创伤性骨盆骨折合并失血性休克的急救护理

我院自 1995年 4月 - 2 0 0 2年 4月共救治骨盆骨折合并失血性休克患者 36例 ,均积极抗休克治疗 ,同时及早处理合并伤 ,严密监测生命体征 ,准确做好急救护理 ,成功抢救 31例。现将护理体会总结如下。1　临床资料　　本组 36例中男 2 6例 ,女 10例 ;年龄 18～ 5 0岁。致伤原因 :车祸伤 2 7例 ,墙体倒塌伤 4例 ,高处坠落伤 3例 ,挤压伤 2例。骨盆骨折合并后尿道损伤 8例 ,合并膀胱破裂 4例 ,合并脾破裂 4例、肝破裂 1例、肾挫伤 1例 ,合并多处肋骨骨折 5例 ,其中血气胸 3例 ,合并会阴部撕裂、肝门毁损共 3例 ,合并上下肢多发骨折 2例。全部病…     

骨盆骨折合并失血性休克的急救与护理

目的:探讨骨盆骨折合并失血性休克患者的急救与护理.方法:结合16例骨盆骨折合并失血性休克患者的早期救治和护理方法.结论:骨盆骨折合并失血性休克患者在短期内救治不及时,会危及生命.因此,我们应该规范骨盆骨折合并失血性休克的早期急救技能和护理技术.结果:16例骨盆骨折均发生失血性休克,其中15例治愈出院,1例死亡.     

骨盆骨折合并会阴撕裂伤的初期处理

目的 探讨骨盆骨折合并会阴撕裂伤的初期处理措施。方法 回顾性分析16例骨盆骨折合并会阴撕裂伤的初期救治情况。男9例，女7例；开放性骨盆骨折10例。结果 15例存活，1例因严重合并伤，术后11天后死于严重的感染。结论 骨盆骨折合并会阴撕裂伤常需多科室合作，采用多种外科修复手段来处理；稳定血流动力学、彻底清创、局部骨折内固定、及时修复损伤器官、放置多条引流管及选择性粪道转移是初期处理的有效手段。     

骨盆骨折合并阴道损伤

报道１１例女性骨盆骨折合并阴道损伤６例痊愈，２例好转，３例死亡。其致伤机理多与会阴部骑跨伤时骨折暴力传导致阴道，使阴道上下受累而致伤有关。作者认为对女性不稳定性骨盆骨折应常规做泌尿生殖道检查。早期妥善处理可有效减少并发症。     

闭合性骨盆骨折合并失血性休克患者的急救与护理

目的 探讨闭合性骨盆骨折合并失血性休克患者的急救与护理措施.方法 对30例闭合性骨盆骨折合并失血性休克患者的严密观察,给予准确急救及护理,观察其预后效果.结果 本组28痊愈出院,2例因合并ARDS、DIC死亡.结论 闭合性骨盆骨折合并失血性休克患者早期发现、早期诊断、早期治疗及严密地观察护理是抢救成功的关键,可提高其预后效果.     

骨盆外固定架在骨盆骨折合并失血性休克治疗中的应用

目的探讨骨盆外固定架在合并失血性休克的骨盆骨折治疗中的应用价值。方法回顾性分析应用骨盆外固定架治疗合并失血性休克的严重骨盆骨折病例45例。结果抢救成功40例,成功率88.9%;外固定架作为最终固定物治疗组中,随访20例,优良率100%;外固定架作为临时或部分固定物治疗组中,随访20例,优良率90%。结论骨盆外固定架固定有助于纠正休克,并且创伤小,可早期活动,减少卧床并发症。在合并失血性休克的骨盆骨折救治中,骨盆外固定架固定是一种有效的治疗方法。     

