经导管血管造影栓塞联合外固定术治疗Tile C型骨盆骨折伴失血性休克的临床疗效

doi:10.3969/j.issn.1671-7171.2022.05.013

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摘要【目的】探讨经导管血管造影栓塞联合外固定术治疗Tile C型骨盆骨折伴失血性休克的临床价值。【方法】回顾性分析2013年3月至2021年8月在本院诊治的102例Tile C型骨盆骨折伴失血性休克患者的临床资料,根据治疗方案不同分为观察组(n=53)和对照组(n=49),其中观察组经导管血管造影栓塞后行外固定术,对照组行外固定术后经导管血管造影栓塞。比较两组患者治疗期间的病死率;抗休克治疗中去甲肾上腺素使用量、输血量及休克纠正时间;治疗前及治疗4 h后检测血乳酸水平;血清炎性反应及氧化应激反应指标水平;栓塞及外固定架相关并发症发生率。【结果】观察组病死率低于对照组,其差异有统计学意义(χ²=4.274,P<0.05);观察组抗休克治疗中去甲肾上腺素使用量、输血量及休克纠正时间均少于对照组(P<0.05);治疗后,两组患者的血乳酸水平较治疗前均降低,且观察组低于对照组(P<0.05);两组治疗后血清高敏C反应蛋白(hs-CRP)水平较治疗前均降低,超氧化物歧化酶(SOD)水平较治疗前均升高(P<0.05)。【结论】经导管血管造影栓塞后行外固定术应用于Tile C型骨盆骨折伴失血性休克的治疗中,有助于降低患者的病死率,减少输血量,缩短休克纠正时间,降低代谢性酸中毒风险。

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关键词 ：骨盆骨/损伤, 骨折/并发症, 骨折/外科学, 休克,出血性/并发症, 栓塞,治疗性, 骨折固定术

Abstract：【Objective】 To investigate the clinical value of transcatheter angiographic embolization combined with external fixation in the treatment of Tile C pelvic fracture with hemorrhagic shock. 【Methods】 The clinical data of 102 patients with Tile C pelvic fracture with hemorrhagic shock treated in our hospital from March 2013 to August 2021 were retrospectively analyzed. According to different treatment schemes, they were divided into observation group (n=53) and control group (n=49). The observation group underwent external fixation after transcatheter angiographic embolization, and the control group underwent transcatheter angiographic embolization after external fixation. The mortality during treatment, the amount of norepinephrine used in anti shock treatment, the amount of blood transfusion and the time of shock correction, the level of blood lactic acid before and 4 hours after treatment, the level of serum inflammatory response and oxidative stress response, and the incidence of complications related to embolization and external fixator were compared between the two groups. 【Results】 The mortality of the observation group was lower than that of the control group, and the difference was statistically significant (χ²=4.274, P<0.05); The amount of norepinephrine used in the observation group was less than that in the control group (P<0.05); After treatment, the level of blood lactic acid in the two groups was lower than that before treatment, and the level of blood lactic acid in the observation group was lower than that in the control group (P<0.05); The levels of serum high-sensitivity C-reactive protein (hs-CRP) and superoxide dismutase (SOD) in the two groups were lower than those before treatment (P<0.05). 【Conclusion】 External fixation after transcatheter angiographic embolization in the treatment of Tile C pelvic fracture with hemorrhagic shock is helpful to reduce the mortality, reduce the amount of blood transfusion, shorten the shock correction time and reduce the risk of metabolic acidosis.

Key words： Pelvic Bones/IN Fractures, Bone/CO Fractures, Bone/SU Shock, Hemorrhagic/CO Embolization, Therapeutic Fracture Fixation

收稿日期: 2022-04-02

中图分类号:

R683.3

通讯作者: *E-mail: jjyy300002022@163.com

引用本文:

张强, 丁涛. 经导管血管造影栓塞联合外固定术治疗Tile C型骨盆骨折伴失血性休克的临床疗效[J]. 医学临床研究, 2022, 39(5): 686-689.
ZHANG Qiang, Ding Tao. Clinical Value of Transcatheter Angiographic Embolization Combined with External Fixation in the Treatment of Tile C Pelvic Fracture with Hemorrhagic Shock. JOURNAL OF CLINICAL RESEARCH, 2022, 39(5): 686-689.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.05.013 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I5/686

[1] 杨晓东,向海波,温湘源,等. 经腹直肌外侧入路结合骨盆随意外架牵引复位治疗陈旧性Tile C型骨盆骨折[J].中华骨科杂志,2020,40(21):1435-1442.
[2] 刘新园,黄继锋,王玮,等. Tile C型骨盆骨折动脉大出血合并硬膜外大血肿的早期救治[J].临床外科杂志,2020,28(9):875-877.
[3] 林志东,文宠佩,王宾,等. 急诊介入栓塞治疗骨盆骨折小动脉损伤隐匿性出血[J].中国介入影像与治疗学,2019,16(1):16-20.
[4] 戴简吉,胡晓钢,金红来. 经桡动脉入路动脉栓塞术治疗骨盆骨折伴失血性休克的初步观察[J].浙江临床医学,2020,22(10):1466-1467.
[5] 李祥,何龙,梁一民,等. 内置外架联合髂腰固定术治疗Tile C型骨盆骨折[J].温州医科大学学报,2019,49(12):922-925.
[6] 韦功滨. 严重骨盆骨折大出血治疗进展[J].重庆医学,2021,50(9):1609-1612.
[7] 吴在德,吴肇汉. 外科学[M]. 第6版.北京: 人民卫生出版社, 2018: 33-34.
[8] 宋虎,陈龙,施建国,等. 3D导航辅助下经皮骶髂螺钉联合前环外固定架治疗Tile B、C型骨盆骨折[J].中华创伤杂志,2018,34(6):497-504.
[9] COPP J, EASTMAN J G. Novel resuscitation strategies in patients with a pelvic fracture[J].Injury,2021,52(10):2697-2701.
[10] 梁伟东. 《骨盆髋臼骨折腹直肌外侧入路——临床与解剖》出版: 分析影响急诊介入治疗骨盆骨折预后的因素[J].介入放射学杂志,2021,30(10):2.
[11] 杜玄,乔欣军,闫致旺,等. 多发骨折术后弥散性血管内凝血的危险因素分析[J].组织工程与重建外科杂志,2019,15(4):248-251.
[12] 王琦,周东生,于震,等. 骨盆骨折大出血骨盆填塞与血管造影栓塞的临床急救进展[J].中华创伤骨科杂志,2020,22(6):501-506.
[13] 陈华.骨盆外架辅助复位联合通道螺钉固定治疗Tile C1型骨盆骨折[J].中华创伤杂志,2018,34(10):919-924.
[14] 游建雄,王精兵,赵庆,等. 动脉栓塞联合外固定术治疗不稳定性骨盆骨折伴出血性休克效果分析[J].介入放射学杂志,2021,30(5):493-497.
[15] WEINBERG D S, NARAYANAN A S, MOORE T A, et al. Assessment of resuscitation as measured by markers of metabolic acidosis and features of injury[J].Bone Joint J,2017,99-B(1):122-127.
[16] 曹家敏,齐涵,韩学敢,等. 血清PCT、hs-CRP联合ESR在四肢骨折内固定术后早期发热患者继发感染中的预测价值[J].创伤外科杂志,2021,23(11):810-817.
[17] 李永升,柯丽秀,赵志明. 股骨近端防旋髓内钉与动力髋螺钉对不稳定型股骨粗隆间骨折患者SOD、AngⅡ的影响[J].河北医药,2020,42(9):1328-1331.