基层医院应用损害控制技术治疗骨盆不稳定骨折

Treatment of unstable pelvic fractures using damage control techniques in rural hospital

目的探讨基层医院应用损害控制技术治疗23例不稳定骨盆骨折的疗效。方法回顾性分析铜梁县中医院骨科2007～2011年收治的23例不稳定骨盆骨折合并严重多发伤患者的病例资料,其中男性18例,女性5例;年龄23～52岁,平均35.4岁。按照Mcmurtry的多发伤骨盆骨折救治方案,10例等待择期手术,13例采取损害控制技术治疗。结果本组均治愈出院,随访6～43个月。23例中无一例死亡,术后发生感染6例,L5神经根损伤1例,均治愈。按Matta骨折移位评定标准:优8例,良10例,可5例;优良率达78.3%。结论基层医院虽然条件一般,但可采取早期救治,获得较好效果。基层医院采用损害控制技术,如骨盆外固定支架固定、骨盆骨折止血纱布填塞止血等,可有效提高不稳定骨盆骨折的治疗水平,但在遇到严重、复杂病例时,应早期救治稳定病情后及时转送上级创伤救治中心。

Objective To evaluate the clinical outcomes of damage control techniques in treating 23 patients with unstable pelvic fractures in rural hospital. Methods A retrospective review was conducted on the patients with unstable pelvic fractures who were treated using orthopedic damage control （ ODC ） methods in rural hospital. From 2007 to 2011,23 patients with unstable pelvic fractures were treated with ODC methods in our hospital, such as pelvic fixation with external fixators and pelvic packing. There were 18 males and 5 females, aged from 23-52 years （mean 35.4 years）. Results All patients were successfully treated and discharged. The follow-up was 6-43 months. The postoperative infection was observed in 6 cases, Ls nerve root injury in 1 case, but the 7 cases were successfully managed. Matta evaluation system showed excellent in 8 cases,good in 10 cases, and acceptable in 5 cases. The excellent and good rate was 78.3%. Conclusion For the patients with unstable pelvic fractures in rural hospital, orthopedic damage control such as pelvic fixation with external fixators and pelvic packing can achieve maximize patients＇ survival. In case of severe trauma cases,patients should be sent to the higher-lever trauma centre.