2019 年第 5 期 第 14 卷

损害控制手术方案在多发伤合并不稳定骨盆骨折中的应用效果

Effect of damage control surgery on multiple trauma complicated with unstable pelvic fracture

作者：吴昊石展英胡居正李兵韦盛旺梁伟

英文作者：

单位：545005广西壮族自治区柳州市工人医院创伤骨科

英文单位：

关键词：骨盆骨折；多发伤；损害控制手术；创伤骨科

英文关键词：

• 摘要：

• 【摘要】目的    探讨损害控制手术(DCS)方案在多发伤合并不稳定骨盆骨折中的应用及其实施效果。方法    回顾性分析2016年7月至2017年6月(DCS理念应用前)广西壮族自治区柳州市工人医院创伤骨科收治的多发伤合并不稳定骨盆骨折患者80例，设为对照组，均采取常规手术方案治疗。前瞻性选取2017年7月至2018年6月(DCS理念应用后)本科室收治的多发伤合并不稳定骨盆骨折患者96例，设为观察组，予以基于DCS理念的分期治疗方案。比较2组患者入院时及确定性手术前血清降钙素原水平、体温及pH值，比较2组术中输血量、手术及住院时间、住院费用、并发症发生率、病死率，按照Matta标准评价骨盆骨折的影像学复位效果。结果    确定性手术前，观察组血清降钙素原水平、体温均明显低于对照组［（1.8±0.6）μg/L比（3.3±0.8）μg/L、（36.0±0.6）℃比（36.4±0.5）℃］，pH值明显高于对照组［（7.36±0.09）比（7.29±0.06）］(均P＜0.01)。观察组术中输血量及手术时间均明显少于/短于对照组［（366±54）ml比（562±85）ml、（136±16）min比（151±21）min］(均P＜0.05)。观察组病死率明显低于对照组［5.2%（5/96）比16.2%（13/80）］(P＝0.019)。观察组术后骨盆骨折复位效果的优良率明显高于对照组［85.7%（78/91）比62.7%（42/67）］(P＜0.001)。观察组并发症发生率明显低于对照组［18.7%（17/91）比47.8%（32/67）］(P＜0.001)。结论    DCS方案在多发伤合并不稳定骨盆骨折的临床救治中具有较好的效果，有助于优先处理危及生命的合并伤，为确定性手术创造了条件和保障，提高了骨盆骨折的复位效果，也降低了病死率和并发症发生率。

• 【Abstract】Objective    To explore the effect of damage control surgery(DCS) on multiple trauma complicated with unstable pelvic fracture. Methods    Eighty patients with multiple trauma and unstable pelvic fracture in Liuzhou Worker′s Hospital, Guangxi Zhuang Autonomous Region from July 2016 to June 2017 were retrospectively analyzed as control group and they were treated with conventional surgical procedures. Ninety-six patients with multiple trauma and unstable pelvic fracture admitted to hospital from July 2017 to June 2018 were enrolled as observation group, they were treated with staging operation based on DCS. Serum procalcitonin(PCT), body temperature and pH value were measured at admission and before definite surgery. Intraoperative blood transfusion volume, operation time, hospitalization time, hospitalization cost, complications and mortality were recorded. Restoration of pelvic fracture in imaging was assessed according to the Matta criteria. Results    Before definite surgery, serum PCT level and body temperature were significantly lower and pH value was higher in observation group than those in control group［（1.8±0.6）μg/L vs （3.3±0.8）μg/L, （36.0±0.6）℃ vs （36.4±0.5）℃, （7.36±0.09） vs （7.29±0.06）］(all P＜0.01). Intraoperative blood transfusion volume and operation time in observation group were significantly less/shorter than those in control group［（366±54）ml vs （562±85）ml, （136±16）min vs （151±21）min］(both P＜0.05). Fatality rate was 5.2%（5/96） in observation group and 16.2%（13/80） in control group(P＝0.019); correct reduction rate of pelvic fracture was 85.7%（78/91） and 62.7%（42/67）(P＜0.001); complication rate was 18.7%（17/91） and 47.8%（32/67）(P＜0.001). Conclusion    DCS has a good therapeutic effect on multiple trauma with unstable pelvic fracture, helping to prioritize life-threatening injuries, create guarantees for definite surgery, improve fracture restoration and reduce the fatality and complications.