Michel J M, Peter R E, Roche B, Vermeulen B, Morel P
Département de Chirurgie, Hôpital Cantonal Universitaire de Genève.
Swiss Surg. 1999;5(1):33-7. doi: 10.1024/1023-9332.5.1.33.
Unstable fractures of the pelvic ring, associated to perineal lacerations are severe injuries occurring during high-energy trauma. High rates of septic complications and mortality have been reported with these injuries. Current treatment guidelines, while dealing with open pelvic fractures or dislocations are discussed, based on a current review of the literature and on our local experience. At our institution, 55 unstable type B or C fractures of the pelvic ring were treated by osteosynthesis between 1991 and 1997. Of these, 11 patients presented with an associated perineal laceration (20%). Simultaneously to the immediate pelvic ring fixation, a diversion colostomy was performed in all these patients. Repeated wound debridements and wide spectrum antibioprophylaxis were associated. Of these 11 patients presenting an open pelvic fracture, only one died of pelvic sepsis at three weeks. 10 patients survived (91%) and went on to bony union, without any local infectious complications. Aggressive multidisciplinary initial surgical management is a rule when dealing with this type of injuries, immediate colostomy and careful wound debridement must be associated to the initial osteosynthesis.
骨盆环不稳定骨折合并会阴撕裂伤是高能创伤中发生的严重损伤。据报道，这些损伤的感染并发症和死亡率很高。基于当前的文献综述和我们的本地经验，讨论了当前处理开放性骨盆骨折或脱位的治疗指南。在我们机构，1991年至1997年间，55例骨盆环B型或C型不稳定骨折接受了骨固定治疗。其中，11例患者伴有会阴撕裂伤（20%）。在立即进行骨盆环固定的同时，所有这些患者均进行了转流性结肠造口术。同时进行反复伤口清创和广谱抗生素预防。在这11例开放性骨盆骨折患者中，只有1例在三周时死于骨盆感染。10例患者存活（91%）并实现骨愈合，无任何局部感染并发症。处理这类损伤时，积极的多学科初始手术治疗是原则，初始骨固定必须结合立即结肠造口术和仔细的伤口清创。
