损伤控制性骨科手术在不稳定型骨盆骨折治疗中的应用价值

The application value of damage control orthopedics surgery in the management of unstable pelvic fractures

目的：探讨损伤控制性手术在不稳定型骨盆骨折治疗中的临床应用价值。方法回顾性分析2011年1月至2015年12月慈溪市人民医院收治的107例不稳定型骨盆骨折患者临床资料，根据患者采用手术方法将患者分为损伤控制性手术组（59例）和 I 期切开复位内固定组（48例）。观察两组术后并发症、骨折复位质量 Lindahl 评价、Majeed 功能评分、住院时间和院内病死率。结果与Ⅰ期切开复位内固定组相比，损伤控制性手术组多脏器功能障碍发生率显著降低（23．73％比45．84％，χ2＝5．793，P ＝0．016）；骨折复位质量Lindahl 评价优良率显著增高（93．22％比79．17％，χ2＝4．597，P ＝0．032）；术后3个月时 Majeed 功能显著增高[（84．41±10．33）分比（74．85±10．72）分，t ＝4．678，P ＝0．000]；院内病死率显著降低（15．25％比31．25％，χ2＝3．892，P ＝0．049）。两组脓毒症、弥漫性血管内凝血、肺栓塞、深静脉血栓、肺部感染、肠梗阻和住院时间等发生率差异均无统计学意义（均 P ＞0．05）。结论损伤控制性骨科手术显著降低不稳定型骨盆骨折患者术后并发症，改善骨盆功能恢复，降低院内病死率。

Objective To investigate the application value of damage control orthopedic surgery in the man-agement of unstable pelvic fractures.Methods From January 2011 to December 2015,107 patients with unstable pelvic fractures were retrospectively studied.All patients were signed into the damage control surgery group （59 cases）or open reduction and internal fixation in stage I group （48 cases）.The postoperative complications, Lindahl evaluation of the quality of fracture reduction,Majeed function score,hospital duration and mortality were observed.Results Compared with the open reduction and internal fixation in stage I group,patients in the damage control surgery group got a significantly lower rate of multiple organ dysfunction （23.73% vs.45.84%,χ2 =5.793, P =0.016）;a higher excellent and good rate of Lindahl evaluation of the quality of fracture reduction （93.22% vs. 79.17%,χ2 =4.597,P =0.032 ）;a higher level of Majeed function score three months after the operation [（84.41 ±10.33）vs.（74.85 ±10.72）,t =4.678,P =0.000];and a higher rate of hospital mortality（15.25% vs.31.25%,χ2 =3.892,P =0.049）.There were no differences between the two groups in sepsis,disseminated intravas-cular coagulation,pulmonary embolism,deep vein thrombosis,pulmonary infection,intestinal obstruction and hospital duration （all P 〉0.05）.Conclusion Damage control orthopedic surgery reduced the postoperative complications of unstable pelvic fractures,improved the pelvic function recovery,and decreased the hospital mortality.