Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

A Retrospective Analysis of the Patterns and Outcomes of Tile B and Tile C Pelvic Fractures in Cameroon

Background: Pelvic fractures constitute about 2% - 8% of all fractures. This incidence may rise up to 25% in poly-traumatised patients. These fractures have a high mortality rate due to the fact that they occur usually as a result of high energy trauma, and most of the injured are poly-traumatised with concomitant haemodynamic instability. The aim of this study is to describe the patterns of injury and complications of unstable pelvic fractures treated in a level III hospital in Cameroon. Methodology: This was a hospital based retrospective analysis of files of patients admitted and treated for unstable pelvic fractures at the Regional Hospital Limbe within a period of 10 years (from 1st of January 2009 to 31st of December 2018). Results: A total of 139 cases of pelvic fractures were identified, amongst which 77 were unstable;68 were finally analyzed. The ages ranged from 18 to 80 years with a mean of 39 ± 5 years. The age group from 20 - 40 years was most represented (58.88%, n = 40). There were 45 males and 23 females giving a sex-ratio of 2:1. Road traffic injuries accounted for most of the cases (73.53%, n = 50). Forty-five (66.2%) were classified Tile B and 23 (33.82%) were Tile C, and 15 cases were open fractures (22.06%). Associated lesions were recorded in 30 cases, fractures of the lower extremity being the most common (33.33%, n = 10). Most of the cases were definitively treated surgically (80.89%, n = 55). The most common complications were surgical site infections (23.64%, n = 13). Conclusion: Unstable pelvic fractures are relatively common. Young males in the age group 20 - 40 years are the most affected, and the most common cause of injury was road traffic accident. Surgical site infections, pressure ulcers, severe anaemia and thrombo-embolism are common complications.

Treatment of Pelvic Limb Fractures in a Hospital of 2e Reference in Mali

Introduction: A fracture is a solution in the continuity of a bone. Pelvic limb fractures may involve one or more of the bones. They constitute a real public health problem, which requires the identification of the factors inherent to this phenomenon for better prevention, but also for quality management of fractures and sequelae. Objectives: Were to describe the epidemiological, clinical and therapeutic profile of pelvic limb fractures in Timbuktu Hospital. Patients and Method: We conducted a prospective, descriptive study in the Surgery Department of Timbuktu Hospital, covering a period of one year from January 1 to December 31, 2017. We collected 39 patients who presented with fractures of the pelvic limbs, who were hospitalized and monitored throughout our study. Results: We obtained a hospital frequency of 2.86% limb fractures. Among the 39 patients included in our study, the male sex was predominant in 69.2% of cases, the average age of our patients was 20.5 years. Pupils and students were in the majority in 48.7% of cases. Road traffic accidents were the most common cause of fracture with 59.0% of cases. The tibia was the most affected segment in 38.5% of cases. Surgical treatment was predominant in 64.0% of cases. We obtained very good results in 94.87% of cases. Conclusion: Limb fractures remain frequent due to road traffic accidents. Osteosynthesis treatment provides a good result with fewer complications.

External fixator with lumbopelvic distraction spondylodesis for vertically unstable pelvic fracture

Objective To evaluate the clinical outcomes of external fixator with lumbopelvic distraction spondylodesis in treatment of vertically unstable pelvic fractures.Methods From January 2008 to March 2009,9 patients(4 males and 5 females)

Stabilization of unstable pelvic fractures with a novel internal-external fixator

An internal-external fixator for stabilization in three cases with unstable pelvic fractures were reported. Compared with external fixation, the internal-external fixator, which is placed in the subcutaneous layer, decreased the risk of pin-track infection, pin site pain, and bowel obstruction; meanwhile, it had the advantage of external fixation： it was easy to apply, controlled damage, and resulted in minimal injury.

