损伤控制在重度骨盆骨折中的应用

Damage Control Orthopaedics in Treatment of Severe Pelvic Fractures

目的探讨骨科损伤控制理论（damage control orthopaedics，DCO）在治疗重度骨盆骨折的初步临床应用结果。方法2004年8月至2007年10月应用DCO方法治疗20例重度骨盆骨折患者。其中4例以外固定支架作为终极治疗，8例前后环均不稳定的骨盆骨折以外固定支架结合股骨髁上骨牵引作为终极治疗，8例一期行外固定支架固定待患者生命体征平稳后二期采用前和／或后路切开复位内固定方法治疗。结果经平均10个月（4～18个月）的随访，20例患者有1例死亡，1例因脑挫裂伤经治后成植物人无生活质量，无内外固定失败等并发症的发生，2例出现跛行、行走痛，1例女性患者出现性交痛。结论应用DCO理论治疗重度骨盆骨折可迅速有效地抢救病人的生命，提高生存率，稳定骨折，减少并发症的发生。

Objective To investigate the clinical effect of damage control orthopedics （DCO） in treatment of severe pelvic fractures. Methods A retrospective study was carried out in 20 cases of severe pelvic fractures treated from Augest 2004 to October 2007,4 cases of them were treated by exteral fixation as the definitive treatment,8 cases were treated by exteral fixation in coordination with skeletal traction from supracondylar of the femur as the definitive treatment ,8 cases whose anterior and posterior rings were both unstable were treated by exteral fixation in coordina- tion with skeletal traction from supraeondylar of the femur at the first stage and ORIF through anterior and/or poste rior approaches at the second stage after their situation was stable. Results At an average follow-up of 10 months （44 18 months ）, 1 case died who was an 65-years-old man suffered with C3 pelvic fracture combined with hepatic disruption and mesentery disruption,1 case combined with severe contusion and laceration of brain was treated by DCO become plant man who had no living quality. Postoperative complications included superficial infection in 1 patient, claudication and walking pain in 2 patients,and algopareunia in 1 female patient. Conclusion DCO benefits patients with severe pelvic fractures in that it allows rapid rescue of patients＇lives, improves the survival rate ,and decreases complication.