骨盆骨折及合并伤的诊断与处理

1987年10月至1996年5月，我院收治骨盆骨折共71例，其中髋臼骨折17例，单纯骨盆骨折24例，骨盆骨折合并伤30例。骨盆骨折合并伤，是严重的多发性损伤，疗效满意，观介绍如下。临床资料本组30例，男16例，女14例。年龄7～46岁．平均29·7岁。骨盆骨折合并休克13例，膀跳损伤2例，尿道损伤7例，死股2例，颅脑损伤2例．内脏损伤10例（隔迹2例，肝破裂2例，脾破裂3例，肾损伤2例，杨系膜撕裂伤1例），合并其他部位骨折、关节脱位15例（腰椎骨折伴截瘫2例，开放性骨折5例，闭合性骨折关节脱位8例），合并饶神经损伤1例．跳总神经损伤1例。治疗效…     

骨盆骨折并失血性休克的急救与护理

目的:探讨对骨盆骨折并失血性休克病人有效的急救与护理措施。方法:通过回顾性总结分析18例该类病人的临床救治与护理过程,总结有效的急救与护理措施。结果:18例病人除1例病情严重合并多发伤死亡外,余17例均治愈出院。结论:①积极而有效的急救措施是抢救休克的关键;②迅速补充血容量,恢复有效的循环血量,保证足够的尿量,保持呼吸道通畅,改善缺氧是纠正休克的重要措施;③全面而细致的观察病情,是早期发现合并损伤,预防并发症的重要手段。     

骨盆骨折合并尿道损伤的观察与护理

骨盆骨折合并尿道损伤临床上较常见，自１９９５年１月～１９９６年１２月共收治此类患者９例，在对其护理过程中，总结出一定经验，现介绍如下。临床资料１．一般资料本组９例均为男性，年龄７～４９岁。均为多发性骨盆骨折，并发尿道完全断裂５例，尿道部分断裂４例，创伤性休克５例，腹膜后血肿３例，股骨颈无移位骨折１例，肋骨骨折２例，尺骨鹰嘴骨折１例。２．治疗方法及结果早期抗休克治疗，导尿成功４例，尿管留置２周。５例行尿道会师术。骨盆骨折均采用保守治疗，手法复位后骨盆悬吊牵引４例，股骨髁上牵引２例，皮牵引３例。住院…     

不稳定型骨盆骨折的疗效探讨

目的 探讨不稳定型骨盆骨折(Tile B和Tilec型)的治疗和疗效。方法 比较78例骨盆骨折患者使用和非使用骨盆外固定支架手术疗效。结果 在38例骨盆骨折患者未使用骨盆外固定支架治疗中，失血性休克的纠正率为76％，死亡率10．6％，平均ISS评分11．6。而在使用骨盆外固定支架治疗的40例患者中，失血性休克的纠正率为90％，死亡率为2．5％，平均ISS评分9．87结论 骨盆外固定支架治疗不稳定型骨盆骨折合并失血性休克，手术简单，疗效可靠，大大降低了患者的死亡率。     

A pelvic fracture model for the assessment of treatment options in a laboratory environment

BACKGROUND: Optimal prehospital and clinical management of patients with severe pelvic trauma is controversial. Prospective evaluations of different treatment strategies have not been performed and treatment is currently not evidence-based. The purpose of the present study was to develop a porcine model of reproducible severe pelvic trauma for subsequent laboratory trials. METHODS: The study was performed on 13 juvenile porcine cadavers. Pelvic fractures were created by applying a pure anterior-posterior compression load to the pelvic ring using a servohydraulic material testing machine. Fracture patterns were classified according to the Young-Burgess classification and the Tile classification using postfracture CT scans including 3D-reconstructions. RESULTS: Disruptions of the posterior pelvic ring segment were unilateral in 12 cases and bilateral in one case transforaminal vertical sacrum fractures. Injuries of the anterior ring segment were obturator ring fractures bilateral, ipsilateral or contralateral to the injury of the posterior ring segment. According to the Tile classification this resulted in 12 type C1 and 1 type C3 fractures. In the Young classification all injuries were classified as type APC III. In six cases transverse process fractures were found ipsilateral to the posterior ring disruption. Initial force drops indicating bony or ligamentous injuries occurred at mean forces of 4030 +/- 269N (range, 3617-4374N). CONCLUSION: The present model was able to create reproducible unstable pelvic fractures and can be used for controlled laboratory trials to study the management of patients with pelvic fractures.     

