Samuels L E, Gross C F, DiGiovanni R J, Dupont J R, Kerstein M D
Department of Surgery, Hahnemann University School of Medicine, Philadelphia, PA 19102-1192.
South Med J. 1993 May;86(5):572-4. doi: 10.1097/00007611-199305000-00018.
Vascular injury is not uncommon in cases of major pelvic trauma. Venous injury is by far the most common associated problem and may lead to exsanguinating hemorrhage. Arterial injury is less common, but certainly not without associated morbidity and mortality. It can lead to persistent bleeding after fixation and stabilization of the pelvic girdle, and occlusion of major pelvic arteries can cause limb ischemia and limb loss. The potential problems with revascularizing the ischemic extremity are (1) other life-threatening injuries that may be present and (2) a retroperitoneal hematoma that can interfere with an anatomic approach. Our solution to the latter problem, as presented here, is placement of a cross-femoral bypass graft, which rapidly and safely restores blood flow in the presence of pelvic fracture and an occluded external iliac artery. The pelvic hematoma is avoided, thereby restoring circulation more quickly, with less blood loss and greater ease.
在严重骨盆创伤病例中，血管损伤并不罕见。静脉损伤是迄今为止最常见的相关问题，可能导致大出血。动脉损伤较少见，但肯定会伴有发病率和死亡率。它可导致骨盆环固定和稳定后持续出血，主要骨盆动脉闭塞可导致肢体缺血和肢体丧失。对缺血肢体进行血管重建存在的潜在问题是：（1）可能存在的其他危及生命的损伤；（2）可干扰解剖入路的腹膜后血肿。我们在此提出的针对后一个问题的解决方案是放置股交叉旁路移植术，在存在骨盆骨折和髂外动脉闭塞的情况下，该手术能迅速且安全地恢复血流。可避免骨盆血肿，从而更快地恢复循环，减少失血且操作更简便。
