Rieger H, Pennig D, Brug E, Bünte H, Krings W
Klinik und Poliklinik für Unfall- und Handchirurgie.
Unfallchirurg. 1991 Mar;94(3):110-5.
Fractures and disruptions of the pelvic ring are usually found in multiply injured patients and exacerbate the life-threatening character of the concomitant injuries. The main prognostic factors are haemorrhagic complications, abdominal trauma and associated injuries of the urogenital tract. All patients admitted to the Department of Surgery of the University of Münster between July 1985 to December 1989 were analysed with particular reference to pelvic ring instability and the accompanying pelvic and abdominal lesions. Of 27 patients with unstable displaced lesions of the pelvic ring, 9 were female (33.3%) and 18 male (66.7%); the average age was 35.1 years. Multiple trauma was present in 25 patients (92.6%). Associated pelvic or abdominal injuries were found in 15 cases (55.6%) [multiple entries]. In 9 patients (33.3%) there were lesions of the urogenital tract. Injuries to pelvic blood vessels were diagnosed in 3 patients (11.1%). In 2 patients (7.4%) there were lesions of the perineum. A ruptured spleen was found in 4 patients (14.8%), lesions of the liver in 3 patients (11.1%), lacerations of the mesentery in 2 patients (7.4%). Bleeding into the mesentery, lacerations of serosa of the sigmoid colon and contusion of the pancreas were each seen in 1 case (3.7%). In 12 patients (44.4%) laparotomy was performed: The mortality in this series was 22.2% (6 patients). The authors propose a procedure for immediate diagnosis of these associated pelvic and abdominal injuries. The key factor for a favourable outcome is the differentiation between intraabdominal and retroperitoneal bleeding. A treatment algorithm is described. The value of laparotomy, interventional radiology and primary anterior stabilization of the pelvic ring with an external frame is discussed.
骨盆环骨折和断裂通常见于多发伤患者，会加重伴随损伤的危及生命的特性。主要的预后因素是出血并发症、腹部创伤以及泌尿生殖道的相关损伤。对1985年7月至1989年12月期间明斯特大学外科收治的所有患者进行了分析，特别关注骨盆环不稳定以及伴随的骨盆和腹部损伤情况。在27例骨盆环不稳定移位损伤患者中，女性9例（33.3%），男性18例（66.7%）；平均年龄为35.1岁。25例患者（92.6%）存在多发伤。15例（55.6%）发现有相关的骨盆或腹部损伤[多项记录]。9例患者（33.3%）存在泌尿生殖道损伤。3例患者（11.1%）诊断为骨盆血管损伤。2例患者（7.4%）存在会阴损伤。4例患者（14.8%）发现脾脏破裂，3例患者（11.1%）存在肝脏损伤，2例患者（7.4%）存在肠系膜裂伤。肠系膜出血、乙状结肠浆膜撕裂和胰腺挫伤各有1例（3.7%）。12例患者（44.4%）接受了剖腹手术：该系列的死亡率为22.2%（6例患者）。作者提出了一种对这些相关骨盆和腹部损伤进行快速诊断的方法。取得良好预后的关键因素是区分腹腔内出血和腹膜后出血。描述了一种治疗方案。讨论了剖腹手术、介入放射学以及使用外固定架对骨盆环进行前路初步固定的价值。
