选择性动脉造影与栓塞在血流动力学不稳定骨盆骨折诊治中的应用

Recurrent and selective angiographic embolization for patients with haemodynamicaHy unstable pelvic fracture

目的探讨选择性动脉造影与栓塞在诊治骨盆骨折伴血流动力学不稳定患者中的应用。方法回顾性分析2002年1月至2008年12月收治的62例骨盆骨折伴动脉损伤患者资料，骨折采用AO分型：A2型2例；B1型6例，B2型9例，B3型8例；C1型16例，C2型13例，C3型8例。其中开放性损伤6例（Gustilo分型：Ⅱ型1例，Ⅲ型5例）。多发伤患者46例，12例发生休克。62例患者在积极补液及应用血管活性药物的同时进行动脉造影检查，其中59例患者行栓塞治疗。结果62例患者行动脉造影79次，其中行2次以上动脉造影患者12例。损伤动脉由多至少依次为臀上动脉、髂腰动脉、骶外侧动脉、闭孔动脉、臀下动脉、阴部内动脉以及髂内动脉和髂外动脉的主干。32例患者伴有两条以上动脉（分支）损伤。59例行骨盆内动脉损伤栓塞治疗的患者中，56例有效。7例患者因腹腔脏器严重损伤抢救无效而死亡，10例失访，45例患者术后获6～52个月（平均14个月）随访。11例患者患侧臀部肌肉力量较健侧弱，未见其他明显并发症。12例多次行选择性动脉造影与（或）栓塞治疗的患者均获随访，其中2例发生患侧臀部肌肉力量减弱。结论选择性动脉造影与栓塞是诊治骨盆骨折患者动脉损伤的有效措施。对于多发动脉损伤或延迟动脉损伤的患者，重复性动脉造影和栓塞治疗是必要且安全有效的。

Objective To evaluate the effect of selective angiography and embolization for the patients with haemodynamically unstable pelvic fracture. Methods Sixty-two patients with haemodynami- cally unstable pelvic fracture were treated in our hospital from 2002 to 2008. Their pelvic fractures were classified on the basis of their X-ray and CT data. By AO classification, there were 2 cases of type A2, 6 B1, 9 B2, 8 B3, 16 C1, 13 C2, and 8 C. There were 6 cases of open injury （by Gustilo classification, 1 type Ⅱ and 5 type Ⅲ ）. Of the 46 cases of multiple injuries, 12 had shock. While active fluid infusion and vascular medication were conducted, the angiograph was done for all patients, 59 of whom also received embolization. Results Seventy-nine angiographs were performed for the 62 cases, and 12 of them received more than twice angiographs. Exams revealed that 32 patients had suffered injury to more than 2 arteries. The injured arteries were sequentially superior gluteal artery, iliolumbar artery, lateral sacral artery, obturator artery, inferior gluteal artery, internal pudendal artery, internal iliac artery and external iliac artery. Of the 59 cases of embolization, 56 were successful. Seven patients died due to severe abdominal organ injury. Forty-five patients got an average follow-up of 14 months （range, 6 to 52 months） . No severe complications were noticed. Conclusions Selective angiography and embolization is an effective intervention for patients with haemodynamieally unstable pelvic fracture. It is mandatory to conduct recurrent angiographic embolization for patients with multiple artery injuries or delayed artery injuries.