| 赵兵刚,高嘉锴,王陶然,宋 晨,张肖在,郑天雷,尹 文.急诊绿色通道对胫腓骨开放骨折治疗效果的分析[J].,2019,19(12):2304-2306 |
| 急诊绿色通道对胫腓骨开放骨折治疗效果的分析 |
| Fast-Track Program on the Treatment of Open Fracture of Tibia and Fibula |
| 投稿时间：2018-11-28 修订日期：2018-12-23 |
| DOI：10.13241/j.cnki.pmb.2019.12.022 |
| 中文关键词: 骨折 开放性损伤 绿色通道 保肢 |
| 英文关键词: Fracture Open injury Fast-Track Limb salvage |
| 基金项目:国家自然科学基金项目(81371982) |
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| 中文摘要: |
| 摘要 目的：比较开通急诊绿色通道与同期常规急诊处置治疗胫腓骨开放骨折的效果，探讨急诊绿色通道对开放骨折合理处置的意义。方法：对2016年1月至2017年12月通过绿色通道处置的35例胫腓骨开放骨折患者的治疗效果进行总结分析，并选取同期按照常规急诊诊疗流程进行处置的52例胫腓骨开放骨折患者作为对照。比较和分析两组患者的接诊至手术时间、死亡率、保肢率、骨折愈合率、并发症发生率和下肢功能评分的差异。结果：87例患者中，62例获得6-24个月(平均12.6个月)的完整随访，其中绿色通道组33例，对照组29例。绿色通道组接诊至手术平均时间5.2±1.8 h，显著短于对照组的49.6±15.4 h(P<0.05)。两组各有1例患者死亡，死亡率无显著差异(P>0.05)。绿色通道组的保肢率(100%)和骨折愈合率(90.9%)显著高于对照组(79.3%和6.90%)(P<0.05)。对照组血栓形成、伤口感染、骨不连、关节功能障碍等并发症的发生率为51.7%显著高于绿色通道组18.2%(P<0.05)。参照下肢Johner-wruhs疗效评定标准，绿色通道组优良率为81.2%，显著高于对照组48.3%(P<0.05)。结论：胫腓骨开放骨折常伴随神经、血管以及皮肤软组织等复合损伤，通过开通急诊绿色通道能够显著提高治疗成功率，降低肢体伤残，有效节约治疗时间。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the effect of Fast-Track program and routine emergency on the treatment of open fracture of tibia and fibula, and explore the significance of the Fast-Track for the rational treatment of open fracture. Methods: From January 2016 to December 2017, a total of 35 patients with open fractures of the tibia and fibula were treated under the Fast-Track program were analyzed. Fifty-two patients with open fractures of the tibia and fibula who were treated according to the routine emergency treatment procedure were selected as controls. The duration between admission to surgery, mortality, limb salvage rate, fracture healing rate, complication rate and lower limb function score were analyzed and compared between two groups. Results: Of the 87 cases of patients, 62 cases completed the follow-up within 6-24 months (mean 12.6 months), including 33 in the fast-track group and 29 in the control group. The average time from the fast-track group to the operation was 5.2±1.8 h, which was significantly shorter than that of the control group (49.6±15.4 h)(P<0.05). One patient died in each group, and there was no significant difference in mortality between two groups(P>0.05). The rate of limb salvage (100%) and fracture healing rate (90.9%) in the fast-track group were significantly higher than those in the control group (79.3% and 6.90%)(P<0.05). The incidence of complications such as thrombosis, wound infection, nonunion, and joint dysfunction in the control group was 51.7%, which was significantly higher than that in the fast-track group (18.2%, P<0.05). According to the evaluation criteria of lower limb Johner-wruhs, the excellent rate of fast-track group was 81.2%, which was significantly higher than that of the control group (48.3%)(P<0.05). Conclusion: Open fractures of tibia and fibula are often accompanied by complex injuries such as nerves, blood vessels, and soft tissues of the skin. By opening the Fast-Track program, treatment success rate can be significantly improved, limb disability can be reduced, and treatment time can be effectively saved. |
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