Current management of severe pelvic and perineal trauma

Mortality associated with pelvic and perineal trauma (PPT) has fallen from 25% to 10% in the last decade thanks to progress accomplished in medical, surgical and interventional radiology domains (Dyer and Vrahas, 2006) [1]. The management strategy depends on the hemodynamic status of the patient (stable, unstable or extremely unstable). Open trauma requires specific treatment in addition to control of bleeding. All surgical centers can be confronted some day with patients with hemorrhagic PPT and for this reason, all surgeons should be familiar with the initial management. In expert centers, management of patients with severe PPT is complex, multidisciplinary and often requires several re-interventions. Obstetrical and sexual trauma, also requiring specific management, will not be dealt with herein.     

Open treatment of pelvic and acetabular fractures

The open operative management of pelvic and acetabular fractures in the obese is technically demanding, with a significantly higher rate of complications compared with patients who are nonobese. The decision to perform surgery should involve a thorough understanding of risks, and patients should be counseled. Careful attention should be paid to patient factors; coexisting systemic conditions and patient positioning to reduce complications. Wound complications are most commonly seen, and techniques to reduce risk should be incorporated. When complications occur, aggressive management can result in successful salvage. Future areas of study should include methods to reduce risk of surgical site infections and improving our understanding of the physiologic alterations that occur with obesity. This article summarizes the current literature on open treatment of pelvic and acetabular fractures in the obese patient, reviews the physiologic adaptations of obesity as they relate to pelvic surgery, highlights risk factors for complications, and provides recommendations to reduce the incidence of complications.     

严重骨盆骨折的救治及手术治疗

目的报道严重骨盆骨折的治疗经验,以期进一步提高其早期诊断和救治水平。方法回顾性分析总结了1994年4月～2002年3月106例严重骨盆骨折的临床资料。结果骨盆骨折主要的致伤原因为交通事故伤(69例,占65.1%)及坠落伤(31例,占29.3%)。106例中,87例生存,19例死亡,死亡率为17.9%,其中10例死于出血性休克,4例死于严重脑外伤,3例死于多器官功能衰竭,2例死于急性呼吸窘迫综合征。其中骨盆骨折手术治疗32例,优良率达91.7%。结论严重骨盆骨折救治中院前急救十分重要,要及时处理严重合并伤,积极行骨盆骨折内固定手术。     

复合性骨盆伤的早期失血及救治相关因素

目的 研究复合性骨盆伤的早期失血及损伤特点，及其与救治关系、对预后结局的影响，探讨其分类救治的方法。方法 对233例具有严重骨盆伤伴有血液动力学不稳定患者按暴力方式、骨盆骨折类型及合并伤情分组，采用生理状态、解剖损伤及输血容量等方面的量化指标进行伤情评定分级，并计算生存概率(Ps)，以此进行比较和统计学分析。结果 骨盆骨折多伴有合并损伤，常为高能量交通伤所致；其出血源、出血量及血流动力学改变为非对称相关；其中不稳定型骨盆骨折合并脏器破裂出血者伤后血压改变和早期输血量均较为显著，骨盆AIS和ISS分值较高，生存概率(Ps)较低。结论 高能量所致骨盆伤多为高危性创伤，易合并多发伤，常有多源性出血，加强整体伤势和出血来源的认识，区别不同伤情，有利于对其进行分类救治。     

应用改良Stoppa入路手术治疗骨盆髋臼骨折的疗效分析

目的探讨应用改良Stoppa入路手术治疗骨盆、髋臼骨折的手术方法及疗效。方法笔者回顾分析自2010-01—2014-12应用改良Stoppa入路手术治疗的48例骨盆、髋臼骨折的临床资料,其中骨盆骨折34例,髋臼骨折14例。结果所有患者获随访6个月~5年,平均24个月。本组手术切口长度(9.2±2.7)cm,手术时间(1.7±0.7)h,出血量(545±230)ml。术后X线片示骨折复位满意,末次随访时疗效根据Matta功能评分标准评定:优36例,良10例,可2例,优良率95.8%。1例术中发生膀胱破裂,1例术后发生深静脉血栓,无切口感染、骨折不愈合、股外侧皮神经麻痹、腹股沟疝及医源性血管神经损伤等并发症发生。结论改良Stoppa入路手术治疗骨盆髋臼骨折具有操作安全、创伤小、视野清晰、骨折易于复位及固定、疗效可靠、并发症少等优点,具有一定的临床应用价值。     

