背景:与直肠损伤相关的开放性骨盆骨折并不常见。常引起严重的盆腔感染,甚至死亡。这种伤害的组合很少被审查。在这里,我们报告了一组开放性骨盆骨折并发直肠损伤患者的盆腔感染和死亡相关因素.
方法:我们回顾性回顾了2010年1月至2014年4月在我院接受治疗的开放性骨盆骨折和直肠损伤患者的记录。从医疗记录来看,年龄,性别,伤害严重程度评分(ISS),骨折的原因,相关伤害,骨折的分类,软组织损伤程度,格拉斯哥昏迷评分(GCS),修订创伤评分(RTS),需要红细胞(PRBC),存在/不存在电击,早期结肠造口术(是或否),排水(是或否),和直肠冲洗(是或否)被提取。进行单变量和多变量分析以确定危险因素与盆腔感染或死亡之间的关系。
结果:确定了20例患者。50%(n=10)的患者发生盆腔感染。四名患者患有败血病,3例死于多器官功能障碍。因此死亡率为15%。根据单变量分析,盆腔感染的患者出现休克,RTS≤8,GCS≤8,前24小时输血≥10个单位,没有结肠造口术,或GustiloIII级软组织损伤.根据多变量分析,休克和没有结肠造口与盆腔感染独立相关.通过单变量分析,与死亡相关的唯一因素是RTS≤8。
结论:早期结肠造口患者盆腔感染的发生率较低(p<0.05)。休克患者盆腔感染的风险较高,我们建议采取积极措施治疗这些患者。根据我们的结果,RTS≤8可能是开放性骨盆骨折合并直肠损伤患者预后不良的预测指标。对于不稳定的骨盆骨折患者,建议在广泛清创后进行切开复位和内固定。
BACKGROUND: Open pelvic fractures associated with rectal injuries are uncommon. They often cause serious pelvic infection, even death. This combination of injuries has been reviewed infrequently. Herein, we report factors associated with pelvic infection and death in a group of patients with open pelvic fractures and concurrent rectal injuries.
METHODS: We retrospectively reviewed the records of patients with open pelvic fractures and rectal injuries who were treated at our institution from January 2010-April 2014. From the medical records, age, gender, Injury Severity Score (ISS), cause of fracture, associated injuries, classification of the fracture, degree of soft-tissue injury, Glasgow Coma Score (GCS), Revised Trauma Score (RTS), packed red blood cells (PRBCs) needed, presence/absence of shock, early colostomy (yes or no), drainage (yes or no), and rectal washout (yes or no) were extracted. Univariable and multivariable analysis were performed to determine the association between risk factors and pelvic infection or death.
RESULTS: Twenty patients were identified. Pelvic infection occurred in 50% (n = 10) of the patients. Four patients suffered septicemia, and three patients died of multiple organ dysfunction. The mortality rate thus was 15%. According to the univariable analysis, the patients in whom pelvic infection developed had shock, RTS ≤8, GCS ≤8, blood transfusion ≥10 units in the first 24 h, no colostomy, or Gustilo grade III soft-tissue injury. According to the multivariable analysis, shock and absence of colostomy were independently associated with pelvic infection. By univariable analysis, the only factor associated with death was RTS ≤8.
CONCLUSIONS: The incidence of pelvic infection was lower in patients having early colostomy (p < 0.05). Patients with shock had a higher risk of pelvic infection, and we recommend aggressive measures to treat these patients. According to our results, RTS ≤8 could be a predictor of poor outcomes in patients with open pelvic fracture and concurrent rectal injury. Open reduction and internal fixation after extensive debridement is recommended in patients with unstable pelvic fractures.