基于损害控制的分期手术方案对多发伤合并不稳定骨盆骨折的疗效分析

The clinical analysis of staged pelvic surgery based on damage control for unstable pelvic fractures associated with multiple injuries

目的研究基于损害控制理论的分期手术方案对多发伤合并不稳定骨盆骨折的临床疗效。方法回顾性分析遂宁市中医院创伤骨科收治的80例多发伤合并不稳定骨盆骨折的患者,其中2012年6月—2014年12月接受传统常规手术治疗42例(常规手术组),男性27例,女性15例;年龄34~53岁,平均45.1岁;2015年1月—2017年6月接受基于损害控制理论的分期手术方案治疗38例(分期手术组),男性26例,女性12例;年龄35~55岁,平均46.1岁。比较两组患者临床预后及术后恢复情况,记录两组患者手术和住院情况。结果分期手术组并发症发生率为21.05%,常规手术组为45.24%,两组差异有统计学意义(P<0.05),两组病死率差异无统计学意义(P>0.05)。分期手术组恢复优良率为86.11%,显著高于常规手术组(P<0.05)。确定性手术前两组患者降钙素原(PCT)、体温(T)及p H水平较入院时均得到显著改善(P<0.05),分期手术组较常规手术组改善效果更为显著(P<0.05)。分期手术组患者入院至确定性手术的时间显著长于常规手术组(P<0.05),手术时间和术中输血量显著低于常规手术组(P<0.05),两组住院时间和住院费用差异无统计学意义(P>0.05)。结论基于损害控制的分期手术方案能显著降低不稳定盆骨骨折患者并发症发生率,改善术后恢复效果。

Objective To study the clinical effects of staged pelvic surgery based on damage control for unstable pelvic fractures associated with multiple injuries. Methods A total of 80 unstable pelvic fractures complicated with multiple injuries in our hospital were retrospectively analyzed. Forty-two patients（ 27 males and 15 females with an average age of 45. 1 years） from Jun. 2012 to Dec. 2014 were treated with conventional method and were the control group,38 patients（ 26 males and 12 females with an average age of 46. 1 years） from Jan. 2015 to Jun. 2017 were treated with surgery based on injury control theory and were the observation group. The clinical prognosis and postoperative recovery of the two groups were compared,and the operation and hospitalization of the two groups were recorded. Results The complication rate was 21. 05% in the observation group and 45. 24% in the control group,the difference between the two groups was significant（ P 0. 05）. There was no significant difference in mortality between the two groups（ P 0. 05）. The excellent rate of recovery in the observation group was 86. 11%,which was significantly higher than that of the control group（ P 0. 05）. The PCT,body temperature and p H levels of the two groups before definitive surgery were significantly improved（ P 0. 05）,the improvement effect of the observation group was more significant than that of the control group（ P 0. 05）. The time of admission to definitive surgery of observation group was longer than that of the control group（ P 0. 05）. The operation time and intraoperative blood transfusion volume were significantly less than those of the control group（ P 0. 05）. There was no significant difference between the two groups in hospital stay and hospitalization expenses（ P 0. 05）. Conclusion The surgical staging scheme based on the damage control can significantly reduce the complications in patients with unstable pelvic fractures and improve the effect of postoperative recovery.