External fixation in early treatment of unstable pelvic fractures

Background Patients with pelvic fractures are often treated in hospitals without the capacity to implement an open reduction internal fixation （ORIF）. This often leads to pelvic malunion in patients with unstable pelvic fracture, shock or even death due to uncontrollable pelvic hemorrhage and unstable hemodynamics. This study explored the role of early external fixation （within 7 days） for patients with unstable pelvic fractures. Methods A retrospective analysis was conducted on 32 patients with unstable pelvic fractures treated with early external fixation from January 2005 to January 2010 （Tile type B： 18 cases; C： 14 cases）. The study comprised 28 males and 4 females, with a mean age of （32_＋8） years （range, 21-56 years）. Of these patients, 22 were treated with emergency pelvic external fixation and 10 were treated with external fixation within 1-7 days. Fifteen cases suffered traumatic hemorrhagic shock. A statistical analysis was conducted to compare fluid infusion and blood transfusion volumes within the first 24 hours of these shock patients with another cohort of patients treated without early external fixation from January 1993 to January 1998. Results The average follow-up was （34.7_＋14.6） months （range, 6-66 months）. Six to eight weeks after external fixation, patients could walk with crutches; by 12 weeks, external fixation was removed and all fractures had healed. Seven patients presented with sequelae, including 3 patients with long-term lumbosacral pain, 3 patients with erectile dysfunction and 1 patient with MoreI-Lavallee lesion and other complications. The 15 shock patients in this study （2005-2010 group） required significantly lower volumes of fluid infusion and blood transfusion （Pfluid=0.000; mtransfusion=0.000） as compared to the 1993-1998 cohort. Conclusions The early application of external fixation in unstable pelvic fracture patients positively affects hemodynamic stability, with outstanding efficacy as a final fixation option for unstable pelvic fractures.

Analysis of early treatment of multiple injuries combined with severe pelvic fracture

Purpose: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. Methods: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200e10,000 mL, with an average volume of 2850 mL. Postoperative followup ranged from 6 months to 1.5 years. Results: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. Conclusion: The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.

Multiple bilateral lower limb fractures in a 2-year-old child： previously unreported injury with a unique mechanism

Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report.

男性不稳定性骨盆骨折患者术后继发勃起功能障碍的关联因素分析

背景勃起功能障碍(erectile dysfunction,ED)是男性不稳定性骨盆骨折术后患者的主要长期并发症之一,其机制不明,探究致伤因素、骨折类型、手术因素与ED的关系对于早期识别和干预具有重要意义。目的分析接受手术治疗的男性不稳定性骨盆骨折患者ED发生的关联因素。方法回顾性分析2010年1月—2022年12月于解放军总医院第一医学中心接受手术治疗的男性不稳定性骨盆骨折患者病历资料。采用单因素和Logistic多因素回归分析受伤年龄、受伤原因、Young-Burgess致伤因素分类、Tile分型、是否合并耻骨联合分离、是否合并外生殖器损伤、是否合并尿道损伤、创伤严重程度评分(injury severity score,ISS)、手术入路、固定材料共10个因素与男性不稳定性骨盆骨折术后继发ED的关联性。结果共纳入112例男性不稳定性骨盆骨折患者,平均年龄(36.55±10.79)岁。112例中49例(43.75%)术后发生ED。ED组与未发生ED组ISS评分(Z=-3.236,P=0.001)、是否合并耻骨联合分离(χ2=24.200,P<0.001)、是否合并尿道损伤(χ2=22.826,P<0.001)差异有统计学意义。多因素Logistic回归分析表明,合并尿道损伤(OR=3.765,P=0.003)、合并耻骨联合分离(OR=8.059,P=0.014)是男性不稳定性骨盆骨折术后患者继发ED的独立关联因素。结论对于男性不稳定性骨盆骨折患者,合并尿道损伤、合并耻骨联合分离是术后康复期继发ED的重要关联因素。因此,在制定诊疗方案时应联合泌尿外科对ED进行早期识别和干预。

