The Application Of Injury Control Orthopedics In The Treatment Of Severe Thoracolumbar Fractures With Severe Multiple Injuries

Objective To explore the feasibility and efficacy of the concept of damage control orthopaedics(DCO)in the treatment of unstable multiple thoracolumbar fractures,and to provide a reference for the selection of surgical timing and treatment.Methods A retrospective analysis was performed on the clinical data of 64 patients with unstable multiple thoracolumbar fractures who were treated in the Department of Orthopedics,North China University of Science and Technology from 2007 to 2015.Among them,33 patients who met the DCO group inclusion criteria from 2011 to 2015 were treated as DCO.Group,31 patients who met the non-DCO group inclusion criteria from 2007 to 2010 as a non-DCO group,compared the indicators of ICU treatment time,length of hospital stay,postoperative complication rate,and improvement of postoperative AISA grade in the two groups of patients.Analysis to assess efficacy.Results The duration of ICU treatment in the DCO group was(8.47±2.47)days,and the length of hospital stay was(25.52±4.23)days.The duration of ICU treatment in the nonDCO group was(10.74±3.25)days,and the hospital stay was(24.35±5.04).d.After statistical analysis,there was a statistically significant difference between the two groups in the time of ICU treatment(P<0.05);there was no significant difference between the two groups in the duration of hospitalization(P>0.05).The incidence of postoperative complications(5 pneumonia,1 ARDS,0 MODS and 1 wound infection)in the DCO group was 21.21%;postoperative complications in the non-DCO group(6 pneumonia,4 ARDS,2 MODS,The incidence of 4 wound infections was 51.61%.After statistical analysis,the difference between the groups was statistically significant(P<0.05).Both groups of patients were followed up for 12 to 24 months(mean 18 months).After the follow-up,both groups had better ASIA classification than before surgery.There was no significant difference between the two groups(P>0.05).Postoperative fracture reduction healed well.Conclusion 1 The use of DCO for staged treatment in the treatment of unstable thoracolumbar fractures,which are mainly multi-trauma,can reduce the incidence of postoperative complications,improve survival rate,and improve prognosis.2 The use of DCO in the treatment of unstable thoracolumbar fractures,which are mainly severe multiple injuries,can shorten the time of ICU treatment and will not prolong hospital stay.3 The definitive surgical timing for patients with unstable thoracolumbar fractures,who are mainly severe multiple injuries,depends on the patient's physiological state.When the patient's condition is unstable,thoracolumbar surgery can be postponed properly,and will not increase the neurological impairment.Once the patient's condition allows,surgery should be performed as soon as possible to avoid complications caused by instability of the spine and long-term bed rest.