摘要
目的探讨前侧皮下内固定(INFIX)在合并膀胱挫伤的骨盆前环骨折中的临床应用价值。方法回顾性分析2018年11月—2020年3月云南大学附属医院急诊外科应用INFIX治疗合并膀胱挫伤的骨盆前环骨折患者9例,男性4例,女性5例;年龄17~61岁,平均37.2岁。道路交通伤4例,挤压伤3例,高处坠落伤1例,其他伤1例。骨折按Tile分型:B1型1例,B2型3例,B3型5例。9例患者均合并膀胱挫伤,且结合病史、体检和辅助检查未发现膀胱破裂和其他部位泌尿系统损伤迹象。术前留置尿管,合理使用抗生素预防感染,待患者生命体征平稳后行手术治疗。记录术中出血量和手术时间,观察并随访术后骨折愈合及并发症情况,采用Matta和Majeed评分标准分别进行骨折复位情况和术后功能恢复的评估。结果术中顺利完成骨盆的复位和固定,其中加用骶髂螺钉固定3例;手术切口长4.5~8.0cm,手术时间45~87min,平均61.5min;术中出血15~70mL,平均35.3mL。术中及术后无膀胱及腹部脏器损伤情况发生,术后随访未发现膀胱功能减退现象;所有病例骨折复位良好,Matta评分优良率100%,均于术后3个月达到骨性愈合;随访6~17个月,平均11.1个月;末次随访术后所有患者功能恢复满意,Majeed评分优良率100%;但术后3例4侧出现不同程度股外侧皮神经症状,经营养神经治疗或取出内固定后逐渐缓解。结论INFIX是治疗合并膀胱挫伤的骨盆前环骨折的有效方法。
Objective To investigate the clinical application value of invasive subcutaneous internal fixator in the repair of the pelvic anterior ring fracture with bladder contusion.Methods Retrospective analysis was performed on 9 patients with anterior pelvic ring fracture complicated with bladder contusion treated with Infix in the Emergency Surgery Department of the Affiliated Hospital of Yunnan University from Nov.2018 to Mar.2020.There were 4 males and 5 females,aged from 17-61 years,with an average of 37.2 years.There were 4 cases of road traffic injuries,3 cases of crush injuries,1 case of falling injuries and 1 case of goring injuries.According to Tile classification,there was 1 case of B1 type,3 cases of B2 type and 5 cases of B3 type.Bladder contusion and hematuria were found in all 9 cases,but no bladder rupture or other signs of urinary tract injury was found.Urinary catheters were indwelled before surgery,antibiotics was used rationally to prevent infection,and surgery was performed after the patients’vital signs were stable.The amount of bleeding and operation time were recorded,and fracture healing and complications were observed.The quality of pelvic fracture reduction was evaluated by the Matta scoring system,and the Majeed score was used to evaluate the clinical efficacy.Results The reduction and fixation of the pelvis were successfully completed during the operation,in which 3 cases were fixed with sacroiliac screws;the length of the surgical incision was 4.5-8.0cm,the operation time was 45-87minutes,with an average of 61.5minutes;the intraoperative bleeding was 15-70mL,with an average of 35.3mL.No bladder or abdominal organ injuries occurred during and after the operation,and no bladder dysfunction was found in the postoperative follow-up.Fracture reduction was good in all cases,and the excellent and good rate of Matta score was 100%.All the fractures healed 3 months after the operation.The follow-up ranged from 6 to 17 months,with an average of 11.1 months.The functional recovery of all cases was satisfactory at the last follow-up,and the excellent and good rate of Majeed score was 100%.However,3 patients had symptoms of lateral femoral cutaneous nerve on 4 sides after operation,and gradually relieved after nerve treatment or removal of internal fixation.Conclusion INFIX is an effective treatment for pelvic anterior ring fractures with bladder contusion.
作者
吴照祥
段家章
亚俊
郭丰勇
吴俊华
Wu Zhaoxiang;Duan Jiazhang;Ya Jun;Guo Fengyong;Wu Junhua(Department of Emergency Surgery,Affiliated Hospital of Yunnan University,Kunming 650021,China)
出处
《创伤外科杂志》
2021年第9期668-672,共5页
Journal of Traumatic Surgery
关键词
骨盆骨折
膀胱挫伤
皮下内固定
pelvic fracture
bladder contusion
invasive subcutaneous internal fixator
