急诊介入动脉栓塞术联合经皮微创螺钉内固定术救治骨盆骨折合并失血性休克(附21例分析)

目的探讨急诊介入动脉栓塞术联合经皮微创螺钉内固定术治疗骨盆骨折合并失血性休克的可行性及安全性。方法回顾性分析21例骨盆骨折并失血性休克患者的资料,21例患者均接受急诊介入动脉栓塞术联合经皮微创螺钉内固定术。经皮微创螺钉内固定术均在介入栓塞术后立即进行。结果 21例患者中,经股动脉造影明确动脉出血18例,均接受相应介入栓塞治疗;另3例造影未见明显动脉出血,接受可疑出血侧髂内动脉预防性栓塞治疗。每例患者经皮微创螺钉内固定术用时均不超过90min。患者术后均未出现严重介入动脉栓塞相关并发症。18例术后好转出院;3例死亡,其中2例术后因多器官衰竭或弥散性血管内凝血死亡,1例术后仍继续出血,因失血性休克死亡。术后随访3个月~18个月,平均(10.81±2.62)个月,所有存活患者骨折均达到骨性愈合,功能良好。结论急诊介入动脉栓塞术联合经皮微创螺钉内固定术治疗骨盆骨折并失血性休克安全、快速、有效且并发症少。

Treatment of pelvic fracture and hemorrhagic shock by emergency interventional arterial embolization combined with percutaneous minimally invasive screw internal fixation:Report of 21 cases

Objective To explore the feasibility and safety of emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation in the treatment of pelvic fracture combined with hemorrhagic shock. Methods A retrospective analysis of 21 patients with pelvic fractures and hemorrhagic shock who were treated with emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation was performed. The percutaneous minimally invasive screw fixation was performed immediately after embolization. Results There were 18 of 21 cases with obvious arterial bleeding confirmed by femoral artery angiography. And the corresponding interventional embolization was performed. No obvious arterial hemorrhage was found in the other 3 cases who received suspicious hemorrhagic internal iliac arterial prophylactic embolization. The time-consuming of percutaneous minimally invasive screw fixation was no more than 90 min for each patient. There was no servious complication associated with arterial embolization after intervention. Totall 18 cases were improved after discharge. Another 3 cases died, including 2 cases died for postoperative multiple organ failure or disseminated intravascular coagulation, 1 case died for hemorrhagic shock caused by still continue bleeding after surgery. The postoperative follow-up was performed during 3-18 months with the average of (10.81±2.62) months. The fractures in all the surviving cases achieved bone healing with good function. Conclusion The emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation is a safe, fast and effective method for the treatment of pelvic fractures and hemorrhagic shock with less complications.