损伤控制骨科理论在不稳定型骨盆骨折救治中的应用  

Application of damage control orthopedics in the treatment of unstable pelvic fracture

作　　者：王延斌[1] 蒲志超[1] 谢伟勇[1] 何灿杰[1] 吴润宝 

机构地区：[1]武警广东省总队医院,广州市510507

出　　处：《实用医学杂志》2014年第8期1281-1283,共3页The Journal of Practical Medicine

摘　　要：目的：探讨损伤控制骨科理论在不稳定型骨盆骨折救治中的临床效果。方法：回顾2006年3月至2012年12月我院收治的23例不稳定型骨盆骨折患者资料。骨折采用Tile分型：B1型2例，B2型4例，B3型5例；C1型6例，C2型3例，C3型3例；损伤严重度评分（Injuryseverityscore，ISS）≥25分，平均34．5分。23例患者来院后立刻限制性容量复苏，维持平均动脉压（MAP）在80．90mmHg水平，随即行损伤控制性手术，控制骨盆出血，术后持续复苏，患者生理状况允许后，按计划进行确定性手术。结果：成功救治19例，死亡4例，其中2例死于失血性休克，1例死于多器官功能衰竭（MOF），1例死于肺动脉栓塞。19例成功救治者均得到随访，随访时间3—32个月，平均随访时间27个月。按Matta标准评定疗效：优9例，良6例，可3例，差1例，优良率78．9％。结论：损伤控制骨科理论应用于不稳定型骨盆骨折救治，可提高患者的存活率及整体疗效，有效预防和减少并发症。Objective To investigate the clinical effect of damage control orthopedics in the treatment of unstable pelvic fractures. Methods Data on 23 cases of unstable pelvic fracture admitted to our hospital from March 2006 to December 2012 were retrospectively analyzed. According to the Tile typing, 2 cases of B1 type, 4 cases of B2 type, 5 cases of B3 type, 6 cases of C1 type, 3 cases of C2 type and 3 cases of C3 type were enrolled in this study. The injury severity score of the patients was over or equal to 25 points, with an average of 34.5 points. The 23 patient were immediately restricted volume resuscitation after admitting into hospital, with keeping the mean arterial pressure （MAP） at the level of 80 to 90 mmHg. The damage control operation was performed promptly, and the pelvic bleeding was controlled and the postoperative recovery was persisted. The definitive surgery was performed on patients under suitable s physiological condition. Results The treatment of 19 cases was successful, 4 patients died, including 2 patients died of hemorrhagic shock and 1 patient died of multiple organ failure （MOF）, and 1 patient died of pulmonary embolism. The 19 cases of successful treatment were followed up for 3 to 32 months, with an average follow-up time of 27 months. According to tMatta standards, 9 cases were excellent, 6 cases were good, 3 cases were generally in, 1 case was poor in, with the excellent rate of 78.9%. Conclusion Damage control orthopedics theory was applied to the treatment of unstable pelvic fracture, which could improve the survival rate and the overall efficacy of patients, and could effectively prevent and reduce the clinical complications.

关 键 词：骨盆骨折 不稳定型 损伤控制骨科 救治 

分 类 号：R687.3[医药卫生—骨科学]