天津医药

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颅脑创伤合并肢体骨折临床分析

王彬1,尉辉杰2,3,王亮2,3,申长虹2,3,张建宁2,3,江荣才1   

  1. 1. 天津医科大学总医院
    2. 天津医科大学总医院神经外科
    3.
  • 收稿日期:2010-09-16 修回日期:2011-02-18 出版日期:2011-07-15 发布日期:2011-07-15
  • 通讯作者: 江荣才

The Management of the Traumatic Brain Injury with limbs fractures

  • Received:2010-09-16 Revised:2011-02-18 Published:2011-07-15 Online:2011-07-15

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摘要： 摘要： 目的 探讨颅脑创伤合并肢体骨折的诊断原则、治疗方法及影响预后因素。方法 回顾性分析我院2005年—2008年收治的颅脑创伤合并肢体骨折59例，总结其受伤机制、颅脑创伤类型，临床表现，诊断方法，治疗，预后等特点，采用Fish确切概率法比较不同伤情导致不同预后所占比例的差异。结果 按GCS评分划分:轻型39例，中型7例，重型13例;出院GOS统计：死亡3例，植物状态4例，重度残疾8例，轻度残疾12例，生存良好32例；入院GCS评分与出院GOS评分呈直线相关关系，不同伤情颅脑创伤患者预后差异明显。结论 在颅脑创伤合并肢体骨折患者中，颅脑损伤是导致预后不良的关键因素。但是，在积极处理颅脑损伤时，重视骨折，尤其是大骨干骨折的诊疗，也是降低该类损伤伤残率和病死率的重要因素。

关键词: 颅脑创伤, 肢体骨折, 救治原则, 预后

Abstract: Abstract Objective To investigate the principle of diagnosis, therapy and the impact factors of prognosis in traumatic brain injuries (TBI) associated with limbs fractures. Methods 59 TBI cases associated with limbs fractures during 2005 and 2008 in our hospital were retrospectively analyzed. The characteristics of these patients were summarized including their injury mechanisms, brain injury types, clinical characteristics, diagnostic methods, treatment measurements and prognosis. Fish exact test was used to assay the discrepancy in the prognosis of the TBI cases in different Glasgow coma scale (GCS) scores. Results According to the GCS scores, the TBI cases were divided into 3 different groups with 39 mild, 7 moderate and 13 sever ones respectively. The Glasgow outcome scale (GOS) was evaluated to reveal 3 died, 4 sustained in vegetative state, 8 suffered from severe disability , 12 suffered from moderate disability, 32 survived well. There was a straight line correlationship between the admitting GCS scores and the discharging GOS ones. Based on the GCS scores, the prognosis of the different types of TBI cases is different. Conclusion The TBI is a pivotal impacting factor on the prognosis of the patients of TBI associated with limbs fractures. However, it should be emphasized to pay special attention to the diagnosis and treatment of limbs fractures, especially the big bone fractures, when the brain injury is treated actively, which is also very important in reducing the mobility and mortality of this kind of injuries

Key words: Traumatic Brain Injury, Limb Fractures, Management, Prognosis.