骨盆骨折急救中外固定架的应用

Application of External Fixator in Rescue of Unstable Fractures

目的:探讨不稳定性骨盆骨折急救中外固定架固定术的可行性。方法:根据骨盆不稳定型骨折的Tile创伤分类,对从2001年1月-2004年12月收治的不稳定型骨盆骨折36例进行分类并采用外固定架治疗。结果:本组36例,术后3d死亡1例,失访2例,33例获得3月-24月随访,总优良率为84.8%(28/33)。结论:不稳定性骨盆骨折,特别是合并循环不稳定者,必须在伤后早期妥善固定这一概念和做法仍未得到足够的重视,致使部分骨盆骨折大出血得不到控制,以至休克程度加重,引发脂肪栓塞综合症、弥漫性血管内凝血、多器官功能不全综合征等严重并发症,甚至死亡。因此,强调在急诊科救治时及早固定不稳定型骨盆骨折至关重要。同时,外固定术具有创伤小,操作简单、便于护理早期离床,并发症少等优点,易于基层推广应用。

Objective： To explore the feasibility of the external fixation in the rescue of the unstable bone fractures. Methods： According to Tile,36 cases of un.stable pelvic fractures from Jau. 2001 to Dec. 2004 were classified and received external fixation theraphy. Results： There were 36 cases in all in the group, one of them was dead on the third day after operation, 2 cases were lost, 33 cases were followed up from 3 months to 24 months, the excellent and good rate was 84.8%. Conclusion： The pelvic fracture, especially combined with unsteady circulation, must be fixed correctly as soon as possible. But this concept and practice had not gotten enough attention. It made some hemorrhage become uncontrol, aggrevates the shock, may cause the fat embolism syndrome, diffused intravascular coagulation（DIC）, multiple organ dysfunction syndrome（MODS）, even death. Therefore, fixing unstable fractures as soon as possible at emergency agency should be very important. Moreover, external fixation might have many advantages, as little trauma, simple operation and few complications. Also, it should be much easier to care the patients and patients recover quickly. So it should be easy to carry out in base hospitals.