中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
11期
1223-1227
,共5页
蓝霞%唐佩福%张立海%陶笙%张群%梁向党%郭义柱%陈华%梁雨田%张伯勋%王岩
藍霞%唐珮福%張立海%陶笙%張群%樑嚮黨%郭義柱%陳華%樑雨田%張伯勛%王巖
람하%당패복%장립해%도생%장군%량향당%곽의주%진화%량우전%장백훈%왕암
骨盆%骨折%出血%止血,手术
骨盆%骨摺%齣血%止血,手術
골분%골절%출혈%지혈,수술
Pelvis%Fractures,bone%Hemorrhage%Hemostasis,surgical
目的 探讨球囊临时阻断髂总动脉控制陈旧性骨盆骨折术中出血的临床应用.方法 2006年1月至2009年6月,手术治疗12例Tile C型陈旧性骨盆骨折患者,男10例,女2例；年龄22～45岁,平均33.9岁.3例使用外固定架固定；9例因救治内脏损伤而贻误早期骨科手术,其中6例骨折未骨性愈合,3例骨折已畸形愈合.术中通过血管介入的方法将球囊导管置于患侧髂总动脉,截骨时充盈球囊,使手术在完全阻断髂总动脉血流的情况下施行.12例行截骨内固定术,其中4例合并坐骨神经损伤症状的患者同时行腰骶干减压术.结果 12例患者手术时间为210～367 min,平均290 min；阻断持续时间45～90 min,平均65 min；术中出血量700～2800 ml,平均1833ml.术后随访12～48个月,平均35个月.切口均甲级愈合；骨折愈合时间16～24周,平均20.6周.术后无一例发生髂总动脉和下肢深静脉血栓形成、肢体远端缺血性坏死.4例合并坐骨神经损伤症状的患者中,3例需扶拐行走,1例正常行走；其余患者2例跛行,6例恢复正常行走.结论 球囊临时髂总动脉阻断血流能大幅度减少术中出血,可避免发生选择性动脉栓塞和结扎术的并发症,提高陈旧性骨盆骨折的手术安全性.
目的 探討毬囊臨時阻斷髂總動脈控製陳舊性骨盆骨摺術中齣血的臨床應用.方法 2006年1月至2009年6月,手術治療12例Tile C型陳舊性骨盆骨摺患者,男10例,女2例；年齡22～45歲,平均33.9歲.3例使用外固定架固定；9例因救治內髒損傷而貽誤早期骨科手術,其中6例骨摺未骨性愈閤,3例骨摺已畸形愈閤.術中通過血管介入的方法將毬囊導管置于患側髂總動脈,截骨時充盈毬囊,使手術在完全阻斷髂總動脈血流的情況下施行.12例行截骨內固定術,其中4例閤併坐骨神經損傷癥狀的患者同時行腰骶榦減壓術.結果 12例患者手術時間為210～367 min,平均290 min；阻斷持續時間45～90 min,平均65 min；術中齣血量700～2800 ml,平均1833ml.術後隨訪12～48箇月,平均35箇月.切口均甲級愈閤；骨摺愈閤時間16～24週,平均20.6週.術後無一例髮生髂總動脈和下肢深靜脈血栓形成、肢體遠耑缺血性壞死.4例閤併坐骨神經損傷癥狀的患者中,3例需扶枴行走,1例正常行走；其餘患者2例跛行,6例恢複正常行走.結論 毬囊臨時髂總動脈阻斷血流能大幅度減少術中齣血,可避免髮生選擇性動脈栓塞和結扎術的併髮癥,提高陳舊性骨盆骨摺的手術安全性.
목적 탐토구낭림시조단가총동맥공제진구성골분골절술중출혈적림상응용.방법 2006년1월지2009년6월,수술치료12례Tile C형진구성골분골절환자,남10례,녀2례；년령22～45세,평균33.9세.3례사용외고정가고정；9례인구치내장손상이이오조기골과수술,기중6례골절미골성유합,3례골절이기형유합.술중통과혈관개입적방법장구낭도관치우환측가총동맥,절골시충영구낭,사수술재완전조단가총동맥혈류적정황하시행.12례행절골내고정술,기중4례합병좌골신경손상증상적환자동시행요저간감압술.결과 12례환자수술시간위210～367 min,평균290 min；조단지속시간45～90 min,평균65 min；술중출혈량700～2800 ml,평균1833ml.술후수방12～48개월,평균35개월.절구균갑급유합；골절유합시간16～24주,평균20.6주.술후무일례발생가총동맥화하지심정맥혈전형성、지체원단결혈성배사.4례합병좌골신경손상증상적환자중,3례수부괴행주,1례정상행주；기여환자2례파행,6례회복정상행주.결론 구낭림시가총동맥조단혈류능대폭도감소술중출혈,가피면발생선택성동맥전새화결찰술적병발증,제고진구성골분골절적수술안전성.
Objective To discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.Results The mean time of operations was 290 min (range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.Conclusion The effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer.
