What are the emergency measures for pelvic fractures? 1. The treatment steps should be decided according to the overall situation. Those with abdominal organ injury and urinary tract injury should cooperate with relevant departments for treatment. Attention should be paid not to open retroperitoneal hematoma during abdominal surgery.
2. Severe pelvic fracture was sent to the surgical monitoring room for treatment. When there is shock, we should actively rescue it, and all kinds of life-threatening complications should be dealt with first. The torn perineum and rectum must be repaired in time. If necessary, vaginal gauze packing, vaginal hemostasis and transverse colostomy can be used. For retroperitoneal hemorrhage, close observation, blood transfusion and rehydration should be carried out. If hypotension is still not improved and blood pressure cannot be maintained after massive blood transfusion and rehydration, hospitals with conditions can do emergency arteriography or perform unilateral or bilateral internal iliac artery embolization under the supervision of X-ray TV. If there is massive bleeding, surgery should be performed to stop bleeding, and the posterior space is loose.
Pelvic fracture When introducing pelvic fracture, the auxiliary arch is often broken first: when the main arch is broken, the auxiliary arch is often broken ahead of schedule. There are many muscles and ligaments attached to the pelvic margin, especially the ligament structure plays an important role in maintaining the pelvis. There are strong sacrococcygeal tubercle ligaments and sacrospinous ligaments at the bottom of pelvis, which can protect pelvic viscera and cause serious damage to pelvic viscera after pelvic fracture.
Diagnosis of pelvic fracture 1, detection of blood pressure.
2. Establish ways of blood transfusion and fluid replacement. Pelvic fracture can be accompanied by pelvic vascular injury. Blood transfusion should not be established in the lower limbs, but in the upper limbs and neck.
3. according to the condition, complete the x-ray and CT examination as soon as possible to check whether there are other combined injuries.
4. Let the patient urinate. If the urine is clear, it means that the urinary tract is not damaged. If hematuria is discharged, it means kidney or bladder damage. If the patient cannot urinate automatically, he should be instructed to induce urine clearance, suggesting that the urinary tract is harmless, hematuria, suggesting kidney or bladder damage. If the urine cannot be led out, sterile saline can be injected into the bladder and then re-injected. More injection and less withdrawal suggest the possibility of bladder rupture, urethral orifice bleeding and difficulty in inserting catheter into bladder, suggesting posterior urethral rupture.
5, diagnostic abdominal puncture with abdominal pain, abdominal distension and abdominal muscle tension and other symptoms of peritoneal irritation can be diagnostic abdominal puncture. If non-condensable blood is aspirated, it is suggested that there is a possibility of rupture of internal organs in abdominal cavity. Negative results can not deny the possibility of abdominal organ injury, and can be repeated if necessary. Because the hematoma in the retroperitoneal space spreads to the anterior abdominal wall, the puncture needle may mistakenly enter the hematoma, so the positive results obtained by multiple diagnostic puncture are far less valuable than the first puncture.
Classification of pelvic fractures
(a) according to the location and number of fractures.
1. The avulsion fracture of pelvic margin occurred at the attachment point of pelvic margin muscle due to severe muscle contraction, and the pelvic ring was not affected. The most common are:
(1) avulsion fracture of anterior superior iliac spine. The result of severe contraction of the sartorius muscle.
(2) Avulsion fracture of anterior inferior iliac spine. The result of severe contraction of rectus femoris.
(3) avulsion fracture of ischial tubercle. The result of severe contraction of hamstring muscle. The above fractures are more common in injuries of young football players.
The direction of violence.
1. Violence comes from lateral fracture (LC fracture). Lateral extrusion pressure can cause a series of injuries to the anterior and posterior pelvic structures and pelvic floor ligaments, which can be divided into:
(1) LC-Ⅰ type: transverse fracture of pubic branch, compression fracture of ipsilateral sacral wing, and sacral fracture are usually difficult to find on conventional X-ray films, and can only be found by CT or MRI.
(2) LC-Ⅱ type: transverse fracture of pubic branch, compression fracture of ipsilateral sacrum wing and iliac bone fracture.
(3) LC-Ⅲ type: transverse fracture of pubic branch, compression fracture of ipsilateral sacroiliac wing, fracture of iliac bone, fracture of contralateral pubic bone, fracture of sacral tubercle and sacrospinous ligament, slight separation of contralateral sacroiliac joint.
2. Violence comes from the front (APC fracture) and is divided into three types:
(1) APC-Ⅰ type: pubic symphysis separation.
(2) APC-Ⅱ type: pubic symphysis is separated, sacrococcygeal tubercle and sacrospinous ligament are broken, sacroiliac joint space is widened, anterior ligament is broken, and posterior ligament remains intact, which indicates that sacroiliac joint is slightly separated and can only be found by ct examination.
(3) APC-Ⅲ type: pubic symphysis is separated, sacral tubercle and sacrospinous ligament are broken, anterior and posterior ligaments of sacroiliac joint are broken, sacroiliac joint is separated, but the pelvis rarely retracts upward.
3. Violence comes from vertical shear (VS fracture), which is usually very violent. The anterior pubic symphysis will be separated or vertical fracture of pubic branch will occur, sacral tubercle and sacrospinous ligament will be broken, and the posterior sacroiliac joint will be completely dislocated, usually accompanied by fracture of sacrum or ilium, and half pelvis can be displaced forward or backward.
4. Violence comes from mixed directions (CM fracture), usually mixed fractures, such as LC/VS or LC/APC. Among all kinds of fractures, type ⅲ fracture and VS fracture are the most serious, and complications are also common.
The clinical manifestation of pelvic fracture is 1. Except for pelvic edge avulsion fracture and sacrococcygeal fracture, all of them have a history of violent injuries, mainly car accidents, falling from high altitude and industrial accidents.
2. It is a serious multiple injury, with common hypotension and shock. If it is an open injury, the condition is more serious.
3. The following signs can be found.
1. Pelvic separation test and squeezing test were positive. The doctor crossed his hands and unfolded two iliac ridges. At this time, the articular surfaces of the two sacroiliac joints are more closely attached, while the fractured anterior pelvic ring is separated. If there is pain, the pelvic separation test is positive. The doctor squeezed the patient's two iliac ridges. If there is pain in the wound, the pelvic compression test is positive. Sometimes, they feel bone friction when doing the last two tests.
2. Pelvic fractures with asymmetric length and displacement of limbs can be measured, and the distance between the sternal xiphoid process and the two anterior superior iliac spines can be measured with a tape measure. The length of the edge moving upward is shorter. You can also measure the distance between the umbilical foramen and the tips of the medial malleolus on both sides.
3. Perineal ecchymosis is a unique sign of pubic and ischial fractures.
4.x-ray examination can show the fracture type and fracture block displacement, but CT examination is more clear about sacroiliac joint. As long as the situation permits, pelvic fracture cases should be examined by CT.