介入栓塞序贯外固定架固定在抢救Tile C型骨盆骨折合并休克患者时的应用价值  

Application value of interventional embolization sequential external fixator in rescue of Tile type C pelvic fracture complicated with shock

作　　者：许斯鼎 时昭胤 王江泽[2] 李金胜 石荣跃 胡添松[4] 郏潜新 XU Si-ding;SHI Zhao-yin;WANG Jiang-ze;LI Jin-sheng;SHI Rong-yue;HU Tian-song;JIA Qian-xin(Department of Interventional Radiology,Zhangzhou Zhengxing Hospital,Zhangzhou,Fujian 363000,China)

机构地区：[1]漳州正兴医院介入科,福建漳州363000 [2]厦门大学附属东南医院骨科 [3]漳州市第三医院介入科 [4]厦门大学附属东南医院介入科

出　　处：《中国骨与关节损伤杂志》2020年第4期341-345,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨介入栓塞序贯外固定架固定在抢救Tile C型骨盆骨折合并休克患者时的临床应用价值及应用时机选择。方法回顾性分析自2010-01—2018-06抢救的145例Tile C型骨盆骨折合并休克患者,53例在输血、补液扩容、升压等抗休克治疗的同时进行单纯介入栓塞治疗(单纯栓塞组),45例急诊行介入栓塞后序贯行外固定架固定(栓塞后固定组),47例骨科医师确定血压允许情况下行外固定架固定后再介入栓塞治疗(固定后栓塞组)。结果单纯栓塞组21例(39.6%)因休克抢救无效而死亡,栓塞后固定组2例(4.4%)因休克纠正不及时死亡,固定后栓塞组中5例(10.6%)死亡。与单纯栓塞组、固定后栓塞组比较,栓塞后固定组输血量、去甲肾上腺素用量更少,栓塞后4 h血乳酸水平更低,休克纠正时间更短,病死率更低,差异均有统计学意义(P<0.05)。结论介入栓塞序贯行外固定架固定既可以控制动脉出血,又可以稳定骨盆环控制静脉出血,具有确切的临床应用价值,符合多发伤救治的损伤控制理念。Objective To explore the application value and opportunity of interventional embolization sequential external fixation in the rescue of Tile type C pelvic fracture patients with shock.Methods One hundred and forty-five cases of Tile type C pelvic fractures combined shock patients rescued from January 2010 to June 2018 were retrospectively analyzed,53 patients underwent simple interventional embolization at the same time as anti-shock therapy such as blood transfusion,fluid expansion,and boosting(simple embolization group),45 cases received sequential external fixator after interventional embolization(embolization before external fixation group),47 cases were fixed with external fixator before interventional embolization after the orthopedic consultant determined that the blood pressure was allowed(embolization after external fixation group).Results Twenty-one patients(39.6%)in the simple embolization group died due to ineffective rescue.Two patients(4.4%)in the embolization group before external fixation died due to shock failure,and 5 patients(10.6%)died in the embolization group after external fixation.Compared with the simple embolization group and the embolization after external fixation group,in the embolization before external fixation group,the blood transfusion volume and norepinephrine dosage were lower,the blood lactate acide of 4 h after embolization was lower,the shock correction time was shorter,and the mortality rate was lower,and the differences were statistically significant(P<0.05).Conclusion Interventional embolization with sequential external fixator can control arterial bleeding and also stabilize pelvic ring to control venous bleeding,which has definite clinical application value and conforms to the concept of injury control in the treatment of multiple injuries.

关 键 词：TILE C型骨盆骨折 休克 介入栓塞 外固定架 损伤控制 

分 类 号：R687.3[医药卫生—骨科学]