开放性骨盆骨折合并严重会阴损伤的治疗效果  

TREATMENT OUTCOMES OF OPEN PELVIC FRACTURES ASSOCIATED WITH SEVERE PERINEAL INJURIES

作　　者：张延辉[1] 刘琳琳[1] 郝琳娜[1] 

机构地区：[1]牡丹江医学院红旗医院,黑龙江牡丹江157011

出　　处：《现代医院》2014年第8期41-42,45,共3页Modern Hospitals

摘　　要：目的：评估开放性骨盆骨折合并严重会阴部损伤的治疗效果。方法分析15例2009年8月～2013年9月间入院开放性骨盆骨折合并严重会阴部损伤（尿道和肛门裂伤）相关的受伤原因、损伤严重程度评分、合并伤、血流动力学状态、复苏和输血、手术操作技术、术中和术后并发症、重症监护时间和住院时间的长短以及死亡率，记录在电脑数据库中进行进一步的评估和分析。结果2例患者死亡，死亡率为13.3％，其中1例APC Ⅲ型因失血性休克，另1例则是由于败血症；1例合并急性肾功能衰竭，治疗后改善，1例（6.6％）LC Ⅱ型；5例血流动力学不稳定的患者（33％）因疑似腹内损伤行剖腹探查；5例患者FAST检查发现腹腔积液，其中3例盆腔血肿，2例脾损伤。结论开放性骨盆骨折合并严重的外阴部损伤的患者死亡率较高。早期诊断和适当的治疗，包括复苏、结肠和膀胱造瘘、反复冲洗、清创和骨盆固定可以改善预后，降低死亡率。Objective The aim of this study was to evaluate the management outcomes of open pelvic fractures asso-ciated with extensive perineal injuries.Methods We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries （urethral and anal canal laceration） admitted between August 2009 and September 2013. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra-and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis.Results Two patients （13.3%） died; the first with a type Ⅲ anteroposterior compression （APC） pelvis fracture was due to uncontrolled hemorrhagic shock, while the latter was due to septicaemia.We had one case with acute renal failure which improved with medical treatment.One patient （6.6%） had sciatic nerve palsy associated with type Ⅱ lateral compression （LC） pelvis fracture.Five hemodynami-cally unstable patients （33%） underwent explorative laparotomy for suspected intra-abdominal injuries.All of these patients had intra -abdominal fluid based on FAST examination.Three of them had large expanding pelvic hematoma and two had spleen injury.Conclusion Open pelvic fractures with extensive perineal injuries of mortality rates are high.Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate .

关 键 词：开放性骨折 会阴部损伤 骨盆骨折 

分 类 号：R683.3[医药卫生—骨科学]