三维(3D)打印技术辅助微创手术治疗骨盆不稳定骨折的临床观察

目的分析三维(3D)打印技术结合微创手术治疗骨盆不稳定骨折的临床疗效。方法选取2019年1月-2022年9月江苏省人民医院和江苏省溧阳市人民医院收治的40例不稳定骨盆骨折患者作为研究对象。所有患者在3D打印技术辅助下,通过微创经皮骨盆前环内固定术(Infix)治疗,部分患者后环不稳定,联合钢板内固定治疗。收集手术相关数据,包括手术时间、失血量、重要组织损伤情况、骨折愈合情况以及术后功能的恢复情况;并在随访过程中,对骨折复位情况和肢体功能进行评估。结果40例患者的伤口在第一阶段就已愈合,未发生伤口感染。患者受伤至手术时间平均为(6.0±1.5)d;骨盆骨折固定术的手术时间为30~95 min,平均(60.8±5.9)min;术中平均失血量为(30.6±11.5)mL;骨折愈合时间为(12.8±2.6)周。根据Matta标准评估骨折复位质量:优33例(82.5%),良7例(17.5%);基于Majeed标准的肢体功能评估结果:30例为优秀(75.0%),10例为良好(25.0%)。结论3D打印技术辅助微创手术内固定可以在术前较好地评估患者骨盆骨折情况,有利于建模,可以缩短手术时间,减少术中失血,提高定位精度,最终达到更好的手术效果。

探索骨盆与下肢骨折患者术前深静脉血栓的危险因素

目的探索引起骨盆与下肢骨折患者术前深静脉血栓(DVT)的危险因素。方法采用回顾性队列研究,分析2017年1月至2021年12月在上海交通大学医学院附属第六人民医院急诊重症监护病房住院治疗的774例骨盆与下肢骨折患者临床资料,采用修正泊松回归分析可疑暴露因素是否为骨盆与下肢骨折患者术前发生DVT的独立危险因素。根据独立危险因素构建列线图预测模型并进行内部验证,以评价其区分度、校准度和临床适用性。结果骨盆骨折患者509例,97例(19.057%)出现DVT;骨盆合并膝关节以下骨折患者79例,21例(26.582%)出现DVT;骨盆合并股骨骨折患者186例,61例(32.796%)出现DVT。分析结果显示骨盆合并股骨骨折[调整后的相对危险度(ARR)=1.619,95%CI 1.223~2.144,P=0.001]、急诊腹部手术(ARR=1.924,95%CI 1.098~3.372,P=0.022)、体重指数≥24 kg/m^(2)(ARR=1.382,95%CI 1.072~1.783,P=0.013)、创伤严重度评分(ISS)≥25分(ARR=1.439,95%CI 1.082~1.913,P=0.012)、年龄40~59岁(ARR=1.594,95%CI 1.104~2.300,P=0.013)以及年龄≥60岁(ARR=1.868,95%CI 1.279~2.730,P=0.001)为骨盆与下肢骨折患者术前发生DVT的独立危险因素;据此所构建的列线图模型对预测DVT风险以及判断是否应该采取干预措施有一定的实用价值。结论骨盆与下肢骨折患者有发生DVT的风险,骨盆合并股骨骨折、经历急诊腹部手术、BMI≥24 kg/m^(2)、ISS≥25分、年龄≥40岁是骨盆与下肢骨折患者术前发生DVT的危险因素,对具有上述特征的患者应高度重视并及时采取适当的DVT防治措施。

