骨盆骨折合并腹部脏器损伤142例临床分析

Clinical analysis of pelvic fractures associated with abdominal organ injuries on 142 cases

目的 探讨骨盆骨折合并腹部脏器损伤的诊断与治疗。方法 回顾性总结 15年收治的 14 2例骨盆骨折合并腹部脏器损伤的致伤原因、手术方法及治疗结果。结果 本组病例全为多发伤 ,休克 91例(6 4 .1% ) ,ISS均值 35。手术治疗 10 3例 ,保守治疗 39例。剖腹探查 91例 ,膀胱修补造瘘 5 6例 ,肝、脾、肾填塞修补或切除 4 5例 ,结直肠修补或造瘘 12例 ,髂内动脉结扎 4 2例 ,选择性动脉造影拴塞 2 9例。本组死亡13例 (9.2 % )。结论 骨盆骨折合并腹部脏器损伤的治疗原则是迅速扩容 ,确定出血原因 ;及时的止血 ;尽早的骨盆固定。结合介入放射技术的应用 ,对提高抢救成功率、降低伤残率、减少死亡率有决定性意义。

Objective To discuss the diagnosis and treatment of pelvic fractures associated with intra-abdominal organ injuries.Methods The cause of trauma,opreative methods and results of 142 cases of pelvic fractures associated with intra-abdominal organ injuries retrospectively in 15 years were summarized.Results All cases in this group were multiple trauma,and 91 cases were in shock stage(64.1%).The average score of ISS was 35.In the group,103 cases received surgical operation,and 39 cases were treated conservatively.In all,laparotomy was performed in 91 cases,bladder anastomosis or cystostomy was performed in 56 cases,hepatic lobectomy,splenectomy,nephrectomy or renal,spleen,liver packing and/or repair were performed in 45 cases,12 cases received colostomy or colon,rectal anastomosis,bilateral internal iliac artery ligation were performed in 42 cases,selective angiography and embolization were performed in 29 cases.Mortality in this group was 9.2%(13 cases).Conclusion The principles in managing pelvic fractures associated with abdominal organ injuries include increase blood volume immediately,find out the cause of bleeding and stop bleeding with laparotomy,pelvic fixation as soon as possible,combination with radiographic and intervention technology.Accurate early diagnosis and effective early treatment are key points to save life,lower the paralysis ratio and decrease the mortality.