Faringer P D, Mullins R J, Feliciano P D, Duwelius P J, Trunkey D D
Department of Surgery, Oregon Health Sciences University, Portland.
Arch Surg. 1994 Sep;129(9):958-63; discussion 963-4. doi: 10.1001/archsurg.1994.01420330072014.
To review the outcomes of patients with open pelvic fractures.
Retrospective review of medical records.
Patients admitted from the injury scene or transferred within 24 hours to a level 1 trauma center.
Thirty-three patients sustaining blunt trauma had pelvic fractures and adjacent wounding.
Treatment protocol that included selective fecal diversion, measures to arrest hemorrhage and prevent wound sepsis, manage associated pelvic injuries, and provide optimal orthopedic outcomes.
Death and sepsis.
Exsanguination occurred in one patient and death owing to head injuries occurred in five patients. Wound sepsis occurred in 31% of patients with colostomy and 19% without colostomy.
Management of open pelvic fractures requires a well-coordinated group using several techniques. Selected patients with open pelvic fractures do not require fecal diversion. Incisions for orthopedic surgery should be considered when decisions are made regarding fecal diversion.
回顾开放性骨盆骨折患者的治疗结果。
病历回顾性研究。
从受伤现场入院或在24小时内转至一级创伤中心的患者。
33例钝性创伤导致骨盆骨折及相邻部位受伤的患者。
治疗方案包括选择性粪便转流、止血及预防伤口感染的措施、处理相关骨盆损伤以及实现最佳骨科治疗效果。
死亡和感染。
1例患者因失血过多死亡，5例患者因头部损伤死亡。接受结肠造口术的患者中31%发生伤口感染，未接受结肠造口术的患者中19%发生伤口感染。
开放性骨盆骨折的治疗需要一个运用多种技术且协调良好的团队。部分开放性骨盆骨折患者无需进行粪便转流。在决定是否进行粪便转流时应考虑骨科手术切口。
