C型不稳定骨盆骨折的外科治疗

Surgical treatment for AO type-C injuries of the pelvic ring

目的分析C型不稳定骨盆骨折的特点,评价其外科治疗效果。方法回顾性分析我科2007年6月～2009年12月治疗的27例C型不稳定骨盆骨折患者资料。男性16例,女性11例;年龄17～61岁,平均35.6岁。道路交通伤13例,坠落伤8例,砸伤6例。按AO分型:C1型23例,C2型3例,C3型1例;2例为开放性骨盆损伤。27例均为严重多发伤患者,ISS评分17～50分,平均29分。入院时间为伤后30分钟～21天,其中12例为伤后24小时内入院,其余15例在受伤1天后入院。结果 27例中1例入院后立即死亡,1例伤后第5天死亡。18例采用了切开复位内固定(ORIF)治疗,6例外固定支架固定治疗,2例外固定支架+ORIF治疗。骨盆骨折ORIF术后1例发生伤口感染。外固定支架固定术后有3例发生感染,均伴随有骨盆会阴部大面积的皮肤脱套伤。21例获得随访,按照Majeed功能评分,平均81分(52～96分),其中优11例,良7例,可2例,差1例。结论 C型不稳定骨盆骨折合并损伤多且重,早期积极地固定控制出血和处理合并伤,重建期ORIF治疗可获得满意的疗效。

Objective To evaluate of the outcome of surgical treatment of AO type-C injuries of the pelvic ring.Methods From Jun.2007 to Dec.2009,27 patients with AO type-C injuries of the pelvic ring were treated in our department.There were 16 males and 11 females,aging from 17 to 61 years.Fractures were caused by traffic accident in 13 cases,high falling in 8 cases and crushing injury in 6 cases.According to the AO classification system,there were 23 type C1,3 type C2,1 type C1.Of 27 cases,2 were open fractures.All patients were multiple injuries,the mean Injury Severity Score（ISS） was 29（17-50）.Twelve patients were admitted into hospital within 24 hours after the initial injury and 15 patients were referred to our hospital 1 day after the initial injury.Results Of 27 cases,one died immediately after admission,another one died 5 days after initial injury.Totally 18 patients were treated by open reduction and internal fixation（ORIF）,6 external fixation（EF） and 2 EF＋ORIF.There was 1 case of postoperative surgical wound infections after ORIF.There were another 3 surgical wound infections,both occurring in patients with a disgloving soft tissue injury.A total of 21 patients completed the Majeed functional assessment at the final follow-up.The mean score was 81 points（range 52-96）,which were graded as 11 excellent,7 good,2 fair,and 1 poor.Conclusion Patients with AO type-C injuries of the pelvic ring have many severer associated injuries.The outcome is satisfactory if the bleeding is controlled immediately,associated injuries are treated actively and the fractures are treated by ORIF in the reconstruction phase.