Advances and future directions for management of trauma patients with musculoskeletal injuries
Advances and future directions for management of trauma patients with musculoskeletal injuries
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DOI：
10.1016/s0140-6736(12)60991-x
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发表时间：
2012-09-22
期刊：
影响因子：
168.9
通讯作者：
Bhandari, Mohit
中科院分区：
文献类型：
--
作者：
Balogh, Zsolt J.;Reumann, Marie K.;Bhandari, Mohit
在严重创伤患者中，肌肉骨骼损伤是最常见的手术原因，也是决定功能结果的主要因素。在这篇文章中，我们总结了多发伤合并严重肌肉骨骼损伤患者的治疗进展和未来方向。对骨折愈合的了解的提高为治疗特别具有挑战性的问题创造了新的可能性，如骨折延迟愈合和不愈合以及大型骨缺损。主要骨科干预的最佳时机是通过增加对损伤后免疫反应的了解来指导的。个体化治疗应该权衡早期最终骨骼稳定的好处和全身并发症(如脂肪栓塞、急性肺损伤和多器官衰竭)可能危及生命的风险。测量骨折愈合、功能和生活质量结果的新方法为指导未来肌肉骨骼损伤治疗的里程碑式试验铺平了道路。
Musculoskeletal injuries are the most common reason for operative procedures in severely injured patients and are major determinants of functional outcomes. In this paper, we summarise advances and future directions for management of multiply injured patients with major musculoskeletal trauma. Improved understanding of fracture healing has created new possibilities for management of particularly challenging problems, such as delayed union and non union of fractures and large bone defects. Optimum timing of major orthopaedic interventions is guided by increased knowledge about the immune response after injury. Individual treatment should be guided by trading off the benefits of early definitive skeletal stabilisation, and the potentially life-threatening risks of systemic complications such as fat embolism, acute lung injury, and multiple organ failure. New methods for measurement of fracture healing and function and quality of life outcomes pave the way for landmark trials that will guide the future management of musculoskeletal injuries.