27例严重骨盆骨折及合并症的急诊救治体会

Emergent Treatment on 27 Cases of Complicated Pelvic Fractures

目的 总结严重骨盆骨折及其合并症的急诊救治经验。方法 2 7例严重骨盆骨折 ,及时补充血容量纠正休克后 ,常规检查腹部B超、CT ,必要时作髂动脉造影或逆行肾盂造影。血流动力学稳定后按各部位伤情严重情况 ,处理合并伤 :其中行大隐静脉移植术 5例 ,直肠造瘘术 7例 ,膀胱造瘘术 12例 (并行膀胱破裂修补术 6例 ,尿道会师术6例 ) ,会阴撕裂修复术 3例。随后行骨盆骨折外固定手术。结果 2 5例存活 ,2例死于失血性休克。平均住院天数35d ,随访 1～ 2a无骨盆畸形、尿道狭窄等后遗症。结论 早期稳定血流动力学、多种外科手段综合运用、运用外固定器固定骨盆环 ,能够有效提高严重骨盆骨折救治率 ,降低死亡率。

Objective To summarize the experiences of emergent diagnosis and treatment on complicated pelvic fractures. Methods While supplementing blood volume to correct hypovolumia, B-type supersonic examination and CT scan on abdomen were carried out, and angiography or retrograde pyelography were made if necessary in 27 cases of complicated pelvic fracture. After stabilization of hemadynamic state, complicating injuries were managed according to the severity of the respective injury: transplantation of great saphenous vein 5 cases, rectostomy 7 cases, cystostomy 12 cases (combined with repair of ruptured bladder 6 cases, urethral reunion operation 6 cases ), repair of laceration of perineum 3 cases. After that, all pelvic fractures were fixed applying external fixative devices. Results 25 cases of patients survived, with 2 cases of patient died of hemorrhagic shock. Average hospitalization time were 35 days. Follow-up in 1～2 years showed no sequelae such as deformity of pelvic and urethrostenosis.Conclusion Emergency treatment including early stablization of hemodynamic state, comprehensive utilization of various surgical techniques, fixation of pelvic ring by external fixative devices can promote the success rate in rescue process of complicated pelvic fractures effectively and decrease mortality finally.