Treatment for severe pelvic fractures associated with polytrauma
WEI Gong-bin
GAO Jin-mou
HU Ping
YANG Jun
LIU Chao-pu
Abstract：Objective To summarize managing methods for severe pelvic fracture and its complications ac-cording to the principle of damage control surgery.Methods The data of 299 patients with severe pelvic fractures from 1998 to 2011 was retrospectively analyzed.Among them 172 were males and 127 were females;the mean age was(47.3 ±8.2)years(19-83) years.The control group consisted of 116 cases without DCS during Jan.1998 and Jan.2004 and the study group consisted of 183 cases during Feb.2004 and Jan.2011 undergoing treatment with DCS.The control group underwent decisive operation initially.The study group underwent internal iliac arteries de-vascularization initially;89 of them were performed pelvic external fixation.In patients with visceral injuries,repair of stomach or intestineand cystostomy was performed to control contamination, and splenectomy and repair of the liv-er were conducted to control bleeding.All patients in the study group were transferred to ICU for resuscitation.The definitive surgery including repair of the pelvis,posterior urethra and rectum was performed when vital signs got sta-ble.Results The survival rates in the control group and the study group were 75.86%( 88/116 ) and 87.98%(161/183) ,respectively.Postoperative complications included hemorrhagic shock in 74 cases,sepsis of pelvic and abdominal cavity in 27,abdominal compartment syndrome in 22,fat embolism in 12,and deep venous embolism in 30.The main causes of death were hemorrhagic shock,multiple organ dysfunction syndrome(MODS),and septic shock.Conclusion The survival rate of severe pelvic fractures was obviously improved by DCS principles.DCS, including initial control of bleeding and contamination ( including fecal and urinary rechanneling ) for simplifying early surgical intervention,is applied by combining with pelvic external fixation.Damage control resuscitation was performed in ICU as well as dealing with complications.Only if the vital signs get stable,the definitive operations such as pelvic,posterior urethra and rectum reconstruction could be done.
Keywords：polytraumapelvic fractureabdominal injurycomplicationresuscitationdamage control
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 265-268 )