文章摘要
解杰,杨帆,陈驾君,李辉,赵鸿,白祥军.损伤控制技术诊断急性肢体骨筋膜室综合征.骨科,2019,10(5):434-439,456
损伤控制技术诊断急性肢体骨筋膜室综合征
Clinical application of damage control techniques in diagnosis of acute extremity compartment syndrome
投稿时间:2019-02-28  
DOI:10.3969/j.issn.1674-8573.2019.05.013
中文关键词: 挤压伤  挤压综合征  急性肢体骨筋膜室综合征  诊断
英文关键词: Crush injury  Crush syndrome  Acute extremity compartment syndrome  Diagnosis
基金项目:湖北省科技计划项目(2018CFB743)
作者单位E-mail
解杰 华中科技大学同济医学院附属同济医院创伤外科 武汉 430030  
杨帆 华中科技大学同济医学院附属同济医院创伤外科 武汉 430030 yf_tjh@163.com 
陈驾君 华中科技大学同济医学院附属同济医院创伤外科 武汉 430030  
李辉 华中科技大学同济医学院附属同济医院创伤外科 武汉 430030  
赵鸿 华中科技大学同济医学院附属同济医院创伤外科 武汉 430030  
白祥军 华中科技大学同济医学院附属同济医院创伤外科 武汉 430030  
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中文摘要:
      目的 研究损伤控制技术(damage control techniques, DCTs)在急性肢体骨筋膜室综合征(acute extremity compartment syndrome, AECS)诊断中的作用。方法 回顾性分析2012年6月至2018年6月我科收治的66例AECS病人的临床资料。其中男42例(63.64%)、女24例(36.36%),年龄为(35.42±14.16)岁(16~67岁)。根据AECS病人诊断过程中是否采用DCTs将病人分为非DCTs诊断组(常规组15例+DCTs治疗组13例)和DCTs诊疗组(38例),对比分析组间诊断指标的差异。结果 ①AECS早、中期确诊率:DCTs诊疗组显著高于非DCTs诊断组(χ2=10.866,P=0.001);②晚期6“P”临床表现:非DCTs诊断组显著高于DCTs诊疗组(χ2=13.630,P<0.001);③检验结果:非DCTs诊断组的血钾、肌酐、尿素氮和pH值异常率均显著高于DCTs诊疗组(χ2=5.332,P=0.021;χ2=10.739,P=0.001;χ2=5.992,P=0.014和χ2=4.962,P=0.026);④并发症:非DCTs诊断组急性肾功能不全(acute renal failure, ARF)和多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)发生率显著高于DCTs诊疗组(χ2=5.120,P=0.024和χ2=4.189,P=0.041)。结论 DCTs优于传统方式,通过早期精准诊断AECS,及时开展损伤控制性治疗,可预防AECS进展为缺血晚期,有利于后续确定性治疗的开展。
英文摘要:
      Objective To study the role of damage control techniques (DCTs) in the diagnosis of acute extremity compartment syndrome (AECS). Methods The clinical data of 66 AECS patients admitted to our center from June 2012 to June 2018 were retrospectively analyzed. Among them, there were 42 males (63.64%) and 24 females (36.36%). The age was (35.42±14.16) years (16-67 years). According to whether DCTs were used in diagnosis, patients were divided into the non-DCTs group (15 patients with conventional diagnosis and treatment, 13 patients with conventional diagnosis and DCTs treatment) and DCTs group (51 patients). The difference in diagnostic indicators between groups was analyzed and compared. Results (1) The early and middle diagnosis rate of AECS in the DCTs group was significantly higher than in the non-DCTs diagnosis group (χ2=10.866, P=0.001); (2) The incidence of late 6 “P” clinical manifestations in the non-DCTs diagnosis group was significantly higher than in the DCTs group (χ2=13.630, P<0.001); (3) The abnormal rate of serum potassium, creatinine, urea nitrogen and pH in the non-DCTs diagnosis group was significantly higher than in the DCTs group (χ2=5.332, P=0.021; χ2=10.739, P=0.001; χ2=5.992, P=0.014 and χ2=4.962, P=0.026); (4) The incidence of acute renal failure and multiple organ dysfunction syndrome in the non-DCTs diagnosis group was significantly higher than that in the DCTs group (χ2=5.120, P=0.024 and χ2=4.189, P=0.041). Conclusion DCTs are superior to the traditional methods. Through accurate diagnosis of AECS in the early stage, the timely implementation of damage control treatment prevents the progression of AECS to late ischemic stage, and facilitates the development of subsequent deterministic treatment.
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