骨盆创伤知名血管损伤的紧急处理策略

目的 探讨骨盆创伤中骨盆知名血管损伤时的紧急处理策略。方法 回顾性分析2005年1月至2021年10月山东省立医院收治的58例骨盆知名血管损伤病人的临床资料，其中男36例，女22例，年龄为（47.9±14.8）岁（24~75岁）。其中“死亡冠”血管损伤15例（医源性损伤8例）；臀上动静脉损伤17例（医源性损伤7例）；臀下动静脉损伤6例（医源性损伤1例）；阴部内动脉损伤13例；髂外动静脉（股动静脉）损伤7例（医源性损伤3例）。所有病人根据不同的血管损伤机制，术中根据不同的情况分别选择直接血管结扎、纱布填塞、血管造影栓塞或联合腹主动脉阻断等方法急救止血。结果 58例骨盆知名血管损伤的病人，其中有55例病人得到成功的处理，术后存活。其中2例因“死亡冠”血管损伤所致的大出血死亡，1例因臀上动脉医源性损伤所致的大出血死亡。结论 临床医生在面对骨盆及臀部创伤时要充分了解并掌握骨盆知名血管损伤的预防和处理，同时也不能忽视骨盆知名血管的潜在损伤。了解骨盆骨折类型与血管损伤的潜在联系，对于“死亡冠”血管，可行预防性结扎避免损伤，一旦损伤在无法结扎的情况下应纱布填塞压迫止血结合介入栓塞；对于臀上和臀下血管，造影栓塞可作为第一选择，必要时可联合腹主动脉球囊阻断；对于阴部内动脉，纱布填塞及造影栓塞均有较好的效果；对于髂外血管的损伤，可在腹主动脉球囊阻断下行血管修补或置换。当骨盆知名血管损伤时，根据具体情况，掌握止血急救的措施，根据自已医院条件和自身的经验选择合适的方法，提高病人的预后和生存率。

Emergency Treatment of Pelvic Well-known Vessels Injury in Pelvic Trauma

Objective To investigate the emergency treatment strategy of pelvic well-known vessels injuries in pelvic trauma. Methods A retrospective analysis was performed on 58 patients with well-known vessels injury from January 2005 to October 2021, including 36 males and 22 females, with age of (47.9±14.8) years old (24-75 years). There were 15 cases of corona mortis vessel injury (8 case of iatrogenic injury), 17 cases of superior gluteal vessels injury (7 cases of iatrogenic injury), 6 cases of inferior gluteal vessels (1 case of iatrogenic injury), 13 cases of internal pudendal artery injury, 7 cases of external iliac vessels (femoral vessels) injury (3 cases of iatrogenic injury). According to different vessel injury mechanisms, all patients underwent direct vascular ligation, gauze packing, angiographic embolization or combined abdominal aortic occlusion to stop bleeding according to different conditions. Results Of the 58 patients with well-known pelvic vessels injuries, 55 were successfully treated and survived. Two of them died of massive hemorrhage caused by the iatrogenic injury of the corona mortis vessel, and one died of massive bleeding due to the iatrogenic injury of the superior gluteal artery. Conclusion In the face of pelvic and hip injuries, clinicians should fully understand and master the prevention and treatment of pelvic well-known vessels injuries. The potential damage of well-known vessels also should not be neglected. Understand the potential relationship between pelvic fracture types and vascular injuries. For corona mortis vessel, preventive ligation is feasible to avoid injury. Once the injury cannot be ligated, gauze packing combined with angiographic embolization should be used; for superior and inferior gluteal vessels, angiography embolization can be the first choice, and if necessary, it can be combined with abdominal aortic occlusion; for internal pudendal artery, gauze packing and angiographic embolization have good effects; for injuries to external iliac vessels, vascular repair or replacement can be performed after abdominal aortic balloon occlusion. When the pelvis is damaged, based on the specific situation, clinicians should master the emergency treatment measures. According to the conditions of the hospital and experience of the clinicians, appropriate methods can improve the patient''s prognosis and survival rate.