AO外固定架在不稳定性骨盆骨折中的临床应用

目的探讨AO外固定架对不稳定性骨盆骨折治疗的疗效和经验。方法回顾性分析24例(13例结合内固定治疗)AO外固定架治疗不稳定性骨盆骨折患者,总结该治疗方法的经验及体会。结果除1例因腹腔脏器破裂大量失血在固定后1d死于失血性休克外,其余23例平均随访13个月,按Matta评定标准,优良率达87.5%。结论①多数情况下单纯外固定架可改善骨盆的稳定性,也可作为终极治疗手段,必要时与内固定结合可增加骨盆的稳定性;②单纯外固定架固定可用于绝大多数B型及部分C型骨折的治疗;③对那些严重损伤,骨盆稳定性差,合并有其它脏器损伤患者,急诊期骨盆外固定架治疗效果显著。     

Contemporary management of pelvic fractures

BACKGROUND: Pelvic fractures occur when there is high kinetic energy transfer to the patient such as would be expected in motor vehicle crashes, auto-pedestrian collisions, motorcycle crashes, falls, and crush injuries. High-force impact implies an increased risk for associated injuries to accompany the pelvic fracture, as well as significant mortality and morbidity risks. Choosing the optimum course of diagnosis and treatment for these patients can be challenging. The purpose of this review is to supply a contemporary view of the diagnosis and therapy of patients with this important group of injuries. METHODS: A comprehensive review of the medical literature, focusing on publications produced in the last 10 years, was undertaken. The principal sources were found in surgical, orthopedic, and radiographic journals. CONCLUSIONS: The central challenge for the clinician evaluating and managing a patient with a pelvic fracture is to determine the most immediate threat to life and control this threat. Treatment approaches will vary depending on whether the main threat arises from pelvic fracture hemorrhage, associated injuries, or both simultaneously. Functional outcomes in the long-term depend on the quality of the rigid fixation of the fracture, as well as associated pelvic neural and visceral injuries.     

骨盆骨折合并尿道断裂的早期手术治疗

目的探讨骨盆骨折合并尿道断裂的早期手术方法及其治疗效果。方法自1995年1月至2005年1月,共收治骨盆骨折合并尿道断裂患者25例。根据Tile的分型方法,骨盆稳定型损伤1例,旋转不稳定型损伤17例,旋转及垂直均不稳定型损伤7例。尿道完全断裂23例、部分断裂2例。手术方法包括：（1）急诊尿道吻合、尿道会师部分吻合、尿道会师、尿道阴道贯通伤修补,同期行骨盆骨折开放复位内固定术9例。（2）急诊尿道会师,延期（7—21d）行骨盆骨折切开复位内固定术10例。（3）急诊膀胱造瘘,限期（3～21d）行尿道会师及骨盆骨折切开复位内固定术6例。结果术后随访6～120个月,平均34个月。骨盆损伤根据Majeed的疗效标准,优17例,良5例,可3例。尿管拔除后,19例（76％）患者排尿通畅,最大尿流率平均为18．6mL／s,排泄性尿路造影示尿道断端对位良好,瘢痕平均长度为0．51cm;5例（20％）出现不同程度的排尿困难,须定期扩张尿道或改行其他手术;1例（4％）女性患者不能控制排尿,须进一步治疗。术后耻骨上原发软组织撕脱伤感染伴耻骨后脓肿形成1例,后尿道狭窄5例,阳痿3例,尿失禁1例。结论骨盆骨折的早期复位和有效固定是实现“无张力尿道修复”的解剖基础。