不稳定型骨盆骨折的救治及手术治疗

The emergency and operative treatment of unstable pelvic fractures

[目的]探讨不稳定型骨盆骨折的早期救治和二期手术治疗经验。[方法]回顾性分析总结2006年7月～2009年12月救治的21例不稳定型骨盆骨折的临床资料。平均年龄37岁(19～58岁);男13例,女8例;平均创伤严重性评分(ISS)为34分(16～59分);按照Tile分型:B型16例(B1型7例,B2型6例,B3型3例),C型5例;17例患者合并其他部位损伤。一期行稳定骨盆、抗休克、处理合并伤等,待生命体征稳定后行切开复位内固定治疗。术后通过Majeed量表评估患者功能愈后。[结果]本组病例平均随访27个月(16～42个月)。平均手术时间为195 min(60～510 min);平均输血量为700 ml(400～1 800 ml);平均骨折愈合时间为13周(11～17周);平均Majeed评分为84.3分(62～100分),其中优10例,良9例,中2例,优良率为90.4%。有1例存在明显步态异常,1例存在马蹄足畸形,均为神经损伤患者。[结论]不稳定型骨盆骨折的合理术前急救处理非常重要,对于此类损伤,应及时稳定骨盆骨折并处理合并伤,在合适的手术时机二期行切开复位内固定治疗,多可获得满意的疗效。

[Objective]To retrospectively evaluate the outcome of early emergency and operative treatment of unstable pelvic fractures.[Method]The outcome of 21 unstable pelvic fractures treated from July 2006 to December 2009 in our department were reviewed.There were 13 males and 8 females,the mean age were 37 years（range,19 to 58 years）.The mean ISS were 34 points（range,16 to 59）.According to Tile classification,there were 16 type-B（7 type-B1,6 type-B2 and 3 type-B3） and 5 type-C fractures.Seventeen patients were combined with other injures.First,patients were treated with stabilizing the pelvic fractures,anti-shock and treatment of combined injuries.Then the pelvic fractures were treated with open reduction and internal fixation.Majeed scale was used to evaluate the outcomes.[Result]The mean follow-up time were 27 months（range,16 to 42 months）.The mean operative time were 195 minutes（range,60 to 510 minutes）,the mean blood transfusion were 700ml（range,400 to 1800 ml）,the mean bone union time were 13 weeks（range,11 to 17 weeks）,and the mean Majeed score were 84.3 points（range,62 to 100 points）.The functional outcome reached to being excellent in 10,good in 9,and fair in 2,with a good and excellent result of 90.4%.One patient showed sever gait abnormal,and another showed clubfoot,patients were combined with nerve injuries.[Conclusion]Timely and properly preoperative treatments are important to unstable pelvic fractures,especially for those combined with other injuries.Second open reduction and internal fixation of pelvic fractures can obtain satisfactorily functional outcomes.