损害控制外科在严重骨盆骨折伴腹部脏器损伤治疗中的应用  

Application of damage control surgery in treatment of severe pelvic fracture combined with ab-dominal organ injuries

作　　者：杨俊 高劲谋 胡平 李昌华 赵山宏 林曦 

机构地区：[1]重庆市急救中心创伤科,400014

出　　处：《中华创伤杂志》2012年第7期661-664,共4页Chinese Journal of Trauma

摘　　要：目的探讨严重骨盆骨折伴腹部脏器损伤时应用损害控制外科（damage control sur-gery，DCS）的可行性和疗效。方法对1995-2010年应用DCS的方法救治严重骨盆骨折伴腹部脏器损伤39例的临床资料做回顾性分析。结果39例严重骨盆骨折伴腹部脏器损伤大出血，行髂内动脉断血术（双侧髂内动脉结扎31例＋双侧髂内动脉主干栓塞8例），早期骨盆外固定支架使用31例。在ICU复苏治疗后再行确定性内固定手术。本组死亡率为21％（8／39），死亡组ISS平均41．6分，主要死于休克和合并伤。共发生并发症7例，合并ARDS3例，右髂总动脉血栓形成1例，膈下脓肿2例，下肢深部感染1例，均痊愈。结论DCS原则的合理、及时应用可提高严重骨盆骨折伴腹部脏器损伤患者的抢救生存率。Objective To probe into the feasibility and efficacy of damage control surgery （DCS） in treating severe pelvic fracture combined with abdominal organ injuries. Methods A retro- spective analysis was done on the clinical data of 39 patients with severe pelvic fractures combined with abdominal organ injuries treated by DCS from 1995 to 2010. Results Devascularization of internal ili- ac arteries was performed to treat massive hemorrhage in the 39 patients with severe pelvic fractures com- bined with abdominal organ injuries, including ligation of bilateral internal iliac arteries in 31 patients and angioembolization of bilateral internal iliae arteries in eight. Meanwhile, early pelvic external fixators were used in 3 l patients. All patients received discriminating internal fixation after resuscitation in ICU. The overall mortality rate was 21% （8/39）, with average ISS of 41.6 points and with hemorrhagic shock and combined injury for the main causes of death. Complications occurred in seven patients including com- bined acute respiratory distress syndrome （ARDS） in three patients, thrombosis of right common iliac ar- tery in one, subphernic abscesses in two, and deep infection of lower extremity in one, but all the compli- cations were cured. Conclusions Reasonable and timely use of DCS can enhance the rescue survival rate of patients with severe pelvic fracture combined with abdominal organ injuries.

关 键 词：多处创伤 骨盆 腹部损伤 骨折固定术 损害控制外科 

分 类 号：R683.3[医药卫生—骨科学] R656[医药卫生—外科学]