Heineck J, Seifert J, Rammelt S, Biewener A, Grass R, Zwipp H
Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinik Dresden, Fetscherstr. 74, 01307 Dresden.
Unfallchirurg. 2006 May;109(5):411-6. doi: 10.1007/s00113-006-1063-z.
With an incidence of only 0.6% of all pelvic injuries, traumatic hemipelvectomy is a rare event. It is defined as open or closed avulsion of one hemipelvis with occlusion or disruption of the main vessels and lengthening or disruption of the nerves, often complicated by urogenital or anorectal injuries. The mechanism of injury in this case is a typical one with extreme abduction and external rotation of the leg, causing sacroiliac joint disruption and symphysis separation. Two other mechanisms described are avulsion when the leg becomes entangled in a piece of machinery or a massive crushing at the groin. After a fast treatment in the field, the patient described was treated with immediate open revision, tamponade and stabilization of the pelvis. Upper leg preservation by reconstruction of the femoral vessels with vascular prostheses was attempted. Because of a broad necrosis of soft tissues, early completion of the hemipelvectomy was performed. The patient recovered well. Miction and bowel evacuation as well as sexual function could be preserved. The resulting quality of life is high and the patient is socially reintegrated without problems.
创伤性半骨盆切除术在所有骨盆损伤中发生率仅为0.6%，是一种罕见的情况。它被定义为一侧半骨盆的开放性或闭合性撕脱，伴有主要血管闭塞或中断以及神经延长或中断，常并发泌尿生殖系统或肛门直肠损伤。该病例的损伤机制是典型的，即腿部极度外展和外旋，导致骶髂关节脱位和耻骨联合分离。描述的另外两种机制是腿部卷入机器时的撕脱或腹股沟处的大面积挤压。在现场进行快速治疗后，该患者接受了立即的开放性修复、填塞和骨盆固定。尝试用血管假体重建股血管以保留大腿上段。由于软组织广泛坏死，早期完成了半骨盆切除术。患者恢复良好。排尿、排便以及性功能得以保留。由此产生的生活质量较高，患者顺利重返社会。
