合并骨盆骨折严重多发伤的一体化救治

目的探讨合并骨盆骨折严重多发伤的治疗方法。方法回顾性分析2002年3月～2008年12月间通过院前急救、院内创伤专业化诊治的一体化救治模式救治89例合并骨盆骨折严重多发伤的临床资料,分析我院一体化救治特点和提高疗效的关键因素。结果本组髂内动脉栓塞14例、结扎27例,骨盆填塞2例;腹腔脏器手术64例;胸腔闭式引流及呼吸支持29例;开颅手术5例;脊柱四肢骨折内固定42例;软组织修复26例。死亡率5.6%(5/89),死因为多器官功能障碍综合征(MODS)。最终骨盆内固定72例,外固定12例。并发症:骨折深部感染5例,深静脉血栓5例,脂肪栓塞综合征3例,肺不张8例,黏连性肠梗阻4例,Ⅰ型呼衰8例,急性肾功能衰竭2例。84例平均随访12.6个月,按刘利民等评价标准:优53例,良21例,中7例,差3例;优良率88.1%(74/84)。结论院前急救与院内创伤专业化诊治的一体化救治及并发症处理是提高合并骨盆骨折严重多发伤疗效的关键。

Integrated treatment of pelvic fractures with severe polytrauma

Objective To study the methods of treatment for pelvic fractures with severe polytrauma.Methods A retrospective study was done on clinical treatment of 89 patients of pelvic fractures with severe polytrouma admitted from Mar.2002 to Dec.2008.Results To control massive bleeding due to pelvic fracture,internal iliac artery embolization was performed in 14 cases,internal iliac artery ligation in 27 cases,pelvic packing in 2 cases,intervention surgery on abdominal viscera in 64 cases,closed drainage of pleural cavity and respiratory support in 29 cases,craniotomy in 5 cases,internal fixation of the fractures of spine or limb in 42 cases,repair of soft tissue in 26 cases.The mortality was 5.6%（5/89）,and the main cause was multiple organ dysfunction syndrome（MODS）.Among 84 survivals with pelvic reconstruction,internal fixation was achieved in 72 cases,and external fixation in 12 cases.Peri-operative complications involved in 5 cases of deep infection,5 deep vein thrombosis（DVT）,3 fat embolism syndrome（FES）,8 atelectasis,4 adhesive ileus due to laprotomy,8 typeⅠ respiratory failure,and 2 acute renal failure（ARF）.All patients were followed up for average 12.6 months.According to criteria described by Liu li-min,fair in 7 cases and poor in 3 cases,the excellent and good rate was 88.1%（74/84）.Conclusion The key to improve curative effect lies in the integrated treatment of traumatology,and management of peri-operative complications.