3D导航下机器人辅助经皮通道螺钉治疗骨盆骨折的临床疗效分析

目的 探讨3D导航下机器人辅助经皮置入骨盆通道螺钉治疗不稳定性骨盆骨折的临床疗效。方法 回顾性分析2023年2月—10月重庆医科大学附属第一医院骨科采用3D导航下机器人辅助经皮置入骨盆通道螺钉技术治疗不稳定性骨盆骨折患者9例。男性4例,女性5例;年龄16~73岁,平均41.6岁;其中道路交通伤4例,高处坠落伤4例,砸伤1例;骨盆骨折Tile分型:B2.2型4例,B3.2型5例。记录手术时间、术中出血量、术中及术后并发症情况,评估骨折复位效果及术后骨盆功能恢复情况。结果 本组术中共置入20枚螺钉,平均2.2枚;置钉通道规划时间22~30min,平均25.8min;螺钉置入时间2~3min,平均2.6min;手术时间32~46min,平均37.2min。无一例进行导针调整,每枚导针置入透视次数3~7次,平均5.5次。术中出血量5~10 mL,平均8.9mL;本组患者术后均未见血管神经损伤等并发症发生。术后根据Matta骨折复位标准评价示骨盆通道螺钉置入位置均为优。结论 3D导航下机器人辅助经皮置入骨盆通道螺钉技术螺钉置入的效率及准确性高,手术操作精细且微创,术中射线暴露的时间短、手术创伤小、术后并发症少。在处理骨盆环损伤的治疗中该技术存在潜在优势。

骨盆髋臼骨折患者合并静脉血栓栓塞性疾病的研究进展

骨盆髋臼骨折(pelvic and acetabular fractures,PAFs)是最常见的骨盆骨折类型之一,多为高能量损伤,骨盆髋臼结构复杂,手术方法有限。髋臼骨折本身所带来的创伤和术后需要长期卧床等情况,导致其临床并发症尤为复杂。静脉血栓栓塞(venous thromboembolic,VTE)是其众多并发症中发生率较高且后果严重的一种。本综述主要以PAFs术后导致的VTE为主要内容,分别从VTE的流行病学、危险因素以及防治措施三个方面展开叙述,旨在帮助改善预后,避免严重并发症的发生。

3D技术辅助手术治疗不稳定骨盆骨折的疗效分析

目的:分析3D技术辅助手术治疗不稳定型骨盆骨折的疗效。方法:选择2020年3月至2022年9月就诊于我院的骨盆骨折患者80例,符合Tile分型中的B型、C型不稳定骨折。以随机数字表法作为分组方式将患者分为观察组(n=40)与对照组(n=40)。对照组采取传统手术方式,观察组应用3D技术辅助手术。比较两组围手术期相关指标,术后6个月骨盆功能,统计两组术后6个月内并发症发生情况。结果:观察组术中出血量与对照组相较更低,手术与拆线时间分别与对照组相较更短,手术费用较对照组高(t=-3.967、-2.194、-2.134、-2.301,P<0.05);术后1周,观察组骨折复位总满意度为95.00%,高于对照组的80.00%(χ^(2)=4.114,P<0.05);观察组术后6个月骨盆功能优良率为87.50%,高于对照组的67.50%(χ^(2)=4.588,P<0.05);观察组术后6个月并发症总发生率(7.50%)与对照组(10.00%)的差异无统计学意义(χ^(2)=0.157,P>0.05)。结论:3D技术辅助手术治疗骨盆骨折,可以缩短手术时间,减少出血量,减少术后拆线时间,提高骨折复位的优良率和骨盆功能,疗效突出。

疼痛控制联合基于损伤控制理论的策略在多发伤合并盆骨骨折患者中的应用

目的探讨多发伤合并盆骨骨折患者接受疼痛控制联合基于损伤控制理论的策略的临床效果。方法选择江苏省苏北人民医院于2021年1月至2023年9月收治的86例多发伤合并盆骨骨折的患者为研究对象,2021年1月至2022年4月入院的患者被纳入对照组(43例),2022年5月至2023年9月入院的患者被纳入观察组(43例)。比较2组患者的疼痛程度、舒适度、恢复情况以及并发症发生情况。结果干预7 d后,2组患者的视觉模拟评分法(VAS)评分均较干预前降低,舒适状况量表(GCQ)评分均较干预前升高;与对照组比较,观察组的VAS评分较低,GCQ评分均较高,上述比较的差异均有统计学意义(P均<0.05)。术后28 d后,与对照组比较,观察组患者的术后恢复优良率更高,并发症总发生率更低,差异均有统计学意义(P均<0.05)。结论给予多发伤合并盆骨骨折患者疼痛控制与基于损伤控制理论的策略干预,能够更好地缓解患者的疼痛程度,提高其舒适度,且有利于患者的术后恢复,并降低并发症发生率。

