目的 探討伴會陰部損傷的開放性骨盆骨折治療方法及療效。 方法 2000 年8 月－ 2010 年7 月，收治16 例伴會陰部損傷的開放性骨盆骨折患者。男12 例，女4 例；年齡17 ～ 69 歲，平均41 歲。致傷原因：交通事故傷9 例，高處墜落傷6 例，重物砸傷1 例。受傷至入院時間為5 ～ 20 min，平均8 min。骨盆骨折按照Tile 分型標準：A 型2 例，B 型6 例，C 型8 例。創(chuàng)面范圍5 cm × 3 cm ～ 15 cm × 12 cm。會陰部損傷部位：腹膜內(nèi)直腸損傷2 例，腹膜外直腸肛管損傷14 例。按創(chuàng)傷嚴重度評分標準（injury severity score，ISS）評分為25 ～ 48 分，平均29 分。入院后按創(chuàng)傷骨折流程急救處理，主要包括急救復蘇、結(jié)腸造瘺、外固定架固定、創(chuàng)面多次清創(chuàng)、沖洗、持續(xù)封閉式負壓引流技術(shù)（vacuum sealingdrainage，VSD）。 結(jié)果 入院4 d 內(nèi)死亡5 例，其中3 例死于失血性休克，2 例死于多器官功能衰竭。余11 例存活患者均獲隨訪，隨訪時間6 ～ 46 個月，平均14 個月。X 線片檢查示骨盆骨折于術(shù)后2 ～ 4 個月達骨性愈合。術(shù)后會陰部損傷創(chuàng)面均有不同程度感染，經(jīng)擴創(chuàng)、VSD 治療后，其中10 例創(chuàng)面直接拉攏縫合后Ⅱ期愈合，1 例行股薄肌皮瓣移位修復后愈合。直腸肛管損傷患者隨訪期間無失禁表現(xiàn)。 結(jié)論 對于伴會陰部損傷的開放性骨盆骨折，應早期積極抗休克、保護重要臟器功能、處理合并癥，后期抗感染、恢復骨盆環(huán)穩(wěn)定性、修復重建直腸肛管及尿道功能，以獲得較好療效。
引用本文： 魏人前,曹興海,涂大華. 伴會陰部損傷的開放性骨盆骨折治療. 中國修復重建外科雜志, 2012, 26(5): 550-553. doi: 復制
| 1. | Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis. J Bone Joint Surg (Br), 2010, 92(11): 1481-1488. |
| 2. | Flint L, Cryer HG. Pelvic fracture: the last 50 years. J Trauma, 2010, 69(3): 483-488. |
| 3. | Petrone P, Inaba K, Wasserberg N, et al. Perineal injuries at a large urban trauma center: injury patterns and outcomes. Am Surg, 2009, 75(4): 317-320. |
| 4. | Kataoka Y, Minehara H, Shimada K, et al. Sepsis caused by peripelvic soft tissue infections in critically injured patients with multiple injuries and unstable pelvic fracture. J Trauma, 2009, 66(6): 1548-1555. |
| 5. | 劉志雄. 骨科常用診斷分類方法和功能結(jié)果評定標準. 北京: 北京科學技術(shù)出版社, 2005: 92-95, 196. |
| 6. | Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306. |
| 7. | Scaglione M, Parchi P, Digrandi G, et al. External fixation in pelvic fractures. Musculoskelet Surg, 2010, 94(2): 63-70. |
| 8. | Dienstknecht T, Berner A, Lenich A, et al. A minimally invasive stabilizing system for dorsal pelvic ring injuries. Clin Orthop Relat Res, 2011, 469(11): 3209-3217. |
| 9. | Rysavý M, Pavelka T, Khayarin M, et al. Iliosacral screw fixation of the unstable pelvic ring injuries. Acta Chir Orthop Traumatol Cech, 2010, 77(3): 209-214. |
| 10. | Ayvaz M, Ca?lar O, Y?lmaz G, et al. Long-term outcome and quality of life of patients with unstable pelvic fractures treated by closed reduction and percutaneous fixation. Ulus Travma Acil Cerrahi Derg, 2011, 17(3): 261-266. |
| 11. | Shoufani A, Samuelov R. Vacuum assisted closure—a new method for wound control and treatment. Harefuah, 2003, 142(12): 837-840, 877. |
| 12. | Ozer MT, Coskun AK, Ozerhan IH, et al. Use of vacuum-assisted closure (VAC?) in high-energy complicated perineal injuries: analysis of nine cases. Int Wound J, 2011, 8(6): 599-607. |
| 13. | 朱躍良, 徐永清, 李軍, 等. 合并會陰部撕裂的Morel-Lavallée 損傷的外科治療. 中國修復重建外科雜志, 2010, 24(6): 726-729. |
| 14. | Kido A, Inoue F, Takakura Y, et al. Statistical analysis of fatal bleeding pelvic fracture patients with severe associated injuries. J Orthop Sci, 2008, 13(1): 21-24. |
