骨科损伤控制在严重骨盆骨折治疗中的应用

Damage control orthopedics for severe pelvic fractures

目的探讨骨科损伤控制（DCO）在严重骨盆骨折治疗中的应用及效果。方法对2004年1月～2006年1月应用DCO方法指导治疗的15例严重骨盆骨折患者进行回顾性分析，并以2003年1月～2006年1月未采用DCO方法指导治疗的15例严重骨盆骨折患者作为对照。治疗组中5例骨盆骨折以外固定支架作为终极手术治疗，10例一期行外固定支架治疗，待患者一般情况稳定后二期采用切开复位方法治疗。“开书状”骨盆前环骨折采用外固定支架临时固定，不稳定后环骨盆骨折采用骶髂螺钉、锁定加压钢板微创内固定，骨盆前后环均有严重损伤的患者采用前后路联合微创固定治疗。对照组患者均一期采用切开复位内固定术治疗。结果治疗组13例患者存活，2例死亡，其中1例死于失血性休克，1例死于多器官功能衰竭。术后并发症包括：急性呼吸窘迫综合征3例，腹腔感染1例，股骨骨折骨不连1例，骨盆外固定支架钉道感染2例。对照组10例患者存活，5例死亡，其中2例死于失血性休克，其中2例死于弥散性血管内凝血，1例死于重度感染。结论将DCO应用于严重骨盆骨折的临床治疗有利于对患者进行迅速有效的、旨在抢救生命的整体治疗，提高患者生存率，减少并发症的发生。

Objective To probe the feasibility and effect of damage control orthopedics （DCO） in treatment of severe pelvic fractures. Methods A retrospective analysis was done on the clinical data of 15 cases of severe pelvic fractures treated by DCO from January 2004 to January 2006. Another 15 cases, as a control group, were treated without DCO from January 2003 to January 2006. In the treatment group 5 of them were treated by external fixation as the definitive treatment, and 10 were treated by external fixation at the first stage and ORIF at the second stage after their situation was stable. The ＂open book＂ fractures were treated by external fixation, and unstable fractures of posterior pelvic ring by mini-invasive internal fixation with sacro-iliac screws and LCP pales. For the patients whose anterior and posterior pelvic rings were severely injured, we conducted mini-invasive fixation through anterior and posterior approaches. The 15 cases of the control group were treated by ORIF at the first stage. Results In the treatment group, 13 patients survived, and 2 died, one from hemorrhagic shock and the other from multiple organ failure （MOF）. Postoperative complications included acute respiratory distress syndrome in 3 cases, abdominal infection in l, nonunion of femoral fracture in 1, and nail tract infection in 2. In the control group l0 patients survived, and 5 died, 2 from blood lose shock, 2 from DIC, and one from severe infection. Conclusion DCO benefits patients with severe pelvic fractures in that it allows rapid rescue of a patient＇s life, improves the survival rate, and decreases complications.