摘要
目的探讨损伤控制理论指导下微创内固定对开放性骨盆骨折的治疗效果。方法回顾性分析2020年3月至2023年3月白银市中心医院收治的4例开放性骨盆骨折的临床资料,早期基于损伤控制理念采用骨盆外固定架固定结合填塞止血、血管介入栓塞等治疗创伤失血性休克,对合并泌尿系及肠管损伤者给予膀胱造瘘、结肠造瘘,待病情稳定后对骨盆骨折实施Starr架牵引复位联合微创螺钉内固定治疗。术后根据合并损伤情况,对泌尿系损伤及肠管损伤进一步处理。结果随访6~12个月,平均随访8个月。末次随访按Matta评分标准,解剖复位3例、满意复位1例,Majeed骨盆功能评分由术前平均54分改善至末次随访的87分,骨折均愈合良好。结论早期损伤控制是救治骨盆骨折合并创伤失血性休克的有效手段,Starr架牵引复位联合微创内固定可达到解剖复位和内固定稳定,避免切开复位二次损伤,为处理合并症提供有利条件,促进骨折早期愈合和骨盆功能恢复。
Objective To investigate the effect of minimally invasive internal fixation in treatment of open pelvic fracture guided by damage control theory.Methods Clinical data of 4 patients suffered from open pelvic fractures admitted to Baiyin Central Hospital from March 2020 to March 2023 were retrospectively analyzed.Based on the concept of damage control,external pelvic fixator fixation combined with tamponade hemostasis and interventional vascular embolization were used to treat traumatic hemorrhagic shock in the early stage.Cystostomy and colostomy were given to patients with urinary tract and intestinal tract injuries.After the condition was stabilized,traction and reduction of pelvic fracture with Starr frame and minimally invasive screw fixation was completed.After operation,further management of urinary tract injury and intestinal tract injury was performed according to the combined injuries.Results The average follow-up time was 8 months(6-12 months).At the last follow-up,anatomical reduction was observed in 3 cases and satisfactory reduction in 1 case according to the Matta score.Majeed pelvic function score improved from 54 points before surgery to 87 points at the latest follow-up,and all fractures had good healing.Conclusion Early damage control is an effective means to treat pelvic fracture complicated with traumatic hemorrhagic shock.Starr frame traction and reduction combined with minimally invasive internal fixation could achieve anatomic reduction and internal fixation stability,avoid secondary injuries of open reduction,provide advantages for the treatment of complications,and promote early fracture healing and pelvic functional recovery.
作者
王平平
谭庆强
吴国兰
赵维龙
王宏章
高志东
贝兴晓
王伟虎
WANG Pingping;TAN Qingqiang;WU Guolan;ZHAO Weilong;WANG Hongzhang;GAO Zhidong;BEI Xingxiao;WANG Weihu(Department of Spinal Surgery,Baiyin Central Hospital,Baiyin,Gansu 730913,China)
出处
《中国骨科临床与基础研究杂志》
2024年第4期268-274,共7页
Chinese Journal of Orthopaedic Clinical and Basic Research
关键词
骨盆
骨折
开放性
休克
出血性
损伤控制
外固定器
骨折固定术
内
最小侵入性外科手术
Pelvis
Fractures,open
Shock,hemorrhagic
Damage control
External fixators
Fracture fixation,internal
Minimally invasive surgical procedures