| 15. | Torres Castro C, Bello González A, Ortuño Numbela BX. Experience in the management of open pelvic fractures at the Mexican Red Cross Trauma Center. Acta Ortop Mex, 2010, 24(3): 159-162. |
| 16. | Dong JL, Zhou DS. Management and outcome of open pelvic fractures: a retrospective study of 41 cases. Injury, 2011, 42(10): 1003-1007. |
| 17. | Sharma OP, Oswanski MF, Rabbi J, et al. Pelvic fracture risk assessment on admission. Am Surg, 2008, 74(8): 761-766. |
- 1. Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis. J Bone Joint Surg (Br), 2010, 92(11): 1481-1488.
- 2. Flint L, Cryer HG. Pelvic fracture: the last 50 years. J Trauma, 2010, 69(3): 483-488.
- 3. Petrone P, Inaba K, Wasserberg N, et al. Perineal injuries at a large urban trauma center: injury patterns and outcomes. Am Surg, 2009, 75(4): 317-320.
- 4. Kataoka Y, Minehara H, Shimada K, et al. Sepsis caused by peripelvic soft tissue infections in critically injured patients with multiple injuries and unstable pelvic fracture. J Trauma, 2009, 66(6): 1548-1555.
- 5. 劉志雄. 骨科常用診斷分類方法和功能結(jié)果評定標準. 北京: 北京科學技術(shù)出版社, 2005: 92-95, 196.
- 6. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
- 7. Scaglione M, Parchi P, Digrandi G, et al. External fixation in pelvic fractures. Musculoskelet Surg, 2010, 94(2): 63-70.
- 8. Dienstknecht T, Berner A, Lenich A, et al. A minimally invasive stabilizing system for dorsal pelvic ring injuries. Clin Orthop Relat Res, 2011, 469(11): 3209-3217.
- 9. Rysavý M, Pavelka T, Khayarin M, et al. Iliosacral screw fixation of the unstable pelvic ring injuries. Acta Chir Orthop Traumatol Cech, 2010, 77(3): 209-214.
- 10. Ayvaz M, Ca?lar O, Y?lmaz G, et al. Long-term outcome and quality of life of patients with unstable pelvic fractures treated by closed reduction and percutaneous fixation. Ulus Travma Acil Cerrahi Derg, 2011, 17(3): 261-266.
- 11. Shoufani A, Samuelov R. Vacuum assisted closure—a new method for wound control and treatment. Harefuah, 2003, 142(12): 837-840, 877.
- 12. Ozer MT, Coskun AK, Ozerhan IH, et al. Use of vacuum-assisted closure (VAC?) in high-energy complicated perineal injuries: analysis of nine cases. Int Wound J, 2011, 8(6): 599-607.
- 13. 朱躍良, 徐永清, 李軍, 等. 合并會陰部撕裂的Morel-Lavallée 損傷的外科治療. 中國修復重建外科雜志, 2010, 24(6): 726-729.
- 14. Kido A, Inoue F, Takakura Y, et al. Statistical analysis of fatal bleeding pelvic fracture patients with severe associated injuries. J Orthop Sci, 2008, 13(1): 21-24.
- 15. Torres Castro C, Bello González A, Ortuño Numbela BX. Experience in the management of open pelvic fractures at the Mexican Red Cross Trauma Center. Acta Ortop Mex, 2010, 24(3): 159-162.
- 16. Dong JL, Zhou DS. Management and outcome of open pelvic fractures: a retrospective study of 41 cases. Injury, 2011, 42(10): 1003-1007.
- 17. Sharma OP, Oswanski MF, Rabbi J, et al. Pelvic fracture risk assessment on admission. Am Surg, 2008, 74(8): 761-766.