摘要
目的分析和探讨合并骨盆骨折的腹部损伤患者的临床特点。方法将我科2011年8月~2013年2月收治的640例多发伤患者分为腹部损伤组(AIG)、骨盆骨折组(PFG)和综合组(IG),回顾性研究3组的致伤原因、损伤部位、伤情程度、骨盆损伤分型、腹部损伤类型、并发症、漏诊情况和治疗效果,探讨此类患者腹部损伤的早期诊断及治疗原则。结果致伤原因依次为道路交通伤、高处坠落伤,IG的高处坠落伤发生率显著高于其它两组(P<0.01)。损伤部位分布由多至少依次为体表、四肢和骨盆、腹部和盆腔脏器、胸部、头颈部和面部。IG的伤情严重程度显著高于其它两组(P<0.01)。IG的混合型(C型)、前后挤压型(APC型)、垂直分离型(VS型)骨折显著高于PFG(P<0.01)。IG的空腔脏器损伤、实空两者都有、腹膜外及腹膜内外均有的腹部损伤显著高于AIG(P<0.01)。IG的酸中毒、低体温及凝血障碍发生率均高于其它两组(P<0.01)。漏诊依次以腹膜后血肿、实质脏器损伤、空腔脏器损伤和脊柱骨折为主。IG死亡率显著高于其它两组(P<0.01)。结论骨盆和腹部脏器同时受累的患者伤情重、不稳定骨折多、易漏诊、病死率高,应及时行抗休克治疗、骨盆外固定和损害控制性剖腹探查,以提高抢救成功率。
Objective To explore the clinical features of multiple traumatic patients of pelvic fracture associated with abdominal injury. Methods A total of 640 patients enrolled from Aug. 2011 to Feb. 2013 were divided into 3 groups( AI group,PF group and I group). Differences among those groups were retrospectively studied to explore rules of diagnosis and treatment from such aspects as injury causes,injury sites,injury severity,fracture classifications,abdominal injury classifications,complications,missed diagnosis and treatment effects. Results Road traffic injuries and high fall injury were the major cause of patients and the incidence rate of high fall injury of I group was significantly higher than the other two groups( P < 0. 01). The most likely injured sites included body surface,extremity and pelvis,abdominal and pelvic organs,chest,head and neck,face. The severe rate of I group was significantly higher than the other two groups( P < 0. 01). The incidence of C type,APC type,VS type pelvic fracture of I group was significantly higher than PF group( P < 0. 01). Injuries of hollow organs and both hollow and solid organs,extraperitoneal and both( extraperitoneal and intraperitoneal) of I group were significant higher than AIG group( P < 0. 01). Acidosis hypothermia and blood coagulation disorder of I group were significantly higher than that of the other two groups( P < 0. 01). Retroperitoneal hematoma,solid organ injury,hollow organ injury and spinal fracture were most likely to be missed. Mortality of I group was significantly higher than the other two groups( P < 0. 01). Conclusion Patients with severe abdominal and pelvic injury are likely to be associated with severe unstable pelvic fractures and are at high risk of missed diagnosis and mortality. Anti-shock,external fixation and damage control laparotomy may be helpful to raise the survival rate.
出处
《创伤外科杂志》
2015年第1期20-24,共5页
Journal of Traumatic Surgery
关键词
多发伤
腹部损伤
骨盆骨折
multiple trauma
abdominal injury
pelvic fracture
