Timmers T K, Tiren D, Hulstaert P F, Schellekens P P A, Leenen L P H
University Medical Centre Utrecht, Department of Surgery, P.O.-box 85500, 3508 GA Utrecht, The Netherlands.
Int J Surg Case Rep. 2012;3(7):246-52. doi: 10.1016/j.ijscr.2012.03.002. Epub 2012 Mar 16.
In this article we present two cases of young men who sustained a traumatic hemipelvectomy.
The first case occurred more than 10 years ago and the second case happened less than 1 year ago. Changes in the management for resuscitation, surgical intervention, and in postoperative treatment are detailed. Goal of this article is to evaluate the changes over time in the treatment of trauma in general and this specific injury in particular.
Maximum survival chance could be achieved by an aggressive resuscitation (following a massive transfusion protocol-ratio of 1:1:1 unit of blood-products), starting pre-hospitally and continued in the emergency department, immediate control of the haemorrhage and direct surgical intervention. Early and frequent re-explorations are necessary to prevent complications as sepsis and to minimize the chance for complications such as disturbed wound healing and fistula formation. The use of the Vacuum-Assisted Closure therapy nowadays gives the patient an earlier recover and lesser chance at developing complications. Early consultation with plastic surgeons needs to be done in order to achieve an adequate definitive wound-closure (reconstructive surgery).
A traumatic hemipelvectomy is a catastrophic and mutilating injury, seldom survivable. Maximum survival chance could be achieved by an aggressive resuscitation, frequent re-explorations, the use of VAC therapy and early consultation with a plastic surgeon for reconstructive surgery.
在本文中，我们介绍了两例遭受创伤性半侧骨盆切除术的年轻男性病例。
第一例发生在10多年前，第二例发生在不到1年前。详细阐述了复苏、手术干预及术后治疗管理方面的变化。本文的目的是评估总体创伤治疗尤其是这种特定损伤治疗随时间的变化。
通过积极复苏（遵循大量输血方案——血液制品比例为1:1:1单位），从院前开始并在急诊科持续进行，立即控制出血和直接进行手术干预，可实现最大生存机会。早期且频繁的再次探查对于预防诸如败血症等并发症以及将伤口愈合不良和瘘管形成等并发症的发生几率降至最低是必要的。如今使用负压封闭引流疗法可使患者更早康复且发生并发症的几率更低。为了实现充分的确定性伤口闭合（重建手术），需要尽早咨询整形外科医生。
创伤性半侧骨盆切除术是一种灾难性的致残性损伤，很少能存活。通过积极复苏、频繁再次探查、使用负压封闭引流疗法以及尽早咨询整形外科医生进行重建手术，可实现最大生存机会。
