不稳定骨盆骨折急救的新进展
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摘要
骨盆骨折是常见的损伤,仅次于四肢和脊柱骨折,并发症较多,有较高的病死率。高能损伤所致骨盆骨折逐年增多,且复杂而严重,临床处理困难。既往多采取非手术治疗,如骨牵引、骨盆悬吊、石膏固定等方法,但病死率高达5%～20%,致残率为1. 9%～36. 6%。随着对骨盆骨折认识的深入,近年来主张对不稳定性骨盆骨折,采取更加积极的治疗,早期评估、损害控制复苏、血管造影栓塞等新理念降低了病死率和致残率。
Pelvic fracture is a common injury just following limb and spine fractures. Its complications are common while the mortality is relatively high. Pelvic fracture caused by high-energy injuries has increased year by year and is often featured by complicated and serious conditions and a high difficulty of clinical treatment. In the past,conservative treatments such as skeletal traction,pelvic suspension and plaster fixation were mostly adopted,but the mortality rate were as high as 5-20% and the disability rate 1. 9-36. 6%. With more thorough understanding of pelvic fractures,more active methods have been advocated for the treatment of unstable pelvic fractures in recent years,and new concepts such as early assessment,damage control resuscitation( DCR) and angiographic embolization have decreased the mortality and the disability rate.
Pelvic fracture is a common injury just following limb and spine fractures. Its complications are common while the mortality is relatively high. Pelvic fracture caused by high-energy injuries has increased year by year and is often featured by complicated and serious conditions and a high difficulty of clinical treatment. In the past,conservative treatments such as skeletal traction,pelvic suspension and plaster fixation were mostly adopted,but the mortality rate were as high as 5-20% and the disability rate 1. 9-36. 6%. With more thorough understanding of pelvic fractures,more active methods have been advocated for the treatment of unstable pelvic fractures in recent years,and new concepts such as early assessment,damage control resuscitation( DCR) and angiographic embolization have decreased the mortality and the disability rate.
引文
[1]胡健,禹宝庆.骨盆骨折的手术入路及其选择[J].中华创伤杂志,2014,30(1):30-32.
[2] Tile M,Pennal GF. Pelvic disruption:principles of management[J].Clin Orthop Relat Res,1980,(151):56-64.
[3] Young JW,Burgess AR,Brumback RJ,et al. Pelvic fractures:value of plain radiography in early assessment and management[J]. Radiology,1986,160(2):445-451.
[4] Halawi MJ. Pelvic ring injuries:emergency assessment and management[J]. J Clin Orthop Trauma,2015,6(4):252-258.
[5] Langford JR,Burgess AR,Liporace FA,et al. Pelvic fractures:part1. Evaluation,classification,and resuscitation[J]. J Am Acad Orthop Surg,2013,21(8):448-457.
[6]张连阳.多发伤的紧急伤情评估策略[J].创伤外科杂志,2010,12(1):1-3.
[7]吴茂铸,倪淑红,应琦,等.多层螺旋CT及后处理技术在骶骨骨折诊断中的应用[J].实用放射学杂志,2010,26(12):1789-1791.
[8]陶杰,吴晓波,陈重,等.急诊床旁创伤重点超声评估结合区域脏器重点超声检查在闭合性腹部创伤中的应用[J].中华创伤杂志,2014,30(2):138-141.
[9]中华医学会急诊医学分会.血流动力学不稳定骨盆骨折急诊处理专家共识[J].中华创伤杂志,2015,31(12):1057-1062.
[10] Martinez F,Alegret N,Carol F,et al. Pelvic fracture in the patient with multiple injuries:factors and lesions associated with mortality[J]. Emergencias,2018,30(2):91-97.
[11] De Robertis E,Kozek-Langenecker SA,Tufano R,et al. Coagulopathy induced by acidosis,hypothermia and hypocalcaemia in severe bleeding[J]. Minerva Anestesiol,2015,81(1):65-75.
[12]禹宝庆,周海燕.不稳定骨盆骨折处理的几个关键问题[J].中华创伤杂志,2014,30(1):12-14.
[13] Guo WA. The search for a magic bullet to fight multiple organ failure secondary to ischemia/reperfusion injury and abdominal compartment syndrome[J]. J Surg Res,2013,184(2):792-793.
[14] Wohlauer MV,Moore EE,Droz NM,et al. Hemodilution is not critical in the pathogenesis of the acute coagulopathy of trauma[J]. J Surg Res,2012,173(1):26-30.
[15]文爱清,张连阳,蒋东坡,等.严重创伤输血专家共识[J].中华创伤杂志,2013,29(8):706-710.
[16] Holcomb JB,Zarzabal LA,Michalek JE,et al. Increased platelet:RBC ratios are associated with improved survival after massive transfusion[J]. J Trauma,2011,71(2S3):S318-328.
[17] Holcomb JB,Del Junco DJ,Fox EE,et al. The prospective,observational,multicenter,major trauma transfusion(PROMMTT)study:comparative effectiveness of a time-varying treatment with competing risks[J]. JAMA Surg,2013,148(2):127-136.
[18]党伟,刘红升,曹阳,等.严重多发伤的急诊救治分析[J].创伤外科杂志,2014,16(5):390-392.
[19]支中正,禹宝庆,敖荣广,等.骨盆骨折急救的研究进展[J].中华创伤杂志,2016,32(12):1137-1141.
