Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Biomed J. 2013 Mar-Apr;36(2):77-83. doi: 10.4103/2319-4170.110401.
Both pelvic fractures and femoral shaft fractures are caused by high-energy injuries. When unstable pelvic fractures and femoral shaft fractures occur concomitantly, the optimal treatment method is controversial. The aim of this study was to establish a reasonable principle for treating such complicated injuries.
Forty patients sustaining unstable pelvic fractures and concomitant femoral shaft fractures were treated in a 7-year period. The initial management of the fractures was started at the emergency service according to the Advanced Trauma Life Support protocol. Unstable pelvic fractures were wrapped by cloth sheets and femoral shaft fractures were immobilized with a splint. Angiography was performed on patients with unstable hemodynamic status. The definitive treatment for combined fractures was performed after stabilizing the hemodynamics. Closed nailing was used for femoral shaft fractures, and pelvic fractures were treated with various techniques.
The mortality rate was 12.5% (5/40) during admission. Thirty-three patients were followed up for an average of 32 months (range, 12-76 months). There were 33 cases of unstable pelvic fractures and 36 instances of femoral shaft fractures. The union rate for pelvic fractures was 100% (33/33), while femoral shaft fractures had a 94.4% (34/36) union rate. The average healing time was 3.3 months (range, 1.6-8.1 months) and 4.1 months (range, 2.5-18.2 months) for pelvic and femoral shaft fractures, respectively. After fracture, 34 hips (94%) achieved a satisfactory result in the Harris hip score and 30 knees (83%) achieved a satisfactory result in the Mize knee score.
Stabilization of the hemodynamics in patients with combined fractures should be the first aim. Angiography to stop arterial bleeding in the pelvis is often life-saving. The definitive treatment for combined fractures, such as pelvic fractures and femoral shaft fractures, should wait until hemodynamics is stabilized.
骨盆骨折和股骨干骨折均由高能损伤引起。当不稳定的骨盆骨折和股骨干骨折同时发生时，最佳治疗方法存在争议。本研究旨在为这种复杂损伤建立合理的治疗原则。
在 7 年期间，治疗了 40 例不稳定骨盆骨折合并股骨干骨折的患者。根据高级创伤生命支持方案，在急救服务处开始对骨折进行初始处理。不稳定的骨盆骨折用布单包扎，股骨干骨折用夹板固定。对不稳定血流动力学状态的患者进行血管造影。在稳定血流动力学后，对联合骨折进行确定性治疗。股骨干骨折采用闭合钉固定，骨盆骨折采用各种技术治疗。
住院期间死亡率为 12.5%（5/40）。33 例患者平均随访 32 个月（范围 12-76 个月）。有 33 例不稳定骨盆骨折和 36 例股骨干骨折。骨盆骨折的愈合率为 100%（33/33），而股骨干骨折的愈合率为 94.4%（34/36）。骨盆和股骨干骨折的平均愈合时间分别为 3.3 个月（范围 1.6-8.1 个月）和 4.1 个月（范围 2.5-18.2 个月）。骨折后，34 髋（94%）在 Harris 髋关节评分中获得满意结果，30 膝（83%）在 Mize 膝关节评分中获得满意结果。
合并骨折患者的血流动力学稳定应是首要目标。血管造影术常用于停止骨盆动脉出血，往往可挽救生命。骨盆骨折和股骨干骨折等联合骨折的确定性治疗应等到血流动力学稳定后再进行。
