封闭式负压引流联合内固定一期治疗骨盆及髋臼骨折合并Morel-Lavallée损伤

ONE-STAGE OPERATION FOR PELVIS AND ACETABULAR FRACTURES COMBINED WITH Morel-Lavallée INJURY BY INTERNAL FIXATION ASSOCIATED WITH VACUUM SEALING DRAINAGE

目的探讨封闭式负压引流(vacuum sealing drainage,VSD)联合内固定一期治疗骨盆、髋臼骨折合并Morel-Lavallée损伤的方法及疗效。方法 2008年6月-2012年10月,收治15例骨盆、髋臼骨折合并Morel-Lavallée损伤患者。男5例,女10例;年龄18~67岁,平均36.8岁。致伤原因:交通事故伤11例,重物压砸伤4例。伤后至入院时间为3 h^9 d,平均5.4 d。Morel-Lavallée损伤部位:髂后上棘上方4例,大转子部7例,大腿近侧前方4例。合并骨盆骨折10例,其中前后挤压型1例,侧方挤压型3例,垂直剪切应力型5例,复合机制损伤型1例;合并髋臼骨折5例,其中横形骨折1例,后柱加后壁骨折1例,横形加后壁骨折1例,双柱骨折2例。骨盆及髋臼骨折均行切开复位内固定,并联合VSD治疗Morel-Lavallée损伤。待引流量<20 mL/d,间断缝合创面或联合游离植皮修复。结果患者住院时间16~31 d,平均20.8 d。13例获随访,随访时间4~16个月,平均7.8个月。Morel-Lavallée损伤均于术后16~36 d愈合,平均21.3 d。骨折手术切口均Ⅰ期愈合,无深部及骨感染发生。X线片复查示骨折均愈合,愈合时间11~18周,平均13.6周。术后6.5个月,8例骨盆骨折按Majeed功能评分,获优5例,良2例,中1例;4例髋臼骨折按照Harris髋关节评分,获优2例,良1例,可1例。结论对于骨盆、髋臼骨折合并Morel-Lavallée损伤,内固定治疗骨折同时联合VSD治疗Morel-Lavallée损伤,既能及时有效治疗Morel-Lavallée损伤,又能保障骨盆、髋臼骨折的手术时机和切口安全。

Objective To investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage （VSD）. Methods Between June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years （mean, 36.8 years）. Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days （mean, 5.4 days）. Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed. Results The hospitalization time was 16-31 days （mean, 20.8 days）. Thirteen cases were followed up 4-16 months （mean, 7.8 months）. The healing time of Morel-Lavallée injury was 16-36 days after operation （mean, 21.3 days）. All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks （range, 11-18 weeks）. At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case; according to Harris hip scoring in 4 cases of acetabular fracture, the results were excellent in 2 cases, good in 1 case, and fair in 1 case. Conclusion To pelvis-acetabular fractures combined with Morel-Lavallée injury, internal fixation treatment for fracture and VSD for Morel-Lavallée injury not only can cure merge Morel-Lavallée injury effectively, but also can guarantee the operation timing and incision safty of the pelvis-acetabular fractures.