腹部脏器损伤合并骨盆骨折和休克患者的损伤控制治疗

Damage control orthopedics in treating patients of severe pelvic fractures combined with shock and abdominal organ injuries

目的探讨一体化损伤控制救治模式对腹部脏器损伤合并休克患者的救治效果。方法回顾性分析2009年6月至2014年9月本院收治的血流动力学不稳定型骨盆骨折合并腹部脏器损伤患者32例,所有病例损伤严重度评分(ISS)平均36.1分(35.2±2.94),采用院前院内一体化损伤控制救治模式进行治疗。腹部损伤应用填塞止血、简单修补、结肠造瘘等方法处理,病情稳定后再二期行骨折确定性内固定、腹部脏器确定性修复重建手术。统计分析患者抢救成功率、死亡率、并发症发生率、临床疗效等指标。结果 32例患者中死亡5例(15.62%),抢救成功率84.38%,发生严重并发症6例(18.75%)。24例行二期内固定手术,术后恢复良好,有2例发生伤口愈合不良;患者行腹部脏器损伤二期重建手术均顺利度过围手术期,未发生严重术后并发症。结论严重骨盆骨折合并腹部脏器损伤病情危急、处理复杂,应用院前院内一体化损伤控制救治模式进行多科协作救治,能有效提高救治成功率。

Objective To study the therapeutic effect of treating patients of hemodynamically unstable pelvic fractures combined with abdominal organ injuries. Methods The clinical data of thir-ty-two patients admitted to our hospital from June 2009 to September 2014 with hemodynamically un-stable pelvic fracture combined with abdominal organ injury were collected in the follow-up study. The mean ISS was 36.1（35.2±2.94）. All 32 patients were treated with the integrated pre-hospital and in-hospital Damage Control Orthopedics Model , including packing hemostasis , simple surgical repair , colostomy, etc. In the secondary union when the patients were in the stable condition, deterministic in-ternal fixation and definitive operation for abdominal organs were applied. The salvage rate, death rate, complication incidence and curative effect incidences were calculated. Results Five patients died and the death rate was 15.62%. Six patients （18.75%） suffered from severe complications. Twenty-four pa tients, after deterministic internal fixation, were in a favorable postoperative recovery; among them, 2 were in poor wound healing. All the patients undergoing the reconstructive surgery for abdominal organs in the secondary union recovered well during the perioperative period and had no severe complications. Conclusions Hemodynamically unstable pelvic fractures combined with abdominal organ injuries can be life-threatening and require complex treatments. The integrated pre-hospital and in-hospital Dam-age Control Orthopedics and inter-disciplinary cooperation are important requirements for management and successful treatment.