外固定支架联合负压封闭引流技术治疗开放性骨盆骨折

Treatment of open pelvic fractures with external fixation and vacuum sealing drainage

目的探讨外固定支架联合负压封闭引流（VSD）技术治疗开放性骨盆骨折的疗效。方法2004年11月至2010年4月共收治7例开放性骨盆骨折患者，男3例，女4例；年龄2～43岁，平均29．3岁。致伤原因：交通伤4例，坠落伤1例，砸压伤1例，挤压伤1例。骨盆骨折按Tile分型：B1型5例，B2型1例，C1型1例。软组织损伤均为开放性损伤，累及髂骨部、臀部、会阴部及腹股沟周围软组织。开放性损伤根据Gustilo—Anderson分型：均为Ⅲ型，均伴有多器官合并伤。创伤严重程度评分为29～57分，平均40．4分。7例早期均采用外固定支架于双侧髂骨前固定骨盆，创面行VSD技术治疗。结果本组7例早期救治过程中1例死亡，3例重型患者行一侧髋臼离断术。6例随访1．5～67个月（平均27．6个月），5例患者骨折均愈合良好，创面修复重建良好；1例创面植皮生成良好，骨折基本愈合。1例出现阴茎勃起功能障碍，1例出现排便功能障碍后遗症。结论开放性骨盆骨折早期行外固定支架固定并联合VSD技术治疗能有效稳定骨盆、减少出血、降低并发症和后遗症的发生率，临床疗效满意。

Objective To report outcomes of treating open pelvic fractures with external fixation andvacuum sealing drainage. Methods Seven open pelvic fractures patients were treated at our hospital from November 2004 to April 2010. They were 3 males and 4 females, aged from 2 to 43 years （mean, 29.3 years）. The fractures were caused by traffic accidents （4 cases）, falling （one case）, smashing （one case） and crushing （one case）. According to the Tile classification, 5 were type B1, one was type B2 and one type C1. All were complicated with injuries to soft tissue and organs. By the Gustilo-Anderson classification, open in- jury was all type Ⅲ, involving soft tissues around the ilium, hip, perineum and inguina. The injury severity score （ISS） ranged from 29 to 57 （average, 40.4） . The fractures were treated with external fixation and the wounds with vacuum sealing drainage. Results One patient died during early treatment and 3 had to sustain amputation of the acetabulum. Six patients were followed up for 1.5 to 67 months （mean, 27.6 months）. Five patients reported good functional response in fracture healing and fine wound repairing outcome. One case reported good tissue generation after wound skin grafting and fundamental fracture healing. Two cases respectively reported erectile dysfunction of penis and functional disorder of defecation. Conclusion In treatment of open pelvic fractures, external fixation and vacuum sealing drainage can effectively stabilize the pelvic ring, and reduce bleedim, and complications as well.