骨盆前环后环骨折与骨盆动脉损伤的相关性研究  

Correlative Study on Pelvic Fracture and Artery Injuries

作　　者：张奉琪[1] 张英泽[1] 潘进社[1] 彭阿钦[1] 吴昊天[1] 赵立力[1] 姚双权[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,河北省石家庄市050051

出　　处：《中国骨与关节损伤杂志》2005年第8期505-507,共3页Chinese Journal of Bone and Joint Injury

基　　金：河北省自然科学基金资助项目(编号:302524)

摘　　要：目的探讨骨盆骨折X线表现与骨盆动脉损伤的关系及诊断、治疗方法.方法自1999年1月～2003年10月,收治55例骨盆骨折合并血管损伤,入院时均处于休克状态,收缩压小于90 mmHg,脉率大于120次/min.输血量400～10800 ml,平均2886 ml.入院后常规摄骨盆后前位、出口位及入口位X线片,经输血和抗休克治疗后,血压不升或升后又下降,排除其他部位出血后即行髂动脉造影,并行动脉栓塞.患者ISS评分平均39±16.根据X线表现分为后环骨折21例,前环骨折12例,髋臼骨折6例,混合骨折16例.结果55例髂内动脉造影患者,50例为髂内动脉及其分支损伤出血,行血管栓塞,4例髂外动脉损伤,3例血栓形成,1例破裂;1例髂总动脉血栓形成.3例死亡,成功率94.55%.损伤最多的血管是臀上动脉(32.56%),其次是骶外侧动脉及髂腰动脉.后环骨盆骨折损伤血管64支,主要臀上动脉、骶外侧动脉及髂腰动脉,前环骨折损伤血管17支,主要为闭孔动脉.混合骨折平均输血3876 ml±1068 ml.结论根据骨盆骨折X线表现可预测血管损伤类型,后环骨折容易引起臀上动脉、骶外侧动脉及髂腰动脉损伤,前环骨折易损伤闭孔动脉,其中最易损伤的是臀上动脉.髂内动脉造影及动脉栓塞是较好的诊断及治疗方法.Objective To investigate the correlation between X- ray image of pelvic fracture and pelvic artery injuries, and discuss the diagnosis and treatment of pelvic artery injuries. Methods From Jan 1999 to Oct 2003, 55 patients with pelvic artery injuries were studied. The mean injury severity score （ISS） was 39 ＋ 16. All patients were hypotensive with systolic blood pressures less than 90 mmHg on arrival to hospital. The average amount of blood transfusion was 2886 ml. Each patient underwent lilac artery angiography. Judging by the pelvic X- ray image, 21 were posterior pelvic fracture, 12 were anterior pelvic fracture, 6 were fracture of acetabulum, and 16 were combined pelvic fracture. Results Among 55 patients, 50 suffered injuries of internal artery or its branches, 3 suffered occlusion of external lilac artery, 1 was external lilac artery disruption and 1 was occlusion of common lilac artery. Three died, and the mortality rate was 5.45 %. The vessel injuries included 1 common lilac artery, 4 external lilac arteries, 2 internal lilac arteries, 42 superior gluteal arteries, 24 lilac lumber arteries, 24 lateral sacral arteries, 8 inferior gluteal arteries, 15 obturator arteries, and 6 pudendal arteries. There were 64 and 17 injured vessels in posterior and anterior pelvic fractures, respectively. Conclusion The injured artery can be predicted. The posterior pelvic fractures can cause injury of superior gluteal arteries, lilac lumber arteries and lateral sacral arteries. The anterior pelvic fracture can cause injury of obturator arteries. The best diagnosis and treatment of the pelvic arteries disruption is embolization.

关 键 词：骨盆骨折 X线表现 动脉损伤 骨盆动脉损伤 后环骨折 相关性研究 髂内动脉造影 动脉血栓形成 臀上动脉 血管损伤 

分 类 号：R683.3[医药卫生—骨科学] R683.2[医药卫生—外科学]