骨盆骨折动脉损伤的影像学研究及临床治疗

Imageologic study and clinical treatment of pelvic fractures combined with artery injuries

目的探讨骨盆骨折动脉损伤的影像学特点及动脉栓塞的方法。方法自1999年1月至2005年6月,收治因骨盆骨折致血流动力学不稳患者60例。男42例,女18例；年龄21～52岁,平均34．5岁。交通伤32例,压砸伤13例,坠落伤9例,其他伤6例。入院时均处于休克状态,常规摄骨盆后前位、出口位及人口位X线片。在抗休克治疗同时,行髂动脉造影。结果后环骨折25例,损伤血管64支；前环骨折13例,损伤血管17支；髋臼骨折6例,损伤血管12支；混合骨折16例,损伤血管36支。1例髂总动脉血栓形成行人造血管移植；4例髂外动脉损伤,3例血栓形成(1例行手术取栓,1例行溶栓再通术,1例未处理),1例破裂行修复术；50例为髂内动脉及其分支损伤出血,行动脉栓塞；5例未发现明显血管损伤。3例死亡。结论根据骨盆骨折X线表现可预测血管损伤类型,后环骨折容易引起臀上动脉、骶外侧动脉及髂腰动脉损伤,前环骨折易损伤闭孔动脉,最易损伤的动脉是臀上动脉。栓塞出血动脉的断端及其吻合支是最佳的治疗方法。

Objective To explore the imageologic characteristics of pelvic fractures with artery injuries and the treatment methods for embolization of arteries. Methods From January 1999 to June 2005, 60 cases （42 males and 18 females） aged 21-52 years （average 34.5 years） with pelvic fractures and unsteady blood dynamics were admitted into our hospital. There were 32 cases with traffic injury, 13 with crushing injury, nine with fall injury and six with other injuries. The mean injury severity score was 39 _＋ 16 （ 16 - 66）. All cases were hypotensive with systolic blood pressure less than 90 mm Hg on the arrival. Routine X-ray examination of dorsaventral, debouch and porch of pelvis was performed. The average amount of blood transfusion was 2 886 ml. All cases underwent iliac artery angiography and pelvic arteriography. Results X-ray examination of pelvic fractures showed posterior pelvic fracture in 25 cases, with 64 branches of blood vessels injured; anterior pelvic fracture in 13, with 17 branches of blood vessels injured; acetabular fracture in six, with 12 branches of blood vessels injured; and combined pelvic fracture in 16, with 36 branches of blood vessels injured, Three cases died, with mortality rate of 5%. One case with common arterial thrombosis was treated with artificial blood vessel transplantation, four cases with external iliac artery injuries including one with artery rupture were treated with prosthesis, and among the three cases with external iliac artery thrombosis, one was treated with dislodgment of thrombosis, one treated with recanalization of thrombolysis and one did not give any treatment. Fifty cases with injury and bleeding of internal iliac artery and its branches were treated with arterial embolization. Five cases showed no obvious injury. Conclusions The types of artery injuries can be predicted through X-ray of pelvic fracture. Posterior pelvic fracture may easily cause injury to superior glnteal arteries, iliac lumber arteries, and lateral sacral arteries. While anterior pelvic fracture will cause injury to obturator arteries. Superior gluteal artery is susceptible to injury. Embolization of injured arteries and anastomosis are preferred treatment for pelvic arterial disruptions.