骨盆骨折合并腹部脏器伤的早期诊治

Early diagnosis and treatment of the pelvic fracture combined with abdominal organ injury

目的探讨骨盆骨折合并腹部脏器伤患者的早期临床特点,减少漏诊及并发症的发生,提高对骨盆骨折合并腹部脏器伤的早期诊治成功率。方法对我院2005年6月至2015年6月急诊收治的102例骨盆骨折合并腹部脏器伤患者进行回顾性研究,其中男64例,女38例;年龄16~65岁,平均(36.8±6.6)岁;受伤至入院时间:半小时至24 h,平均(364.25±17.35)min;根据Tile评分法分型,A型47例,B型32例,C型23例。对腹腔脏器损伤的类型、临床表现、并发症、漏误诊情况、治疗方案及效果进行分析,总结骨盆骨折合并腹部脏器伤的早期诊断及处理方案。结果本组中84例为腹腔内脏器破裂,18例腹腔脏器未破裂。平均确诊时间为伤后6.5 h。行剖腹探查72例,腹腔镜探查12例,其中因肝破裂损伤严重转开腹3例,I期介入栓塞止血治疗12例。治愈89例,死亡13例,其中创伤性失血性休克继发DIC 9例,感染性休克1例,重型颅脑损伤2例,肺栓塞1例,救治成功率为87.25%。发生早期漏诊2例,其中1例合并结肠破裂经抢救无效死亡,另1例小肠嵌入骨折间隙继发肠梗阻破裂,术后2个月始愈。结论骨盆骨折合并腹部脏器损伤的患者伤情重而复杂,极易漏误诊而直接危及生命。早期分析病情、完善相关检查,及时行抗休克治疗、骨盆外固定,必要时早期行腹部探查和损害控制性手术可提高早期确诊率与救治成功率。

Objective To investigate the early clinical features of patients with the pelvic fracture combined with abdominal organ injury, in order to reduce missed diagnosis and complications, as well as to improve the early diagnosis and treatment success rate of the pelvic fracture combined with abdominal organ injury. Methods From June 2005 to June 2015, a retrospective study was performed on 102 patients with the pelvic fracture complicated with abdominal organ injury. There were 64 males and 38 females, aged 16 to 65 years with an average of（ 36.8 ± 6.6） years. From injury to admission： half an hour to 24 hours, with an average of（ 364.25 ± 17.35） min. According to Tile typing： 47 cases were of A, 32 cases of B and 23 cases of C. The trauma type of abdominal organs, clinical manifestations, complications, the misdiagnosis and treatment of abdominal visceral injury were analyzed to summarize the early diagnosis and treatment protocol of the pelvic fracture combined with abdominal organ injury. Results In this group, 84 cases were of intraperitoneal visceral organ rupture and 18 cases not. The average time of diagnosis confirmation was 6.5 hours after the injury. Laparotomy was performed on 72 cases and laparoscopy in 12 cases, among whom 3 cases were converted to the laparotomy because of severe hepatic rupture. Twelve cases received Stage I interventional embolization. Eighty-nine cases were cured, while 13 cases died（ 9 cases of traumatic hemorrhagic shock secondary to DIC, 1 case of septic shock, 2 cases of severe craniocerebral injury, 1 cases of pulmonary embolism）. The success rate of the treatment was 87.25%. Early missed diagnosis occurred in 2 cases, among whom 1 case combined with colonic rupture and died after the salvage and another 1 case was of intestinal obstruction rupture followed by small intestine embedded fracture（ 2 months postoperatively, start to heal）. Conclusions Patients with the pelvic fracture combined with abdominal organ injury are featured with complicated conditions, which are easy to be misdiagnosed and thus endangering patients＇ survival. The early diagnosis rate and success rate of the treatment can be improved by early analysis of the disease, improved comprehensive examination, timely anti-shock treatment and pelvic external fixation. Early abdominal exploration and damage control surgery should be considered when necessary.