目的 制定不完全性半骨盆离断伤评估表,探讨其对指导治疗不完全性半骨盆离断伤的价值.方法 回顾性分析2003年1月至2015年12月,治疗14例不完全性半骨盆离断伤患者资料,男10例,女4例;年龄21～55岁,平均31岁;11例为急诊入院,3例为外院转入;Tile分型均为C型骨盆骨折,其中C1型9例,C2型3例,C3型2例.根据患者软组织的损伤程度、骨性结构距中轴距离、髂血管损伤程度以及神经损伤程度四项标准对患者进行伤情评估,每一项评估标准按损伤程度分为四级,分别对应1～4分,总分16分,制定不完全性半骨盆离断伤评估表;其中评分＞12分,则立即行半骨盆离断术;8＜评分≤12分,则根据实际情况再次评估,并建议行半骨盆离断术;4＜评分≤8分,则尽力保肢;评分≤4分,则绝对保肢.结果 14例患者按不完全性半骨盆离断伤评估表进行评价,评分为9～15分,平均11分;其中9～12分12例,超过12分2例,均应行半骨盆离断术.14例患者中,3例在急救复苏阶段死亡;7例在出血得到控制后,早期行半骨盆离断术,全部抢救成功;4例尝试保肢或保留半侧骨盆,其中3例因感染而死亡,1例在一期半髋离断术后第6天因感染而二期行半骨盆离断术,术后存活.结论 不完全性半骨盆离断伤评估表可以早期迅速、准确地对不完全性半骨盆离断伤进行评估,明确诊断,有助于指导急救流程;在休克得到控制后,早期进行半骨盆离断术,可以提高急救的成功率.%Objective To conclude partial traumatic hemipelvectomy score and assess its value in partial traumatic hemipelvectomy treatment.Methods Data of the managements of 14 partial traumatic hemipelvectomy patients between January 2003 and December 2015 were retrospectively analyzed.10 of these patients were males and 4 females,with an average age of 31 (range,21-55).11 patients were brought directly to the hospital emergency department,and 3 patients were transferred from other hospitals.According to Tile classification system,all pelvic fractures were type C fracture:nine with type C 1,three with type C2 and two with type C3.Partial traumatic hemipelvectomy score was concluded according to soft tissue injury severity,the distance between hemi-pelvic and body axis,injury degree of iliac vessel and nerve.All these factors were further classified into four grades (range,1-4) on the basis of injury severity.Based on clinic outcomes and our experiences,hemipelvectomy should be performed at the early stage when patients had scores more than 12;if the score was between 8 and 12,reassessment should be done according to practical situation and hemipelvectomy was recommended;if the score was between 4 and 8,limb salvage was strongly recommended;if the score was below 4,limb salvage should be done.Results All 14 patients were assessed by partial traumatic hemipelvectomy.The average score was 11 (range,9-14).12 of them were scored at the range of 9-12.2 of them had scores more than 12.3 patients died during the initial resuscitation stage.7 patients underwent completion of the hindquarter amputation after control of hemorrhage and all the patients were successfully survived.Limb preservation was attempted in 4 patients:3 of them died eventually because of infection.1 patient underwent hip disarticulation in emergency operation,but this patient eventually required hindquarter amputation for severe infection.Conclusion Partial traumatic hemipelvectomy score could be a rapid and accurate tool in initial assessment of partial traumatic hemipelvectomy.After the control of hemorrhage,early hemipelvectomy could lower the death rate of this kind of patients.
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