髋臼骨折合并臀上动脉损伤1例剖析.docVIP

髋臼骨折合并臀上动脉损伤1例剖析 　　[摘要] 臀上动脉损伤通常并发于髋臼骨折或髋关节后脱位，损伤发生后常常在局部形成创伤性假性动脉瘤，患侧臀部肿胀并可见皮下瘀斑，其治疗方法多样。本例臀上动脉损伤后局部形成假性动脉瘤，并无臀部肿胀或瘀斑等典型体征，而术中大量出血，术野内被血液覆盖，创腔内无法找到血管断端，使用纱布填塞加压止血无效，手术机动性地选择带导丝的儿童用8号导尿管阻断患侧髂总动脉，获得满意的止血效果，手术得以顺利进行。使用本方法可以提高臀上动脉损伤诊出率，且应对术中动脉出血简单有效，能够降低休克风险。 　　[关键词] 髋臼骨折；后柱骨折；臀上动脉；出血 　　[中图分类号] R683.3 [文献标识码] A [文章编号] 1673-7210（2017）04（c）-0176-03 　　[Abstract] Injury of superior gluteal artery is often secondary to acetabular fractures or posterior dislocation of hip joint， which can be closely followed by a traumatic pseudoaneurysm at local， hip swelling and ecchymosis can also be found in affected parts of these cases， and various treatment modalities can be chosen. In this case， pseudoaneurysm was formed after superior gluteal artery injury， with no typical signs， such as hip swelling and ecchymosis， which resulted in excessive intraoperative hemorrhage， and the operation field was soon covered by pouring blood， the broken ends of the vessel couldnt be reached， and gauze packing didnt work. A flexible decision was made to occlude the common iliac artery with childrens catheter， which carries a piece of guide wire， and the hemostatic effect was satisfying， then the operation was proceeded successfully. This method can improve the diagnosis rates of superior gluteal artery injury， which is simple and effective to reply the intranperativearterial hemorrhage， and it can decrease the risk of shock. 　　[Key words] Acetabular fracture； Posterior column fracture； Superior gluteal artery； Hemorrhage 　　?S着经济发展，交通运输业日益繁荣，交通拥堵等环境问题愈发凸显，交通安全问题亦不容忽视。髋臼骨折作为一种由高能量创伤所致的复杂骨折，多发生于交通事故中，有研究表明，虽然髋臼骨折在所有交通伤中所占比例不高，但交通伤却是髋臼骨折的最主要致病因素，占所有致伤因素的50%～80%，且患者多为机动车司机[1]。本病例中，患者即为私家车司机，驾车遭遇交通事故后，以“髋臼骨折（后柱骨折）”为诊断经急诊入院，由于骨折类型简单，AO分型为A2型，Judet-Letournel分型中为单纯的后柱骨折，受当时查体技术条件限制，无法明确是否存在动脉损伤，且患者入院后生命体征一直平稳，无相关动脉损伤体征，而术中发现臀上动脉损伤并大量出血，手术一度陷入被动。本课题组从该病例的诊疗出发，对驾驶员特殊髋臼受伤机制导致血管损伤的风险进行探讨，以达到对相似病例提高血管损伤诊出率、降低手术风险发生率的目的。 　　1 病例资料 　　1.1 研究对象 　　患者，男性，48岁，司机，2016年10月5日以“车祸致左髋部疼痛不敢活动1 h”为主诉来山东大学附属省立医院（以下简称“