伤害控制骨科学取得的成功,已为越来越多的多发伤病人带来福祉,为骨科医师所接受,推动了创伤研究的进步。提醒医者一句老话:“Priman non nocere”(不要进一步伤害病人)。作为理念的转变,必然涉及到治疗策略和新技术的应用。目前,能反映创伤伤害严重程度的生理指标和炎性介质测定以及基因多态性与创伤相关性研究,都取得了一些骄人的成果。由于应用时间尚短,DCO应用大多是依靠各自的临床经验,尚不统一。一些困惑大家的问题,如DCO的适应证、二次手术的时机和方式、临床各科如何团结协作等问题,亟待研究解决。
医者期盼:加强DCO基础和临床研究,创造条件,建立或健全生化标记物和基因数据库,如出现严重创伤的病人,可根据其临床生理指标,结合病人生化标记物水平,以至基因多态性测定结果,全面、客观的评估创伤的严重程度,早期进行预后评估,不断提高救治水平。要引入循证医学原则,检验其有效性、安全性和科学性,日臻至善。愿伤害控制骨科学在严重创伤救治中发挥越来越重要的作用,有效地减少创伤性骨髓炎的发生率。
(鲁 菁)
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