血常规指标对老年急诊骨盆及下肢骨折手术患者术后深静脉血栓形成的影响及预测价值分析

目的 分析血常规指标对老年急诊骨盆及下肢骨折手术患者术后深静脉血栓(DVT)形成的影响及预测价值。方法 回顾性分析2020年6月至2022年2月洛阳市东方人民医院收治的82例急诊行骨盆及下肢骨折手术治疗的老年患者的临床资料,收集患者性别、年龄等一般资料以及术前白细胞计数(WBC)、红细胞计数(RBC)等血常规资料,并根据术后是否出现DVT将其分为DVT组与非DVT组,分析血常规指标对老年急诊骨盆及下肢骨折手术患者术后DVT形成的影响及预测价值。结果 82例急诊行骨盆及下肢骨折手术治疗的老年患者中,19例(23.17%)患者术后出现DVT,设为DVT组;63例(76.83%)患者术后未出现DVT,设为非DVT组。多因素Logistic回归分析结果显示,RBC、中性粒细胞计数(NEU)为老年急诊骨盆及下肢骨折手术患者术后DVT形成的影响因素(95%CI为1.411~7.553、 1.450~5.476,P=0.006、 0.003)。受试者操作特征(ROC)曲线分析结果显示,当RBC、 NEU的截断值分别为4.05×10^(12)/L、 6.40×10^(9)/L时,其预测老年急诊骨盆及下肢骨折手术患者术后DVT形成的曲线下面积(AUC)分别为0.811与0.780,敏感度分别为63.2%与52.6%,特异度分别为95.2%与88.9%,而两者联合预测的AUC为0.842、敏感度为84.2%、特异度为84.1%。结论 老年急诊骨盆及下肢骨折手术患者术后DVT的形成与RBC及NEU有关,检测RBC、 NEU有助于预测DVT的发生。

不稳定骨盆骨折合并髋臼骨折手术治疗效果

目的 探讨不同手术方法对不稳定骨盆骨折伴髋臼骨折的疗效。方法 选取2013年10月至2023年10月凌源市中心医院骨外科50例骨盆不稳定伴有髋臼骨折患者为研究对象,分析其临床特点,采用随机数字表法分为两组,分别开展传统髂腹股沟入路手术治疗(甲组)与Stoppa入路手术治疗(乙组),各25例。观察并比较两组手术时间、切口长度、术中出血、术后引流量、骨折愈合时间、骨盆骨折治疗优良率、髋臼骨折治疗优良率、术后并发症发生率。结果 乙组的手术时间、切口长度、术中出血、术后引流量、骨折愈合时间均小于甲组(P <0.05)。乙组骨盆骨折治疗优良率高于甲组(P <0.05)。乙组髋臼骨折治疗优良率高于甲组(P <0.05)。乙组术后并发症发生率低于甲组(P <0.05)。结论 对于不稳定性骨盆骨折伴有髋臼骨折的患者,应用Stoppa术式治疗,疗效明显,不良反应小,有较高的临床应用价值。

