血流动力学不稳定骨盆骨折损害控制

Application of damage control in treating pelvic fracture patients with unstable hemodynamics

血流动力学不稳定骨盆骨折死亡率可高达60%,临床救治极富挑战。首先应采用物理检查、影像学检查、实验室检查综合评估骨折稳定性、出血的来源和性质,然后采用损害控制策略控制出血是血流动力学不稳定骨盆骨折救治成功的关键。钝性骨盆骨折导致的出血中,超过80%来源于静脉,在积极液体复苏的基础上,一般可以通过无创骨盆外加压、骨盆前方外固定支架和骨盆C型钳固定等措施减小骨盆容积和稳定骨盆来控制出血。上述措施无效时,可考虑采用骨盆腹膜外填塞来止血。其他约20%的出血来源于动脉,常需进行血管造影和栓塞来止血。

The mortality of pelvic fracture patients with unstable hemodynamics can reach as high as 60%.And its clinical treatment is extremely challenging.First of all,physical examination,imaging examination and laboratory tests should be used to evaluate fracture stability,the source and nature of bleeding,and then the damage control strategy should be used to control bleeding,which is the key to successful treatment of hemodynamically unstable pelvic fractures.More than 80% of the bleeding caused by blunt pelvic fractures is originated from the veins.On the basis of active fluid resuscitation,non-invasive pelvic compression,pelvic anterior external fixation and pelvis Cclamp fixation can be used to reduce pelvic volume and stabilize pelvis so as to control bleeding.If the above measures fail to control bleeding,extraperitoneal pelvis could be applied to stop bleeding.About 20% of bleeding comes from arteries,which often requires angiography and embolization.