CAJ | 학술논문

目的：分析和探讨合并骨盆骨折的腹部损伤患者的临床特点。方法将我科2011年8月～2013年2月收治的640例多发伤患者分为腹部损伤组（AIG）、骨盆骨折组（PFG）和综合组（IG），回顾性研究3组的致伤原因、损伤部位、伤情程度、骨盆损伤分型、腹部损伤类型、并发症、漏诊情况和治疗效果，探讨此类患者腹部损伤的早期诊断及治疗原则。结果致伤原因依次为道路交通伤、高处坠落伤，IG的高处坠落伤发生率显著高于其它两组（ P＜0.01）。损伤部位分布由多至少依次为体表、四肢和骨盆、腹部和盆腔脏器、胸部、头颈部和面部。 IG的伤情严重程度显著高于其它两组（P＜0.01）。 IG的混合型（C型）、前后挤压型（APC型）、垂直分离型（VS型）骨折显著高于PFG（P＜0.01）。 IG的空腔脏器损伤、实空两者都有、腹膜外及腹膜内外均有的腹部损伤显著高于AIG（ P＜0.01）。 IG的酸中毒、低体温及凝血障碍发生率均高于其它两组（ P＜0.01）。漏诊依次以腹膜后血肿、实质脏器损伤、空腔脏器损伤和脊柱骨折为主。 IG死亡率显著高于其它两组（ P＜0.01）。结论骨盆和腹部脏器同时受累的患者伤情重、不稳定骨折多、易漏诊、病死率高，应及时行抗休克治疗、骨盆外固定和损害控制性剖腹探查，以提高抢救成功率。
목적：분석화탐토합병골분골절적복부손상환자적림상특점。방법장아과2011년8월～2013년2월수치적640례다발상환자분위복부손상조（AIG）、골분골절조（PFG）화종합조（IG），회고성연구3조적치상원인、손상부위、상정정도、골분손상분형、복부손상류형、병발증、루진정황화치료효과，탐토차류환자복부손상적조기진단급치료원칙。결과치상원인의차위도로교통상、고처추락상，IG적고처추락상발생솔현저고우기타량조（ P＜0.01）。손상부위분포유다지소의차위체표、사지화골분、복부화분강장기、흉부、두경부화면부。 IG적상정엄중정도현저고우기타량조（P＜0.01）。 IG적혼합형（C형）、전후제압형（APC형）、수직분리형（VS형）골절현저고우PFG（P＜0.01）。 IG적공강장기손상、실공량자도유、복막외급복막내외균유적복부손상현저고우AIG（ P＜0.01）。 IG적산중독、저체온급응혈장애발생솔균고우기타량조（ P＜0.01）。루진의차이복막후혈종、실질장기손상、공강장기손상화척주골절위주。 IG사망솔현저고우기타량조（ P＜0.01）。결론골분화복부장기동시수루적환자상정중、불은정골절다、역루진、병사솔고，응급시행항휴극치료、골분외고정화손해공제성부복탐사，이제고창구성공솔。
Objective To explore the clinical features of multiple traumatic patients of pelvic fracture asso-ciated with abdominal injury .Methods A total of 640 patients enrolled from Aug .2011 to Feb.2013 were divided into 3 groups (AI group,PF group and I group).Differences among those groups were retrospectively studied to ex-plore rules of diagnosis and treatment from such aspects as injury causes ,injury sites,injury severity, fracture classi-fications,abdominal injury classifications,complications,missed diagnosis and treatment effects.Results Road traffic injuries and high fall injury were the major cause of patients and the incidence rate of high fall injury of I group was significantly higher than the other two groups (P<0.01).The most likely injured sites included body surface,extremity and pelvis,abdominal and pelvic organs ,chest,head and neck,face.The severe rate of I group was significantly higher than the other two groups (P<0.01).The incidence of C type,APC type,VS type pelvic fracture of I group was significantly higher than PF group (P<0.01).Injuries of hollow organs and both hollow and solid organs,extraperitoneal and both ( extraperitoneal and intraperitoneal ) of I group were significant higher than AIG group( P<0.01).Acidosis hypothermia and blood coagulation disorder of I group were significantly higher than that of the other two groups(P<0.01).Retroperitoneal hematoma,solid organ injury, hollow organ injury and spinal fracture were most likely to be missed .Mortality of I group was significantly higher than the other two groups (P<0.01).Conclusion Patients with severe abdominal and pelvic injury are likely to be associated with severe unstable pelvic fractures and are at high risk of missed diagnosis and mortality .Anti-shock, external fixation and damage control laparotomy may be helpful to raise the survival rate .