围手术期综合干预对骨盆及下肢骨折术后住院期间发生深静脉血栓的预防价值

目的探讨围手术期综合干预对骨盆及下肢骨折术后住院期间发生深静脉血栓(DVT)的预防价值。方法收集2021年6月至2023年6月于首都医科大学附属北京积水潭医院接受手术治疗的200例骨盆及下肢骨折患者的临床资料,根据围手术期是否接受综合干预将患者分为观察组(n=93,接受围手术期综合干预)和对照组(n=107,未接受围手术期综合干预)。比较两组患者的骨折专科信息和手术相关指标,术后住院期间相关指标以及术后住院期间并发症发生情况。结果观察组患者全身麻醉、术中低体温的比例均低于对照组患者,术后启动低分子肝素的时间短于对照组患者,差异均有统计学意义(P﹤0.05)。术后住院期间,两组患者均未发生明显的出血,但两组患者的卧床时间,感染、恶心呕吐并发症的发生率比较,差异均无统计学意义(P﹥0.05)。观察组患者术后D-二聚体水平升高的比例、下肢DVT的发生率均低于对照组患者,差异均有统计学意义(P﹤0.05)。结论围手术期综合干预可降低骨盆及下肢骨折患者术后住院期间DVT的发生率,降低全身麻醉和术中低体温的比例,缩短术后启动低分子肝素的时间,安全性好,值得临床推广和进一步研究。

120院前急救结合院内救治损伤控制策略在多发伤并骨盆骨折中的应用价值分析

目的探讨120院前急救结合院内救治损伤控制策略在多发伤并骨盆骨折中的应用价值。方法80例多发伤并骨盆骨折患者,采用随机数字表法分为观察组及对照组,每组40例。对照组给予常规救治,观察组给予120院前急救结合院内救治损伤控制策略。比较两组患者救治效果、骨折复位效果、生活质量评分、并发症发生情况、满意度评分。结果观察组救治成功率100.00%高于对照组的90.00%,死亡率0低于对照组的10.00%(P<0.05)。观察组骨折复位后移位距离≤1 mm、>1 mm且≤3 mm、>3 mm占比分别为90.00%、7.50%、2.50%,对照组分别为35.00%、40.00%、25.00%,观察组骨折复位后移位距离短于对照组(P<0.05)。观察组社会功能、生理功能、情感职能、生理职能、精神健康、活力、总体健康、躯体疼痛评分均高于对照组(P<0.05)。观察组并发症发生率为2.50%,低于对照组的15.00%(P<0.05)。观察组对沟通情况、应急处理、急救秩序、病区管理、临床操作满意度评分分别为(94.11±0.98)、(95.32±0.99)、(95.98±1.03)、(96.01±1.02)、(97.12±0.91)分,高于对照组的(88.25±1.03)、(85.52±1.06)、(86.93±1.43)、(90.11±1.27)、(91.03±1.12)分(P<0.05)。结论120院前急救结合院内救治损伤控制策略对多发伤并骨盆骨折患者的治疗效果十分理想,能够提高救治效果、骨折复位效果、生活质量、满意度,减少并发症发生,值得推广应用。

微创经皮钢板内固定术与皮下内固定支架术治疗骨盆前环骨折患者的效果比较

目的:比较微创经皮钢板内固定术与皮下内固定支架术治疗骨盆前环骨折患者的效果。方法:回顾性分析2020年6月至2022年6月该院收治的106例骨盆前环骨折患者的临床资料,根据术式不同将其分为观察组(n=53)、对照组(n=53)。对照组采用皮下内固定支架术治疗,观察组采用微创经皮钢板内固定术治疗,比较两组手术相关指标(住院时间、手术时间、骨折愈合时间、术中出血量)水平、血清骨转化状态指标[骨特异性碱性磷酸酶(BAP)、骨钙素(OCN)、总I型胶原氨基端延长肽(T-P1NP)]水平、骨盆垂直移位距离和并发症发生率。结果:观察组住院时间、手术时间、骨折愈合时间均短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05);术后2周,两组血清BAP、OCN水平高于术前,且观察组高于对照组,两组血清T-P1NP水平低于术前,且观察组低于对照组,差异均有统计学意义(P<0.05);术后6个月,两组骨盆垂直移位距离均短于术前,且观察组短于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:微创经皮钢板内固定术治疗骨盆前环骨折患者可改善骨转化状态指标水平,降低手术相关指标水平,缩短骨盆垂直移位距离,效果优于皮下内固定支架术治疗。