Arthurs Zachary, Kjorstad Randy, Mullenix Phillip, Rush Robert M, Sebesta James, Beekley Alec
Department of Surgery, Madigan Army Medical Center, 9040A Reid St., Tacoma, WA 98431, USA.
Am J Surg. 2006 May;191(5):604-9. doi: 10.1016/j.amjsurg.2006.02.009.
High-velocity, penetrating pelvic injuries present one of the most difficult challenges to military trauma surgeons. The patients often present in physiologic extremis, and their injury-site patterns frequently include soft tissue, pelvic fractures, genitourinary tract, rectum, vascular structures, and intra-abdominal viscera.
A retrospective review of the 31st Combat Support Hospital damage-control laparotomy database, under an Institutional Review Board-approved protocol, revealed 28 patients with severe multisystem penetrating pelvic injuries. Up to 75 data points were queried for each patient and subjected to descriptive analysis using SPSS 11.0.4 Statistical Software Package (SPSS, Inc, Chicago, IL).
Of 28 patients with severe penetrating pelvic injuries, 43% had extraperitoneal rectal, 43% had urologic, and 50% had major vascular injuries. On average, patients required 4 abdominal operations for treatment of all injuries. Six of 28 (21%) patients died within the first week after injury, and 36% of patients with vascular and rectal injuries died.
Management of these injuries frequently required damage-control techniques and a staged, multidisciplinary approach to reconstruction. Combined rectal and vascular injuries were the most devastating in this type of injury complex.
高速穿透性骨盆损伤是军事创伤外科医生面临的最具挑战性的难题之一。患者常处于生理极限状态，其损伤部位模式通常包括软组织、骨盆骨折、泌尿生殖道、直肠、血管结构和腹腔内脏器。
在机构审查委员会批准的方案下，对第31战斗支援医院损伤控制剖腹手术数据库进行回顾性研究，发现28例严重多系统穿透性骨盆损伤患者。对每位患者查询多达75个数据点，并使用SPSS 11.0.4统计软件包（SPSS公司，伊利诺伊州芝加哥）进行描述性分析。
在28例严重穿透性骨盆损伤患者中，43%有腹膜外直肠损伤，43%有泌尿系统损伤，50%有主要血管损伤。平均而言，患者需要进行4次腹部手术来治疗所有损伤。28例患者中有6例（21%）在受伤后第一周内死亡，血管和直肠损伤患者的死亡率为36%。
这些损伤的处理通常需要采用损伤控制技术和分阶段、多学科的重建方法。在这类复杂损伤中，直肠和血管联合损伤最为致命。
