Scaglione Michelangelo, Parchi Paolo, Digrandi G, Latessa M, Guido G
Orthopaedic Department, University of Pisa, via Risorgimento 36, Pisa, Italy.
Musculoskelet Surg. 2010 Nov;94(2):63-70. doi: 10.1007/s12306-010-0084-5. Epub 2010 Nov 18.
Pelvic fractures account for 4-5% of all fracturated patients, and they occur in 4-5% of polytraumatized patients. In the most of the cases, they are consequent to high-energy trauma with a high percentage of lesions of other organs (cerebral, thoracic, and abdominal lesions. The most of the patients (80%) who die are dying within the first hours after trauma for a massive hemorrhagic shock. When the pelvic fracture and the patient's hemodynamic conditions are both unstable, osteosynthesis of the fracture is mandatory. Fracture stabilization should be performed within the first hour after trauma (as soon as possible), and it should be considered as part of the resuscitation procedure. We usually make an urgent stabilization of pelvic fracture with an anterior external fixator technique. We have revised all unstable pelvic fractures treated in our department (Orthopaedic Clinic Pisa University) from 2000 up to the 2005 to determine a correct treatment protocol for these lesions. Pelvic stabilization, reducing the pelvic volume and bleeding from the stumps of fracture, determines the arrest of the hemorrhage, as evidenced by the sharp decline in the number of transfusions in postoperative period. In these cases, there is an absolute indication for an urgent pelvic stabilization. Pelvic stabilization, whether temporary or permanent, allows to control the bleeding because it (1) leads to a reduction in the volume pelvis with a containment on the retro-peritoneal hematoma (2) reduces bleeding from the fracture fragments (3) reduces motility fracture promoting the blood clotting. The stabilization of the pelvis also makes it easier to manage the patient and his mobilization for the implementation of subsequent investigations. In our experience, external fixator accounts for its characteristics the gold standard approach for the urgent stabilization of these lesions, and, for most of them, it can be used as the definitive treatment. External fixation is a quick and easy procedure for pelvic fractures stabilization for surgeons with experience with this technique.
骨盆骨折占所有骨折患者的4% - 5%，在多发伤患者中也占4% - 5%。在大多数情况下，它们是由高能创伤导致的，常伴有其他器官的高比例损伤（脑、胸和腹部损伤）。大多数死亡患者（80%）在创伤后的最初几小时内因大量失血性休克而死亡。当骨盆骨折且患者血流动力学状况均不稳定时，骨折的骨固定术是必需的。骨折固定应在创伤后第一小时内（尽快）进行，应将其视为复苏程序的一部分。我们通常采用前路外固定架技术对骨盆骨折进行紧急固定。我们回顾了2000年至2005年在我们科室（比萨大学骨科诊所）治疗的所有不稳定骨盆骨折病例，以确定针对这些损伤的正确治疗方案。骨盆固定，减少骨盆容积和骨折断端出血，可使出血停止，术后输血量急剧下降就证明了这一点。在这些情况下，紧急骨盆固定有绝对指征。骨盆固定，无论是临时的还是永久的，都能控制出血，因为它（1）使骨盆容积减小，限制腹膜后血肿；（2）减少骨折碎片出血；（3）减少骨折活动，促进血液凝固。骨盆固定也便于对患者进行管理及其后续检查的移动。根据我们的经验，外固定架因其特点是紧急固定这些损伤的金标准方法，而且对于大多数此类损伤，它可作为确定性治疗方法。对于有该技术经验的外科医生来说，外固定是一种快速且简便的骨盆骨折固定方法。
