严重骨盆骨折的救治

目的探讨严重骨盆骨折的治疗方法和疗效。方法总结、分析从1992年1月至2007年12月收治的严重骨盆骨折患者106例。按照Tile分型B型47例，C型59例。其中骶髂关节脱位或分离21例，髋臼骨折伴中心性脱位19例，8例耻骨联合明显分离。106例均有不同程度创伤性休克，58例并发腹膜后血肿，26例并发肝脾破裂或肠管破裂或尿道损伤。结果106例经综合治疗，103例救治成功，死亡3例。病情稳定后19例髋臼骨折伴中心性脱位患者14例行手术治疗，根据Matta的复位标准：解剖复位10例，良好复位3例，差1例。根据美国矫形外科研究院髋关节功能评定标准：优9例，良2例，可2例，差1例；8例耻骨联合明显分离患者行切开复位钢丝或钢板内固定，分离纠正。结论早期正确的诊断、多学科协同抢救患者生命是治疗严重骨盆骨折的关键，可降低死亡率；病情稳定后部分病例行再手术内固定，可降低病残率。

The remedy of severe pelvic fracture

Objective To investigate the therapeutic method and effect for severe pelvic fracture. Methods 106 severe pelvic fracture subjects between January 1992 and December 2007 were summarized and analyzed. According to Tile type, 47 cases were B type and 59 cases were C type, in which 21 cases were with dislocation or disjunction of articulatio saeroiliaea,19 cases with fracture of acetabulum and central dislocation, 8 cases with disjunction apparently of symphysis pubis, 106 cases with wound shock in different degree, 58 cases supervened retroperitoneal hematoma and 26 cases supervened splenic rupture and hepatorrhexis or intestinal tracheal rupture or urethral injury. Results After combined therapy, of the 106 patients, 103 cases were successfully remedied and 3 cases died. Of the 19 patients with fracture of acetabulum and central slip, 14 were undertaken operation after pathogenetic condition stabilized. According to reposition standardization of Matta, 10 cases were with anatomical reposition, 3 cases with reposition well, 1 case bad. According to articulatio coxae functional evaluation standardization from American Academy of Orthopaedic Surgery, 9 cases were excellent, 2 well, 2 common,1 bad; 8 patients with disjunction apparently of symphysis pubis were rectificated after operation of open reduction and internal fixation with steel-wire or steel plate. Conclusion Early and correct diagnosis and cooperation between divisions is critical for therapy for severe pelvic fracture and can decrease fatality; some of patients undertaken operation of internal fixation after pathogenetic condition stabilized can de, crease the rate of disability.