[20]都定元.院前创伤急救进展:新研究带来的机遇与挑战[J].创伤外科杂志,2012,14(4):292-296.
[21] Shakur H,Roberts I,Bautista R,et al. Effects of tranexamic acid on death,vascular occlusive events,and blood transfusion in trauma patients with significant haemorrhage(CRASH-2)a randomised,placebo-controlled trial[J]. Lancet,2010,376(9734):23-32.
[22] Roberts I,Shakur H,Afolabi A,et al. The importance of early treatment with tranexamic acid in bleeding trauma patients:an exploratory analysis of the CRASH-2 randomised controlled trial[J]. Lancet,2011,377(9771):1096-1101,1101e1091-1092.
[23]张连阳.骨盆骨折大出血救治的外科技术[J].创伤外科杂志,2015,17(1):1-4.
[24] Hou Z,Smith WR,Strohecker KA,et al. Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality[J]. Orthopedics,2012,35(3):e319-324.
[25]胡平.严重骨盆骨折早期外科止血技术的相关问题[J].中华创伤杂志,2017,33(11):974-976.
[2] Tile M,Pennal GF. Pelvic disruption:principles of management[J].Clin Orthop Relat Res,1980,(151):56-64.
[3] Young JW,Burgess AR,Brumback RJ,et al. Pelvic fractures:value of plain radiography in early assessment and management[J]. Radiology,1986,160(2):445-451.
[4] Halawi MJ. Pelvic ring injuries:emergency assessment and management[J]. J Clin Orthop Trauma,2015,6(4):252-258.
[5] Langford JR,Burgess AR,Liporace FA,et al. Pelvic fractures:part1. Evaluation,classification,and resuscitation[J]. J Am Acad Orthop Surg,2013,21(8):448-457.
[6]张连阳.多发伤的紧急伤情评估策略[J].创伤外科杂志,2010,12(1):1-3.
[7]吴茂铸,倪淑红,应琦,等.多层螺旋CT及后处理技术在骶骨骨折诊断中的应用[J].实用放射学杂志,2010,26(12):1789-1791.
[8]陶杰,吴晓波,陈重,等.急诊床旁创伤重点超声评估结合区域脏器重点超声检查在闭合性腹部创伤中的应用[J].中华创伤杂志,2014,30(2):138-141.
[9]中华医学会急诊医学分会.血流动力学不稳定骨盆骨折急诊处理专家共识[J].中华创伤杂志,2015,31(12):1057-1062.
[10] Martinez F,Alegret N,Carol F,et al. Pelvic fracture in the patient with multiple injuries:factors and lesions associated with mortality[J]. Emergencias,2018,30(2):91-97.
[11] De Robertis E,Kozek-Langenecker SA,Tufano R,et al. Coagulopathy induced by acidosis,hypothermia and hypocalcaemia in severe bleeding[J]. Minerva Anestesiol,2015,81(1):65-75.
[12]禹宝庆,周海燕.不稳定骨盆骨折处理的几个关键问题[J].中华创伤杂志,2014,30(1):12-14.
[13] Guo WA. The search for a magic bullet to fight multiple organ failure secondary to ischemia/reperfusion injury and abdominal compartment syndrome[J]. J Surg Res,2013,184(2):792-793.
[14] Wohlauer MV,Moore EE,Droz NM,et al. Hemodilution is not critical in the pathogenesis of the acute coagulopathy of trauma[J]. J Surg Res,2012,173(1):26-30.
[15]文爱清,张连阳,蒋东坡,等.严重创伤输血专家共识[J].中华创伤杂志,2013,29(8):706-710.
[16] Holcomb JB,Zarzabal LA,Michalek JE,et al. Increased platelet:RBC ratios are associated with improved survival after massive transfusion[J]. J Trauma,2011,71(2S3):S318-328.
[17] Holcomb JB,Del Junco DJ,Fox EE,et al. The prospective,observational,multicenter,major trauma transfusion(PROMMTT)study:comparative effectiveness of a time-varying treatment with competing risks[J]. JAMA Surg,2013,148(2):127-136.
[18]党伟,刘红升,曹阳,等.严重多发伤的急诊救治分析[J].创伤外科杂志,2014,16(5):390-392.
[19]支中正,禹宝庆,敖荣广,等.骨盆骨折急救的研究进展[J].中华创伤杂志,2016,32(12):1137-1141.
[20]都定元.院前创伤急救进展:新研究带来的机遇与挑战[J].创伤外科杂志,2012,14(4):292-296.
[21] Shakur H,Roberts I,Bautista R,et al. Effects of tranexamic acid on death,vascular occlusive events,and blood transfusion in trauma patients with significant haemorrhage(CRASH-2)a randomised,placebo-controlled trial[J]. Lancet,2010,376(9734):23-32.
[22] Roberts I,Shakur H,Afolabi A,et al. The importance of early treatment with tranexamic acid in bleeding trauma patients:an exploratory analysis of the CRASH-2 randomised controlled trial[J]. Lancet,2011,377(9771):1096-1101,1101e1091-1092.
[23]张连阳.骨盆骨折大出血救治的外科技术[J].创伤外科杂志,2015,17(1):1-4.
[24] Hou Z,Smith WR,Strohecker KA,et al. Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality[J]. Orthopedics,2012,35(3):e319-324.
[25]胡平.严重骨盆骨折早期外科止血技术的相关问题[J].中华创伤杂志,2017,33(11):974-976.