简介:Objective:Toinvestigatetheinfluenceofhipandpelvicfracture,especiallyacetabularfracturecomplicatedbysciaticnerveinjuryonclinicalfeaturesandprognosisofsciaticnerveinjury.Methods:FromJanuary1987toJanuary2000,17patients(14maleand3female)whohadhipandpelvicfracturescomplicatedbysciaticnerveinjuryweretreatedwithoperativereductionandinternalfixationandfollowedupfrom10monthsto5years.Theaverageagewas38years(ranging23-56years).Theleftextremitieswereinvolvedin11patientsandtherightin6.Twelvepatientsunderwentprimaryexplorationandneurolysisand5patientsunderwentsecondaryoperation.Results:Preoperatively,8patientsweretreatedwithlargedosesoforalnarcoticstocontroltheirseveresciaticpain.Threeofthe8patientsunderwentpatient-controlledanalgesiaandepiduralanalgesia.Afteroperation,excellentandgoodratesofreductionandfunctionalrecoveryofsciaticnervewere94.1%and88%respectively.Fourpatientsstillhadsciaticpainand2patientsfailedtorecover.Sciaticnervefunctionimprovedwithin3-6monthsaftersurgeryin11patients.Conclusions:Hipandpelvicfracturescanresultinsciaticnerveinjury,especiallycommonperonealnerveinjuryandprognosisispoor.Openreductionandinternalfixationcombinedwithnerveexplorationandneurolysisshouldbeusedasearlyaspossibleforseveresciaticpain.
简介:Objective:Toinvestigatetheapproachofemergencymanagementforseverepelvicfractureassociatedwithinjuriesofadjacentvisceraandevaluatethetherapeuticeffect.Methods:Thedataof79patientswithseverepelvicfractureassociatedwithinjuriesofadjacentviscerawereretrospectivelystudied,andthestudycoveredaperiodof14years.Results:Toceasemassivebleedingduetopelvicfracture,ligationofinternaliliacarterieswasperformedon33cases,andangioembolizationon8.Of42patientswithcysticor/andurethralinjury,35underwentcystostomyanddelayedreconstruction,and7receivedaprimaryrealignment.Allof17patientswithinjuryofretroperitonealrectumunderwentdivertingcolostomyoftheproximalendofsigmoidwithpresacraldrainage,but4receivedprimaryrepairwithoutcolostomy.In22patientswithintraperitonealcolorectalinjury,19weremanagedwithprimaryrepairoranastomosiswhile3receivedacolostomy.Theoverallmortalityratewas8.86%(7/79);themaincauseswerehemorrhagicshockandassociatedinjury.Thecomplicationsincludedurethro-rectalfistulain4cases,thrombosisofrightcommoniliacarteryin1,ARDSfollowingchesttraumain1,andparaplegiain1.Exceptthepatientwithparaplegia,allofthemwerecured.Conclusions:Promptdiagnosisandpropertreatmentarethekeytosuccess.Devascularizationofinternaliliacarterieswithexternalfixationcageofthepelvis,cystostomyandproximalsigmoidostomyareeffectiveproceduresinemergencytreatmentofthecriticalpatients.