腔隙闭合术辅助内固定一期治疗合并骨盆骨折的Morel-Lavallée损伤的疗效分析

One-stage treatment of Morel-Lavallée injury complicated with pelvic fracture by lacunar closure-assisted internal fixation

目的探讨腔隙闭合术辅助内固定一期治疗合并骨盆骨折的Morel-Lavallée损伤的临床疗效。方法回顾性分析西安交通大学医学院附属红会医院创伤骨科2018年5月至2020年11月期间收治的32例合并骨盆骨折的Morel-Lavallée损伤患者资料。男21例,女11例;年龄为18~58岁,平均40.5岁。损伤部位:单侧髋部20例,双侧髋部6例,腰背部4例,大腿后侧2例。骨盆骨折采用闭合或切开复位内固定,同时联合腔隙闭合术治疗Morel-Lavallée损伤。记录患者的住院时间、伤口愈合情况、骨盆功能及并发症发生情况等。结果本组患者的住院时间为14~28 d,平均19.2 d。32例患者术后获6~18个月(平均9.3个月)随访。23例患者行1次腔隙闭合术后Morel-Lavallée损伤区域伤口愈合,最终皮肤成活良好,无皮肤软组织坏死等并发症发生;4例患者行2次腔隙闭合术后损伤区域伤口获愈合;3例患者损伤区域伤口愈合后周围皮肤浅感觉减退;1例患者损伤区域出现伤口脂肪液化,经对症处理后伤口痊愈;1例患者伤口见少量分泌物,细菌培养呈阴性,经对症处理后伤口痊愈。32例患者骨折均获愈合,愈合时间为3~6个月,平均3.9个月。末次随访时Majeed骨盆功能评分为65~100分,平均84.5分。结论对于合并骨盆骨折的Morel-Lavallée损伤,腔隙闭合术辅助内固定一期治疗可获得满意的临床疗效。

Objective To investigate the clinical effects of lacunar closure-assisted internal fixation in the one-stage treatment of Morel-Lavallée injury complicated with pelvic fracture.Methods The 32 patients were retrospectively analyzed who had been treated for Morel-Lavallée injury complicated with pelvic fracture at Department of Orthopedic Trauma,Honghui Hospital Affiliated to Xi'an Jiaotong University from May 2018 to November 2020.They were 21 males and 11 females,aged from 18 to 58 years(average,40.5 years).The injury was located at a unilateral hip in 20 cases,at bilateral hips in 6 cases,at low back in 4 cases,and at posterior thigh in 2 cases.The pelvic fractures were treated by open reduction and internal fixation while the Morel-Lavallée injuries by lacunar closure at the same time.Their wound healing,pelvic function and complications were observed regularly.Results The hospital stay of 32 patients ranged from 14 to 28 days,averaging 19.2 days.The patients were followed up for 6 to 18 months(mean,9.3 months).The area of Morel-Lavallée injury healed after one lacunar closure in 23 patients who obtained fine skin survival and no soft tissue necrosis or other complications;the wounds in the Morel-Lavallée injury area healed well after secondary lacunae closure in 4 patients.Superficial sensation of the skin decreased around the Morel-Lavallée injury area after wound healing in 3 patients.Wound fat liquefaction was found in the Morel-Lavallée injury area but responded to symptomatic treatment in one patient.A small amount of wound secretion found in the Morel-Lavallée injury area was cured also by symptomatic treatment in another patient whose bacterial culture was negative.All the fractures healed after 3 to 6 months(average,3.9 months).At the last follow-up,the Majeed scores for the pelvic function ranged from 65 to 100 points,averaging 84.5 points.Conclusion For Morel-Lavallée injury complicated with pelvic fracture,lacunar closure-assisted internal fixation can result in a satisfactory one-stage treatment.