伴发骨盆骨折的腹部损伤病例分析

Clinical analysis of abdominal injuries associated with pelvic fractures

目的:探讨伴发骨盆骨折时腹部损伤的诊断及治疗方法。方法:回顾性分析2008-09-2011-09期间我院收治47例伴发骨盆骨折的腹部损伤病例的致伤原因与脏器损伤关系,探讨脏器损伤的早期诊断及治疗原则。结果:车撞伤29例、坠落伤11例、压砸伤7例,X线或CT证实为骨盆骨折,腹部超声或CT均提示腹腔积液;伴发失血性休克32例、肝破裂3例、脾破裂5例、肠系膜破裂4例、小肠破裂4例、直肠破裂3例、膀胱破裂3例、尿道断裂2例;手术治疗18例,包括2例阴性探查,无死亡病例。结论:伴发骨盆骨折的腹部损伤在早期进行抗休克等治疗的同时应对患者的致伤原因、临床表现、化验检查及影像学进行综合分析,并逐步分类排除脏器损伤,不能排除时果断剖腹探查对提高抢救成功率、降低死亡率有重要意义。

Objective：To discuss the diagnosis and treatment of abdominal injuries associated with pelvic fractures.Method：The relationship between the cause of trauma and organ injuries of 47cases of abdominal injuries associated with pelvic fractures retrospectively from September 2008to September 2011were summarized and early diagnosis and therapeutic principle on organ injuries were discussed.Result：In this group,29cases of traffic accident injuries,11cases of fall wound and 7cases of crush injuries proved to have pelvic fractures by X-ray or CT examination.Seroperitoneum was prompted by abdomen ultrasound and CT examination.In all,hemorrhagic shock was performed in 32cases,liver,spleen,mesentery,small intestine,rectum,bladder and urethra were ruptured respectively in 3cases,5cases,4cases,4cases,3cases,3cases and 2cases.In these cases,18cases received surgical operations including 2case of negative operation and no patient died.Conclusion：Countershock and other treatments should be performed in the initial stage of abdominal injuries associated with pelvic fractures,meanwhile,the cause of trauma,clinical manifestation,chemical examination and imageology should be also synthetically analyzed and organ injuries should be gradually eliminated.Exploratory laparotomy may be significant to raise achievement ratio of salvage and reduce mortality if organ injuries can not be eliminated.