伤害控制骨科学在合并骨盆骨折多发伤病人救治中的应用体会

目的探讨运用伤害控制骨科学救治合并骨盆骨折的多发伤病人，并选择合适手术时机的临床体会。方法对26例合并骨盆骨折多发伤患者进行伤害控制治疗，根据血流动力学、氧饱和度、体温、有无凝血障碍、尿量、血乳酸盐浓度及G反应蛋白情况选择合适手术时机进行确定性手术，并对患者住院时间、创伤至二次确定手术固定时间和Matta评分等指标进行量化分析。结果除1例骨盆骨折合并严重胸腹外伤患者，抗休克同时急诊剖腹探查术中因多脏器功能衰竭死亡，4例急诊行骨盆外固定架固定，其余21病例选择合适的确定性手术时机，行骨盆内固定，从创伤至二次确定手术固定时间5～26d，平均9．7d，平均住院天数32．5d，经12～24个月，平均16个月的随访，各部位骨折均达到骨性愈合，肢体功能恢复满意，平均Matta骨盆髋臼骨折功能评级优良率93％．结论对合并骨盆骨折的严重多发伤病人进行伤害控制性治疗选择合适手术时机，疗效满意。

Application of damage control orthopedics to treatment of polytrauma patients with pelvic fracture

Objective To explore the efficacy of damage control orthopedics on polytrauma panents with pelvic fraeture,and to analyze the appropriate operating opportunity for them. Methods 26 pelvic-fractured patients with multiple traumas underwent damage control orthopedics, and appropriate operating opportunities were selected according to the hemodynamics, oxygen saturation, coagulation time, urinary output, lactate concentration and C-reactive protein. Then the hospitalization time, determined fixation operation time and Matta score were analyzed. Results One patient complicated with thoraco-abdominal injuries died of MODS during exploratory laparotomy. Four patients had external fixation emergency-operation. Twenty-one patients were applied determined fixation operation at appropriate time,the average period was 9.7 days from the trauma to the determined operation, and hospitalization time was 32. 5 days,After 16 months of follow up period on average, fractures of each part all obtained bone union and their limb functions recovered satisfactorily with fineness rate of 93 % according to Metta score. Conclusion Choosing appropriate operating opportunity to damage control orthopedics is effective on severe polytrauma patients with pelvic fracture.