骨盆骨折伴髂股血管损伤的治疗

The treatment of pelvic fracture with iliac vascular injury

回顾我科收治的10例骨盆骨折伴髂股血管损伤的急救策略及治疗,探讨如何提高此类损伤患者的抢救成功率及治疗效果。10例骨盆骨折伴股动脉损伤患者经抗休克及止血处理均抢救成功,其中4例保肢成功;4例初期保肢成功,此后由于出现肾衰竭或肢体坏死等并发症,行髋关节离断术;2例由于伤肢毁损严重,急症截肢。对伴有股血管损伤的骨盆骨折患者,接诊后应该及时评估伤情,积极抗休克治疗,尽早修复损伤的股血管。股血管修复适用于血管壁无明显挫伤者,对直接修复困难者加以血管移植。对血管严重损伤患者,可应用血管移植或重建术。如果患者双下肢均有股血管损伤,一条下肢毁损严重需要截肢,可以取截肢侧的血管修复保肢侧损伤的股血管。

The first-aid strategy and treatment of 10 patients with iliac pelvic fractures and femoral vascular injuries treated in our department, to discuss how to improve the success rate and the therapeutic effect of these patients. The10 cases of pelvic fractures with femoral artery injury were successfully treated via the treatments with anti-shock and hemostasis, including 4 patients with limb salvage success; 4 cases had early limb salvage success, then hip joint amputation was operated on them since renal failure, limb necrosis and other complications occurred; and 2 cases received acute amputation due to severe limb injury. For patients with pelvic fracture associated with femoral vascular injury, a timely assessment of injury, actively anti-shock treatment and early repair of damaged blood vessels should be taken at admission. Femoral vascular repair is applicable to the cases whose vascular wall has no obvious contusion, to the cases whom have difficulties in direct repair, vascular transplantation is applied. Vascular transplantation or reconstruction can be applied for severe vascular injury. If both lower limbs of patients have femoral vascular injury, one with extremely damage requiring amputation, the blood vessels of the amputation limb can be taken to repair the injured femoral artery of the limb for salvage.