腹膜外填塞术在血流动力学不稳定型骨盆骨折急救止血中的应用研究进展  

Application of pre‑peritoneal packing in emergency hemostasis for hemodynamically unstable pelvic fracture:a review

作　　者：黄申博 方跃[1] 何帅[1] 黄涵禹 Huang Shenbo;Fang Yue;He Shuai;Huang Hanyu(Department of Orthopedics,Trauma center,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,创伤医学中心,成都610041

出　　处：《中华创伤杂志》2025年第1期111-116,共6页Chinese Journal of Trauma

摘　　要：血流动力学不稳定型骨盆骨折是由钝性外力导致的骨盆骨折,并伴有低血压,需要大量输血,病死率可达40%~65%。血流动力学不稳定型骨盆骨折早期治疗的关键在于控制出血,目前主要的止血手段包括骨盆支架固定、腹膜外填塞术、髂内动脉结扎或髂内动脉栓塞等。但由于急救止血时间紧迫、出血部位难以确定等问题,血流动力学不稳定型骨盆骨折依然是创伤外科医师面临的严峻挑战。腹膜外填塞术是在紧急情况下用于控制血流动力学不稳定型骨盆骨折出血的一种治疗方法,能有效控制骨盆骨折后的静脉和骨折端出血,降低病死率,且操作简便快捷,尤其适用于无法迅速行血管造影栓塞或患者血流动力学极不稳定的情况。但临床上关于腹膜外填塞术与血管造影栓塞术等其他止血方法的选择仍存在争议。为此,笔者对腹膜外填塞术在血流动力学不稳定型骨盆骨折急救止血中的应用研究进展进行综述,为此类损伤的临床治疗提供参考。Hemodynamically unstable pelvic fracture results from blunt external force and is often accompanied by hypotension.Massive blood transfusion is needed in the case and the mortality rate can be 40%‑65%.The key to the early treatment of hemodynamically unstable pelvic fracture lies in bleeding control.Currently,the primary methods of hemostasis include pelvic brace fixation,pre‑peritoneal pelvic packing,internal iliac artery ligation,internal iliac artery embolization,etc.However,due to the urgent need for emergency hemostasis and the difficulty in identifying the bleeding sites,hemodynamically unstable pelvic fracture remain a serious challenge for trauma surgeons.Pre‑peritoneal pelvic packing used in emergency situations to control the bleeding hemodynamically unstable pelvic fracture can effectively control venous and fracture‑site bleeding after pelvic fracture and reduce mortality.Moreover,it is easy and convenient to operate and is especially suitable for cases in which angiographic embolization can not be performed immediately or the patients are hemodynamically extremely unstable.However,there is still a controversy in the clinical practice regarding the selection between pre‑peritoneal pelvic packing and other hemostatic methods such as angiographic embolization.To this end,the author reviewed the progress of the researches on the application of pre‑peritoneal pelvic packing in emergency hemostasis for hemodynamically unstable pelvic fracture,aiming to provide a reference for its clinical treatment.

关 键 词：骨盆 骨折 休克 创伤性 止血 腹膜外填塞术 

分 类 号：R683.3[医药卫生—骨科学]