腹主动脉球囊阻断术治疗骨盆骨折大出血  

Treatment of massive bleeding after pelvic fracture with temporary occlusion of abdominal aorta

作　　者：李连欣[1] 周东生[1] 王鲁博[1] 王伯珉[1] 穆卫东[1] 王甫[1] 

机构地区：[1]山东大学附属省立医院骨科,济南250021

出　　处：《中华骨科杂志》2011年第5期487-490,共4页Chinese Journal of Orthopaedics

摘　　要：目的 探讨股动脉插管暂时性腹主动脉球囊阻断术治疗骨盆骨折大出血的疗效.方法 回顾性分析2003年5月至2010年5月采用股动脉插管暂时性腹主动脉阻断术治疗的23例骨盆骨折大出血患者的临床资料.男15例,女8例;年龄17～62岁,平均32岁.致伤原因：交通伤17例,高处坠落伤4例,其他2例.骨盆骨折AO分型：B2型4例,B3型2例,C1型1例,C2型4例,C3型12例.闭合性骨折18例,开放性骨折5例.所有患者均行股动脉插管暂时性腹主动脉阻断,盆腔探查止血;15例行单侧髂内动脉结扎,6例行双侧髂内动脉结扎;17例患者行骨盆骨折复位外固定支架固定,6例一期钢板内固定.结果 23例患者均被抢救成功.手术时间2～7 h,平均4.2 h;腹主动脉阻断时间15～120 min,平均46 min;输血量1500～8500 ml,平均4000 ml.14例患者采用术中自体血回输,回输血量700～5000ml,平均1500 ml.21例患者获随访,随访时间5～36个月,平均26个月.根据Tornetta和Matta评定标准,骨盆骨折复位结果：优13例,良7例,可2例,差1例.术后功能根据Majeed评分：优11例,良4例,可4例,差2例.术后并发症：伤口感染1例,脂肪液化1例,经换药治愈;下肢深静脉血栓1例,保守治疗痊愈;骶髂关节复位不良1例,骨盆畸形愈合1例,未行特殊处理.无动脉穿破,肾功能损害,脊髓缺血损伤,腹腔、盆腔器官缺血性坏死,血管内膜损伤等腹主动脉阻断相关并发症.结论 股动脉插管暂时性腹主动脉阻断术可以在最短时间内提供最有效的止血,迅速改善失血性休克,维持有效循环;提高抢救成功率,降低骨盆骨折早期病死率;是骨盆骨折大出血紧急状态下的有效抢救措施之一.Objective To explore the efficacy of temporary occlusion of abdominal aorta in the treatment of massive bleeding after pelvic fracture.Methods From May 2003 to May 2010,temporary occlusion of abdominal aorta was performed for 23 patients with massive bleeding after pelvic fracture.There are 15 male and 8 female patients with a mean age of 32 years （range,17-62 years）.The mechanisms of injury included traffic accidents in 17 cases,falls in 4,engine injury in 1 and crash injury in 1 case.According to AO classification,4 cases were of type B2,4 of type B3,2 of type B3,1 of type C1,4 of type C2,and 12 of type C3.After aorta occlusion,the internal iliac vessel was ligated and the bleeding sites were tamponed.The fractures of pelvis were reduced.External fixation was used in 17 cases and screws and plates were used to fixation in 6 cases.Results All cases were rescued successfully.The average volume of blood transfusion was 4000 ml （range,1500-8500 ml）.Intraoperative self-blood transfusion was performed in 14 patients.The average volume of self-blood transfusion was 1500 ml （range,700-5000 ml）.Twenty-one patients were followed;the duration of follow-up was 26 months （range,5-36 months）.The functional results were excellent in 11 cases,good in 4,fair in 3 and poor in 2 according to Majeed scores system.Complications included 2 cases of infection,1 of lower limb deep venous thrombosis,1 of malreduction of sacroiliac joint,and 1 of malunion of pelvic fracture.No complication was found due to the aorta occlusion or the internal iliac vessel ligation.Conclusion Temporary occlusion of abdominal aorta was an efficient and quick method in the treatment of massive bleeding after pelvic fracture.

关 键 词：骨盆 骨折 出血 止血 手术 

分 类 号：R687.3[医药卫生—骨科学]