52例严重骨盆型多发伤的救治.docVIP

52例严重骨盆型多发伤的救治 　　作者：罗小波，王子明，王爱民 作者单位：第三军医大学大坪医院野战外科研究所骨科，重庆400042 　　【摘要】 目的总结严重骨盆型多发伤的救治经验和救治程序，以期进一步提高其救治水平。方法2003年1月~2007年7月对52例严重骨盆骨折进行损伤严重度评分(AISISS)和全身炎症反应综合征 (SIRS)评分，抗休克治疗, 骨盆外固定器固定+下肢骨牵引，创伤重症监护室(ICU)监护和稳定后骨盆切开复位内固定。结果全部病例当天血压恢复正常，无死亡。优19例，良18例，优良率达71%;可12例，差3例。结论严重骨盆型多发伤的院内救治应遵循损害控制原则，按照特定的救治程序进行,并强调骨盆外固定支器+下肢骨牵引的应用。 　　【关键词】 骨盆骨折;多发伤;外固定;骨牵引 　　The management of severe multiple injury with pelvic trauma 　　LUO Xiaobo,WANG Ziming，WANG Aimin 　　Department of Orthopedic,Institute of Surgery Research，Daping Hospital,Third Military Medical University, Chongqing400042,China 　　Abstract：ObjectiveTo summarize the clinical experience of treatment and procedure of severe multiple injury with pelvic trauma in order to improve the management level.MethodsFor 52 patients with severe multiple injury with pelvic trauma admitted into our hospital from January 2003 to July 2007，the injury severity score(AISISS) and systematic inflammatory response syndrome score(SIRS) were counted，the countershock treatment was taken,the final diagnosis was made,pelvic external fixator was fixed temporarily,traumatic intensive care unit (ICU) was monitored，open reduction and internal fixation was taken after the patients condition stabilized.ResultsAll the patients survived and recovered to their normal blood pressure within 24 hours after injury.71% patients got satisfactory result,excellent 19，good 18，fair 12，poor 3.ConclusionDamage control orthopedic(DCO)and definite treatment procedure are very important for the management of severe multiple injury with pelvic trauma.The use of the pelvic external fixator and skeletal traction of lower extremity is indispensable. 　　Key words:pelvic fracture;multiple injury;external fixation;skeletal traction 　　严重骨盆型多发伤，即以骨盆型为主的严重多发性损伤，是指在严重多发性损伤中，以骨盆环的损伤为主AIS值≥4分，AO分型为C型骨盆骨折，即骨盆环骨折后环开放性不全性受损伴或不伴失血量20%，或者骨盆环骨折后环完全性破坏伴或不伴有开放性损伤、失血量20%，这些损伤超过限定的严重程度(ISS90≥17 分)[1，2]。我院自2003年1月~2007年7月收治骨盆骨折158例，其中52例为严重骨盆型多发伤，遵循损害控制(damage