严重骨盆骨折76例早期救治分析  

The summaries and analysis of early treatment of severe pelvic fracture

作　　者：黄光斌[1] 胡平[1] 高劲谋[1] 王攀[1] 李涛[1] HUANG Guang-bin;HU Ping;GAO Jin-mou;WANG Pan;LI Tao(Chongqing Emergency Medical Center,The Affiliated Center Hospital of Chongqing University,Chongqing400014,China)

机构地区：[1]重庆市急救医疗中心重庆大学附属中心医院创伤科,重庆400014

出　　处：《创伤外科杂志》2019年第1期14-18,共5页Journal of Traumatic Surgery

基　　金：重庆市科委社会事业与民生保障科技创新专项(cstc2016shms-ztzx10001)

摘　　要：目的总结分析严重骨盆骨折的早期救治体会。方法回顾性分析2008年1月—2017年1月重庆市急救医疗中心收治的76例严重骨盆骨折患者临床资料。其中男性63例,女性13例;年龄19～75岁,平均44. 3岁。致伤原因:道路交通伤37例(卡车碾压2例),高处坠落伤19例,重物压砸伤18例,钢缆绞伤1例,保险带牵拉伤1例。本组患者损伤严重度评分(ISS)平均38分。合并颅脑损伤31例,胸部损伤11例,腹部及盆腔脏器损伤56例,脊柱及四肢损伤37例。治疗方法包括早期抗休克措施、救治骨盆出血的髂内动脉断血为主的外科止血技术以及处理合并脏器损伤和并发症。早期重点动态观察心率、血压、血常规、凝血功能;是否有大量失血导致的消耗性凝血病;是否有骨盆骨折合并血管损伤或医源性髂外动脉损伤导致的下肢缺血。结果成功救治61例,存活率80. 2%,失血导致的病死率6. 5%。死亡15例(ISS平均值42. 6分),死亡原因包括:失血性休克5例,颅脑损伤7例,心脏损伤1例,肺部感染1例,多脏器功能衰竭1例。术后并发症:尿道狭窄2例(二期修复术后),性功能障碍1例(合并尿道断裂),下肢截肢1例(股动脉血栓),消耗性凝血病18例。结论严重骨盆骨折早期救治重点在骨盆止血。髂内动脉断血技术包括结扎和栓塞均能有效止血,而且没有确切的缺血并发症,难点在于手术适应证选择;对邻近脏器损伤处理非常重要,容易忽略血管损伤;消耗性凝血病处理棘手,要尽早发现并及时治疗,使用重组Ⅶ因子效果满意。Objective To summarize and analyze the early treatment of severe pelvic fracture.Methods Totally 76 cases of severe pelvic fracture from Jan.2008 to Jan.2017 were summarized retrospectivly.There were 63 males and 13 females aged from 19-75(average,44.3)years.Totally 37 were injured from traffic accidents,19 from high falling,18 from heavy objects,1 from steel cable wring and 1 case from safety belt pulling.Therapeutic methods included early anti-shock measures,surgical hemostasis based on internal iliac artery hemorrhage for pelvic hemorrhage,and treatment for combined organ injury and complications.Early attention was focused on dynamic observation of heart rate,blood pressure,blood routine,coagulation function;and whether there was a large amount of blood loss caused by consumptive coagulopathy.In addition,attention was paid to observing whether there was pelvic fracture combined with vascular injury or iatrogenic external iliac artery injury caused by lower limb ischemia.Results These patients included 31 cases combined with head trauma,11 cases with chest injury,56 cases with abdominal and pelvic viscera injury and 37 cases with spine and extremities injury.This group of patients had ISS of 38 points,and got successful treatment in 61 cases.Fifteen cases were dead and the mortality was 19.8%,and the death rate caused by hemorrhage was 6.5%.The causes of death included 5 cases of hemorrhagic shock,7 cases of braniocerebral injury,1 case of heart injury,1 case of pulmonary infection,and 1 case of multiple organ failure(MOF).The post-operative complications included 2 cases of urinary tract obstruction,1 case of sexual dysfunction with urinary tract disruption,1 case of lower limb amputation due to the treatment delaying after femur artery thrombosis,and 18 cases of consumption coagulopathy.Conclusion Early treatment of severe pelvic fractures focuses on pelvic bleeding control.Iliac artery ligation and embolization are effective and safe surgical methods without definite complications.The difficulty lies in the

关 键 词：骨盆骨折 髂内动脉 凝血病 止血 

分 类 号：R683.3[医药卫生—骨科学]