CAJ | 학술논문

目的探讨伴有直肠肛管损伤的开放性骨盆骨折的治疗. 方法 1998年10月至2008年10月共收治35例开放性骨盆骨折患者,其中19例伴有直肠肛管损伤,对此19例患者的资料进行回顾性分析.骨折按Tile方法分类:A型1例,B型5例,C型13例.直肠肛管损伤部位:腹膜内直肠损伤3例,腹膜外直肠损伤11例,肛管损伤5例.患者入院后,临床治疗按四步流程开展:①急救复苏:抢救生命和控制出血,②结肠造瘘与清创,③骨盆骨折的治疗,④后期创面的处理. 结果 19例患者均存活,并获得12～48个月(平均18个月)随访.直肠肛管损伤治疗结果按Hiltunen标准进行评价:18例治愈(无失禁及部分失禁),1例出现医源性狭窄后经扩肛治疗改善.骨盆骨折按Majeed疗效评价:优3例,良11例,可4例,差1例,优良率为73.7%.创面愈合:18例创面Ⅰ期愈合或Ⅱ期经过植皮及转移皮瓣修复后愈合,其中1例创面有不同程度感染,经换药、引流及加强抗炎后愈合;1例创面损伤及感染严重,行右股骨中上段截肢、转移皮瓣覆盖会阴创面及双侧睾丸移位置于腹部皮下,加强换药后好转,留待Ⅱ期整形处理. 结论对于伴有直肠肛管损伤的开放性骨盆骨折,通过术前准确的评估,结合伤情的演变规律,分阶段按照止血与液体复苏、骨科损伤控制、多学科联合、复合固定技术、感染控制等一系列原则序贯而针对性地进行处理,患者可存活,并能取得较满意的效果.
목적 탐토반유직장항관손상적개방성골분골절적치료. 방법 1998년10월지2008년10월공수치35례개방성골분골절환자,기중19례반유직장항관손상,대차19례환자적자료진행회고성분석.골절안Tile방법 분류:A형1례,B형5례,C형13례.직장항관손상부위:복막내직장손상3례,복막외직장손상11례,항관손상5례.환자입원후,림상치료안사보류정개전:①급구복소:창구생명화공제출혈,②결장조루여청창,③골분골절적치료,④후기창면적처리. 결과 19례환자균존활,병획득12～48개월(평균18개월)수방.직장항관손상치료결과 안Hiltunen표준진행평개:18례치유(무실금급부분실금),1례출현의원성협착후경확항치료개선.골분골절안Majeed료효평개:우3례,량11례,가4례,차1례,우량솔위73.7%.창면유합:18례창면Ⅰ기유합혹Ⅱ기경과식피급전이피판수복후유합,기중1례창면유불동정도감염,경환약、인류급가강항염후유합;1례창면손상급감염엄중,행우고골중상단절지、전이피판복개회음창면급쌍측고환이위치우복부피하,가강환약후호전,류대Ⅱ기정형처리. 결론 대우반유직장항관손상적개방성골분골절,통과술전준학적평고,결합상정적연변규률,분계단안조지혈여액체복소、골과손상공제、다학과연합、복합고정기술、감염공제등일계렬원칙서관이침대성지진행처리,환자가존활,병능취득교만의적효과.
Objective To investigate the clinical treatment of open pelvic fractures associated with anorectal injury. Methods We retrospectively reviewed the medical data of 19 patients who had been treated at our department between October 1998 and October 2008 for open pelvic fractures associated with anorectal injury. By Tile classification, there were 1 type A, 5 type B and 13 type C. Three cases suffered from intraperitoneal rectal injury, 11 from extraperitoneal rectal injury and 5 from injury to the anal canal. Their treatment was carried out in 4 steps. First, emergency resuscitation to rescue life and control massive hemorrhage; second, sigmoid colon ostomy and debridement to handle anorectal injury; third, management of the pelvic fracture; fourth, later wounds management. Resnits No death occurred in this group. All the 19 patients were followed up for 12 to 48 (average, 18) months. The anorectal injury was cured in 18 cases and improved in 1 case. According to the Majeed evaluation, the outcome of pelvic fractures was excellent in 3 cases, good in 11, fair in 4, and poor in 1. The good to excellent rate was 73. 7%. The wounds healed at one or two stages after grafting and flap transfer in 18 eases. Conclusion C, oed outcome of open pelvic fractures associated with anorectal injury may result from timely emergency resuscitation, aggressive manage-ment of anorectal injury and proper management of pelvic fractures by orthopaedists in cooperation with spe-cialists from other disciplines.