臨床整形外科49巻4号

2014年04月発行

誌上シンポジウム 整形外科外傷治療の進歩

Damage control orthopaedics（DCO）の概念・治療戦略

著者： 新藤正輝¹

所属機関： ¹帝京大学医学部附属病院外傷センター

ページ範囲：P.309 - P.313

　多発外傷患者の骨折に対する治療方針についてはearly total care(ETC)とdamage control orthopaedics(DCO)の大きく2つの概念がある．しかし，それぞれの治療の有用性や適応については明確な指標はなく，いまだ議論が続いている．治療方針決定に当たってチーム医療は不可欠であり，整形外科医は集中治療医，救急医とともに個々の症例の全身状態，手術内容，手術時間を十分に協議し理解したうえで方針を決定することが重要である．

参考文献

1) Bone LB, Johnson KD, Weigelt J, et al:Early versus late stabilization of femoral fractures:A prospective randomized study. J Bone Joint Surg Am 71:336-340, 1989

2) Bosse MJ, MacKenzie E, Riemer BL, et al:Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. J Bone Joint Surg Am 79:799-808, 1997

3) Carlson DW, Rodman GH Jr, Kahehr D, et al:Femur fractures in chest-injured patients:is reaming contraindicated? J Orthop Trauma 12:164-168, 1998

4) Dunham CM, Bosse MJ, Clancy TV, et al:Practice management guidelines for the optimal timing of long-bone fracture stabilization in polytrauma patients:The EAST Practice Management Guidelines Work Group. J Trauma 50:958-967, 2001

5) Giannoudis PV, Smith RM, Bellamy MC, et al:Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures. An analysis of the second hit. J Bone Joint Surg Br 81:356-361, 1999

6) Golus RJA, Gimbrere JSF, Van Niekirk JLM, et al:Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 22:895-903, 1982

7) Harwood PJ, Giannoudis PV, Probst C, et al:The risk of local infective complications after damage control procedures for femoral shaft fracture. J Orthop Trauma 20:181-189, 2006

8) Jonson KD, Cadambi AJAI, Seibert GB:Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries:Effect of early operative stabilization of fractures. J Trauma 25:375-384, 1985

9) Lichte P, Kobbe P, Dombroski D, et al:Damage control orthopedics:current evidence. Curr Opin Crit Care 18:647-650, 2012

10) Nowotarski PJ, Turen CH, Brumback RJ, et al:Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am 82:781-788, 2000

11) Pape HC, Aufm'Kolk M, Paffrath T, et al:Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion:a cause of posttraumatic ARDS? J Trauma 34:540-548, 1993

12) Pape HC, MD, van Griensven M, Rice J:Major secondary surgery in blunt trauma patients and perioperative cytokine liberation:determination of the clinical relevance of biochemical markers. J Trauma 50:989-1000, 2001

13) Pape HC, Giannoudis P, Krettek C:The timing of fracture treatment in polytrauma patients:relevance of damage control orthopedic surgery. Am J Surg 183:622-629, 2002

14) Pape HC, Grimme K, van Griensven M, et al:Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters:prospective randomized analysis by the EPOFF Study Group. J Trauma 55:7-13, 2003

15) Roberts CS, Pape HC, Jones AL, et al:Damage control orthopaedics:evolving concepts in the treatment of patients who have sustained orthopaedic trauma. Instr Course Lect 54:447-462, 2005

16) Scalea TM, Boswell SA, Scott JD, et al:External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures:damage control orthopedics. J Trauma 48:613-621, 2000

17) Scannell BP, Waldrop NE, Sasser HC, et al:Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients. J Trauma 68:633-640, 2010

18) Seibel R, Laduca J, Hassett JM, et al:Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg 202:283-295, 1985

19) The Canadian Orthopaedic Trauma Society:Reamed versus unreamed intramedullary nailing of the femur:comparison of the rate of ARDS in multiple injured patients. J Orthop Trauma 20:384-387, 2006

20) Van den Bossche MR, Broos PL, Rommens PM:Open fractures of the femoral shaft, treated with osteosynthesis or temporary external fixation. Injury 26:323-325, 1995