严重骨盆骨折伴多发伤院前院内一体化损伤控制救治模式的建立及临床应用  

Establishment and clinical application of integrated prehospital and in-hospital damage control orthopedics model for severe pelvic fractures with polytrauma

作　　者：赵资坚 蔡史健[1] 张荣臻[1] 刘梦璋[1] 林昌盛[1] 李继锋[1] 邹育才[1] 

机构地区：[1]汕头市第二人民医院骨科,广东515011

出　　处：《中国骨与关节损伤杂志》2015年第6期561-565,共5页Chinese Journal of Bone and Joint Injury

基　　金：汕头市科技计划项目[汕府科(2013)103号]

摘　　要：目的探讨在损伤控制骨科(DCO)理论基础上建立一套骨盆骨折伴多发伤院前院内一体化损伤控制救治模式,并总结其临床应用效果。方法自2008-03—2013-10诊治严重骨盆骨折伴多发伤37例,采用严重骨盆骨折伴多发伤院前院内一体化损伤控制救治模式进行处理。院前急救:现场应用骨盆带12例、床单捆扎18例、抗休克裤7例。院内急救:第一阶段对重要器官进行功能评估、复苏、有针对性地快速诊断,适当处理,控制创伤进一步发展;第二阶段进行ICU重症监护,积极维护呼吸循环功能,预防感染等并发症,控制全身炎症反应;第三阶段二期骨折最终行内固定手术。结果本组死亡4例,2例因骨盆骨折合并大出血休克死亡,1例脑疝死亡,1例因腹腔严重感染败血症死亡,死亡率10.8%。发生严重并发症8例,其中ARDS 2例,MODS 2例,DIC 1例,严重感染2例,败血症1例,并发症发生率21.6%。26例在病情稳定后二期行骨盆内固定手术,7例仍以原外固定架固定。结论严重骨盆骨折伴多发伤患者病死率高、并发症多、救治困难,以DCO为理论指导,加强急救体系建设,规范急救流程,多科协作,按院前院内一体化损伤控制救治模式开展救治,能切实提高救治成功率,减少并发症发生。Objective To study the establishment of an integrated prehospital and in-hospital damage control orthopedics model for severe pelvic fractures with polytrauma, and summarize its elinieal application. Methods The clinical course and outcome of thirty-seven patients admitted to our hospital from March 2008 to Oetober 2013 with severe pelvic fracture combined with polytrauma were presented in the follow-up study. All the patients were treated with the integrated prehospital and in-hospital damage control orthopedics model. Pre-hospital emergency care： twelve patients were put on pelvie belts, eighteen were bound with bed sheets and 7 were. put on anti-shock trousers. In-hospital emergency care： in the first stage, the patients＂ vital organs were accessed and resuscitated, and diagnosed rapidly and specifically. Steps were made to control damage. In the second stage, the patients were taken under ICU intensive care. The necessary steps were taken to maintain their respiratory and circulatory function, prevent complications including infections, and control the systemic inflammatory response. In the third stage, deterministic internal fixation was employed in the secondary union. Results Four patients died, among them, two died of shock from pelvic facture combined with hemorrhoea, one died of cerebral hernia and the other one died of severe sepsis in the abdominal cavity. The death rate was 10.8%. Eight patients （21.6%） suffered from severe complications, among them, two suffered from ARDS, two from MODS, one from DIC, two from severe infections, and one from sepsis. Deterministic internal fixation was employed to twenty-six patients in the secondary union when they were in the stable condition. Seven＇patients received deterministic external fixation as final fixation. Conclusion High case fatality rates and complication rates are associated with severe pelvic fractures with polytrauma and it is difficult to cure them. With damage control orthopedics （DCO） as the theoretical guidance, we can raise the

关 键 词：骨盆骨折 多发伤 损伤控制骨科 急救 

分 类 号：R683.3[医药卫生—骨科学]