CAJ | 학술논문

目的探讨应用骨盆外固定支架复位固定、结肠造瘘、反复清刨、创口封闭负压引流等措施治疗开放性骨盆骨折会阴撕裂感染的疗效.方法 2004年2月至2011年1月,治疗8例开放性骨盆骨折会阴撕裂伤感染患者,男7例,女1例；年龄22～59岁,平均36.3岁；交通伤5例,高处坠落伤2例,重物压伤1例.骨盆骨折按Tile分型:B型3例,C型5例；创口部位根据Faringer等分区均为Ⅰ区.行骨盆外固定支架固定、早期结肠造瘘、反复清创、创口封闭负压引流等方法治疗,待感染控制后择期修补撕裂的会阴及根据骨盆骨折移位情况行骨折复位固定术.结果在给予骨盆外固定支架固定、结肠造瘘、反复清创、创口封闭负压引流等综合治疗后,8例患者感染治愈,体温、血常规恢复正常,创口愈合.受伤至创口愈合时间为8～43 d,平均17 d.1例患者于创口愈合后行切开复位内固定术；4例早期行骨盆外固定支架固定患者复位满意,未再进一步治疗；3例合并损伤较重患者,刨口愈合1个月后全身情况才允许行手术治疗,但此时骨折周围已见明显骨痂生长,故未再进一步治疗,骨折畸形愈合.8例患者骨折均愈合,愈合时间3～6个月,平均3.6个月.患者均获得随访,随访时间6～36个月,平均16个月.Majeed骨盆骨折评分:优2例,良3例,可2例,差1例；优良率为62.5％.结论应用外固定支架、结肠造瘘、反复清创、创口封闭负压引流等措施在开放性骨盆骨折会阴撕裂感染的治疗中能有效控制感染、降低感染率及死亡率,对缩短伤口愈合时间有积极作用.
목적 탐토응용골분외고정지가복위고정、결장조루、반복청포、창구봉폐부압인류등조시치료개방성골분골절회음시렬감염적료효.방법 2004년2월지2011년1월,치료8례개방성골분골절회음시렬상감염환자,남7례,녀1례；년령22～59세,평균36.3세；교통상5례,고처추락상2례,중물압상1례.골분골절안Tile분형:B형3례,C형5례；창구부위근거Faringer등분구균위Ⅰ구.행골분외고정지가고정、조기결장조루、반복청창、창구봉폐부압인류등방법치료,대감염공제후택기수보시렬적회음급근거골분골절이위정황행골절복위고정술.결과 재급여골분외고정지가고정、결장조루、반복청창、창구봉폐부압인류등종합치료후,8례환자감염치유,체온、혈상규회복정상,창구유합.수상지창구유합시간위8～43 d,평균17 d.1례환자우창구유합후행절개복위내고정술；4례조기행골분외고정지가고정환자복위만의,미재진일보치료；3례합병손상교중환자,포구유합1개월후전신정황재윤허행수술치료,단차시골절주위이견명현골가생장,고미재진일보치료,골절기형유합.8례환자골절균유합,유합시간3～6개월,평균3.6개월.환자균획득수방,수방시간6～36개월,평균16개월.Majeed골분골절평분:우2례,량3례,가2례,차1례；우량솔위62.5％.결론 응용외고정지가、결장조루、반복청창、창구봉폐부압인류등조시재개방성골분골절회음시렬감염적치료중능유효공제감염、강저감염솔급사망솔,대축단상구유합시간유적겁작용.
Objective To evaluate the effect of external fixator,colostomy,repeated debridement and vacuum-assisted closure (VAC) to treat open pelvic fractures concomitant with perineal laceration and infection.Methods A retrospective analysis was made about 8 cases of open pelvic fractures concomitant with perineal laceration and infection from February 2004 to January 2011.It includes 7 men and 1 woman,with the average age of 36.3 years (ranged from 22 to 59 years).Five cases were injured by traffic accident,2 cases were fall-down from height,and 1 case was crushed by weight.Fractures type according to Tile:3 cases were type B,5 cases were type C.All cases were type I according to Faringer classification.All patients were treated with external fixator according to the displacement of pelvic fractures,early colostomy,repeated debridement,and after infection be controlled,VAC was used to close wound and drainage.Results The eight cases of open pelvic fractures concomitant with perineal laceration and infection were followed up from 6 to 36 months,with the average of 16 months.The infection was healed in all patients,and the body temperature and blood routine got normal.The period from injury to wound closing was from 8 to 43 days,with the average time of 17 days.According to the Majeed evaluation system,the pelvic fractures healing was evaluated after treatment:2 cases were excellent; 3 cases were good; 2 cases were fair;,1 case was poor;,the good to excellent rate was 62.5％.Conclusion The method of applying external fixator,colostomy,repeated debridement and VAC to treat open pelvic fractures concomitant with perineal laceration and infection is useful.The methods played an active role in controlling infection,reducing infection rates and mortality rates,and shortening the healing time.