摘要
目的探讨术前髂内动脉栓塞及预置腹主动脉球囊在治疗复杂骨盆骨折中的作用及临床疗效。方法回顾性分析2012年3月至2015年5月，采用术前2h在数字减影血管造影（digital subtraction angiography, DSA）下行髂内动脉栓塞、并预置腹主动脉球囊治疗7例c3型骨盆骨折患者资料，男3例，女4例；年龄16-61岁，平均34岁；C3．2型5例，C3．3型2例。其中合并四肢骨折5例，颅脑损伤2例，肺挫伤4例，腹、盆腔脏器损伤2例；受伤至手术时间10-33d，平均19d。患者入院后控制出血，采用骨盆外固定支架临时固定，对移位的骨盆骨折行下肢大重量牵引复位，重症监护复苏及全身状态调整，待患者病情稳定后行确定性手术。术前采用3D打印技术行手术预演，术前2h通过DSA对骶髂关节周围骨折移位明显一侧行髂内动脉栓塞，术中经腹直肌外侧入路从前方对前、后环及髋臼骨折进行复位固定，其中2例患者复位骶髂关节周围骨折时出血量大，使用术前预置的腹主动脉球囊临时阻断腹主动脉（≤60min）。结果7例患者均顺利完成手术，手术时间135～320min，术中出血440～3350ml；随访时间12～36个月，平均18个月。术后复查X线及CT，Matta评价优5例，良2例，优良率100％；骨折均临床愈合，愈合时间8-12周；术后7例均合并不同程度骶丛或腰骶干神经损伤（M02例、M12例、M22例、M31例），术中同时予以神经探查松解。根据英国医学研究会神经损伤委员会（Nerve Injuries Committee of the British Medical Research Council, BMRC）神经损伤分级评价神经松解术后疗效，术后3个月2例患者（M0）足下垂症状无明显改善，余5例（M42例、M53例）BMRC评价平均提高2．8个等级，效果理想。结论通过术前髂内动脉栓塞结合预置腹主动脉球囊，可有效控制术中出血，经腹直肌外侧切口入路能较好显露骨盆的前、后环，并能完
Objective To evaluate the clinical outcome of bleeding control by preoperative embolization of internal iliac artery with DSA and intra-operative presetting abdominal aorta balloon, combine with the operation techniques of exposure, reduc- tion and internal fixation of pelvic fracture through lateral-rectus approach. Methods From March 2012 to May 2015, 7 patients with type C3 pelvic fractures admitted to our department from March 2012 to May 2015, treated with preoperative embolization of internal iliac artery under digital subtraction angiography 2 h before surgery and presetting abdominal aorta balloon were retrospec- tively reviewed. There were 3 males and 4 females, with an average age of 34 years （range, 16 to 61 years）. According to AO classi- fication, all 7 cases belonged to type C3 （3.2：5 cases; C3.3：2 cases）, including 5 cases with limb fracture, 2 cases with craniocere- bral trauma, 4 cases with pulmonary contusion, 2 cases with injury of abdominsal organs. Time from injury to operation was 19 days on average （10 to 33 days）. Patients received damage control surgery treatment including bleeding control and temporary ex- ternal fixation, and ipsilateral tractions with heavy weight, intensive care and corrections of general situation before operation. The fracture model was manufactured by 3D printing and fracture reduction was simulated on computer preoperatively. Embolization of internal iliac artery was performed in the side of severe displaced sacroiliac joint with DSA 2 hours preoperatively. Reduction was performed to stabilize anterior-posterior pelvic ring and acetabular fractures via the intraoperative lateral-rectus approach. And 2 cases were performed by temporary balloon occlusion of abdominal aorta （≤ 60 min） for bleeding control in reduction of in the side of sacroiliac joint fractures. Results All the 7 cases had undergone the operations successfully, and the operating time was from 135-320 min with blood loss from 440-3 350 ml. According to Matta radiologieal evaluat
作者
杨晓东
刘涵
周忠信
韩卫雨
夏广
谷诚
李涛
黄伟奇
麦奇光
金大地
樊仕才
Yang Xiaodong Liu Han Zhou Zongxin Han Weiyu Xia Guang Gu Cheng Li Tao Huang Weiqi Mai Qiguang Jin Da- di Fan Shicai(Department of Orthopaedics, Guangzhou Huadu District People＇s Hospital, Guangzhou 510800, China Depart- ment of Orthopaedics, the third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China Department of Vascular Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第1期11-16,共6页
Chinese Journal of Orthopaedics
基金
广东省前沿与关键技术创新专项资金（2015B010125006）
临床研究启动计划（LC2016ZD032）
关键词
骨盆
骨折
栓塞
治疗性
Pelvics
Fractures, bone
Embolization, therapeutic
