| ObjectiveTo analyze, summarize the characteristics of polytrauma with fractures and clinical curativie effect of damage control by screening mass clinical cases and other related datas, for the purpose of providing preliminary foundation for the evaluation of traumatic conditions, treatment preferences, operative occasion, operative technique and prognosis.MethodsNinety-eight cases of severe polytrauma with fractures admitted in our department from January 2007 to April 2010 were in this retrospective study. The patients were analyzed and evaluated by Injury Severity Score(ISS). They were divided into three groups according to ISS before the operation:Group A (I-SS'values from 16 to 24), Group B(ISS'values from 25 to 35), Group C(ISS'v-alues above 35). To evaluate the curative effect, the three groups were quan-titative analyzed in ISS, injured sites, operation sites, transfusion, deter-ministic operation time, length of stay, mortality rate, complications rate.Result1. There were 75 male and 23 female patients, male to female ratio was 3.26:1. They aged from 4 to 80 years old, the average age was 31.44±15.02 years old. The high incidence of age were 21 to 30 years old and 31 to 40 years old, accounting for 30.61%and 29.59%. Traffic accident injury was the leading cause in all with a total of 53 cases(54.1%), following by High Fall Injury,18 cases all together(18.4%),and the remaining 13 cases were Bruise (13.3%),7 cases of Wounds (7.1%), Machinery injuries in 5 cases (5.1%), Traumatic in 2 cases (2.0%). There were 284 injured sites in total, with the average were 2.90 sites. Among them, there are 39 cases of craniocerebral injury,34 of face,8 of neck, 29 of chest,26 of abdomen,24 of spine,49 of upper extremity,69 of lower extremity and 6 of the other body surface. The ISS valued from 16 to 75, the average was 27.10±9.24. A number of 81 patients were cured and improved. The total success rate was 82.65%.17 cases had been died or give up the treatment to discharged dying of an illness with the mortality rate was 17.35%to add up. To compare the indexes of death group and survival group, the proportion of High Fall Injury patients in death group was significantly higher than survival group, with craniocerebral injury was the main injuried site. The ISS score of death group was much higher than survival Group, and the other was showed in Table 1. Most of them died of hemorrhagic shock, MODS and central respiratory failure.2. The patients were divided into 3 groups according to ISS:there were 41 cases in group A (ISS'values from 16 to 24), aged 33.49±15.84 years old, and transfusion were 182.49±262.25ml, the average ISS score was 19.22±2.89, the number of injured sites was 2.82±0.62, the number of surgical sites was 1.18±0.83, definitive operation time after operation were 7.31±6.23 days, length of stay were 31.98±12.56 days, complications rate was 9.76%, mortality rate was 4.88%.Group B(ISS'values from 25 to 34), aged 32.16±13.63 years old, the average ISS score was 28.79±3.11, and transfusion were 462.89±488.73ml, the number of surgical sites was 1.63±0.46, definitive operation time after operation were 14.78±7.03 days, the number of injured sites was 3.10±0.51, length of stay were 45.50±16.72 days, complications rate was 43.56%, mortality rate was 7.89%.Group C(ISS'values above 35), aged 30.16±15.42 years old, the average ISS score was 40.74±8.84, and transfusion were 815.79±964.95ml, the number of surgical sites was 2.15±0.71, definitive surgery time after operation were 19.21±6.45 days, the number of injured sites was 3.10±0.51, length of stay were 18.89±21.40 days, complications rate was 84.21%, mortality rate was 63.16%.3. By statistical analysis, there was no significant difference among three groups in the age, injured sites (P>0.05). There was significant difference in transfusion, length of stay, operative sites, definitive surgery time, complications rate and mortality rate among the three groups (P<0.05). Conclusion1. The high incidence age of multiple traumas with fractures is 21to 30 years old and 31 to 40 years old. Traffic accident injury is the leading cause in all causes of trauma. The total success rate is 82.65%. The cases which are caused by High Fall Injury or associated with craniocerebral injury have higher mortality rate in the causes of trauma.2. With the ISS score increasing, treatment process becomes more complex and the course of disease is longer. Complications rate of group 25 to 34 of ISS is 43.56%, mortality rate of ISS above 35 group reaches 63.16%。So we should be focus more attention on the cases which is valued more than 25 by ISS,in order to reduce complications and improve the prognosis of patients.3. ISS is helpful for the evaluation of traumatic conditions, treatment preferences, operative occasion, operative technique and prognosis. Operative occasion depends on the pathogenetic condition needs and the stability of the patients'general condition.4. Polytrauma with fractures should be considered as a systemic disease. The cognition of Pathology, Physiology, acurate injury classification and elaborative therapeutic plan was the key of successful treament. In order to save the lives of polytrauma patients and improve the physiological state, the damage control surgery should be considered first. It's valuable for improving the success rate if the treatment of polytrauma with fractures such complex trauma following the principles of damage control.
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