不稳定型骨盆骨折的治疗体会

Treatment of unstable pelvic ring 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教训。方法回顾2007年1月～2011年11月诊疗的32例不稳定型骨盆骨折的临床资料。以骨科损伤控制理论为指导,一期采取抗休克、稳定生命体征、过渡性简单外固定治疗,然后实施有效内固定手术恢复骨盆的稳定性。结果本组随访6～64个月,平均29个月。有3例切口感染,经抗感染、换药、理疗等治愈;L5神经根损伤1例,6个月后功能完全恢复。1例骨盆有倾斜,患肢短缩2 cm。按Matta骨折移位评定标准,优14例,良13例,可4例,差1例,优良率达87.1%。结论合理的急救处理是不稳定型骨盆骨折治疗的重要基础;及时把握手术时机,选择合理的手术入路和固定方案,行二期切开复位内固定治疗,多可获得满意的疗效。

Objective To retrospectively evaluate the clinical experience of early emergency and operative treatment of unstable pelvic fractures. Methods From Jan. 2007 to Nov. 2011, thirty-two cases of unstable pelvic ring fracture were treated. According to orthopedic injury control theory, anti-shock, stable vital signs, transitional simple external fixation were implemented, and then the effective internal fixation were performed to restore the stability of the pelvis. Results The patients were followed up for a mean of 29 months, from 6 months to 64 months. 3 cases of wound infection were healed by anti-infective, incision cleaning and physical therapy cure; L5 nerve root injury in 1 case, and returned six months after injury. One cases of pelvic tilt, limb shortening 2 cm.According to the Matta standards, the results were excellent in 14, good in 13,fair in 4, and poor in 1, with excellence rate of 87.1%. Conclusion Timely and reasonable first-aid treatment is an important basis for the treatment of unstable pelvic fracture; promptly grasp the timing of surgery, promptly grasp the timing of surgery, the reasonable choice of surgical fixed program are basic of satisfactory results.