and July,2007. The patients were analyzed and appraised by quantizing the index of ISS,injury sites, operation sites, earlier period transfusion quantity and time of revitalization, operation opportunity, length of stay and Matta score.ResultThere were 60 cases of severe polytrauma who have mainly sustained pelvic trauma, 34 male and 26 female.The average age was 34.6 years, from 11 to 68.There were 32 cases of traffic accident injury, 11 of crush injury and 15 of High Fall Injury.There were 21 cases accompanied hemorrhagic shock which are divided into the group of limited resuscitation and the group of common resuscitation according to early resuscitation method.The group of limited resuscitation:average ISS is 30.72, average resuscitation volume is 1009.09ml, average resuscitation time is 102.72min, average HGB after resuscitation is 98.36g/L. The group of common resuscitation:average ISS is 30.90, average resuscitation volume is 3175.00ml, average resuscitation time is 246.00min, average HGB after resuscitation is 79.90g/L. Between The group of limited resuscitation and The group of common resuscitation, there are no significant difference for the ISS(P>0.05), significant difference for the resuscitation volume(P<0.05), significant difference for the resuscitation time(P<0.05), significant difference for the HGB after resuscitation(P<0.05).All the cases were divided into 3 groups according to Tile Classes of pelvic fracture.There were 42 GroupⅠdefined Tile Classes C1:average ISS was 24.83, Matta score satisfactory result was 81.0%. GroupⅡdefined Tile Classes C2:average ISS was 31.30, Matta score satisfactory result is 60.0%. There were 8 GroupⅢdefined Tile Classes C3:average ISS was 35.00, Matta score satisfactory result was 37.5%.Among the GroupⅠ,ⅡandⅢ, there were significant difference for the Matta fineness rate(P<0.05), no significant difference for the injury sites(P>0.05), no significant difference for the operation sites(P>0.05), no significant difference for the operation time(P>0.05), and no significant difference for the length of stay(P>0.05).The ISS of all the cases were betweem 17 and 50, and the average was 27.27. All the cases were divided into 3 groups according to ISS. There were 30 Group A(17～24):average ISS is 19.73, average operation site is 1.10, average operation time is 9.30 days after injury, average length of stay is 31.73 days. There were 20 Group B(25～34):average ISS is 30.90, average operation site is 1.70, average operation time is 15.50 days after injury, average length of stay is 57.95 days. There were 10 Group C(≥35):average ISS is 41.87, average operation site is 2.50, average operation time is 21.17 days after injury, average length of stay is 78.60 days. Among the Group A, B and C, there are no significant difference for the injury sites(P>0.05), no significant difference for the Matta fineness rate(P>0.05), significant difference for the operation sites(P<0.05), significant difference for the operation time(P<0.05), significant difference for the length of stay(P<0.05).Conclusion1. The conception of severe polytrauma who have mainly sustained pelvic trauma was proposed.2. During the emergency resuscitation, the patients of severe polytrauma who have mainly sustained pelvic trauma accompanied hemorrhagic shock were treated by the limited resuscitation. It can make the resuscitation volume less, controlling of hemorrhage better and resuscitation effect more significant.3. Damage Control Orthopedics was benefit for severe polytrauma who have mainly sustained pelvic trauma, especially temporary fixation by the pelvic external fixator could control the damage efficiently. In the procedure of Damage Control Orthopedics, Iss was benefit for guiding damage control operation and controlling operation opportunity, and Tile Class was benefit for predict the prognosis earlier.