骨折合并闭合性腹部损伤肾挫裂伤的临床诊断和治疗
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摘要
目的探讨骨折合并闭合性腹部损伤肾挫裂伤的临床特点及诊断治疗方法。方法回顾性分析46例骨折合并闭合性腹部损伤肾挫裂伤患者的受伤原因、临床表现、实验室和影像学检查结果、诊断措施及治疗过程等临床资料。结果本研究46例患者中,合并多发肋骨骨折14例,胸腰段脊柱骨折12例,四肢骨折16例,多发骨折4例;Ⅰ级肾损伤17例,Ⅱ级肾损伤13例,Ⅲ级肾损伤12例,Ⅳ级肾损伤4例。多发肋骨骨折14例给予胸带固定保守治疗,胸腰段脊柱骨折12例给予行切开复位钉棒固定术,四肢骨折16例行切开复位钢板内固定术,多发骨折4例行切开复位内固定术。Ⅰ～Ⅲ级患者采取保守治疗,2例Ⅲ级继发性出血行手术探查肾脏修补术;Ⅳ级肾损伤4例保守治疗1例,急诊探查肾修补术2例,肾切除术1例。46例患者均治愈出院。结论对于骨折合并闭合性腹部损伤肾挫裂伤,应根据影像学检查正确评估肾损伤程度并选择合理的治疗方案;骨折处理时早期应强调在无痛、镇静下进行,待肾挫裂伤病情稳定、影像学提示血肿范围2周无增大时可行骨折手术,同时应注意预防下肢静脉血栓形成。
Objective To investigate the clinical characteristics, diagnosis and treatment methods of fracture combined with blunt abdominal injury renal contusion. Methods The causes, clinical manifestations, laboratory and imaging examinations results, diagnostic measures and treatment process of 46 cases with fracture combined with blunt abdominal injury renal contusion were retrospectively analyzed. Results Of the 46 patients in this study, patients were complicated with fracture including 14 cases of multiple rib fracture, 12 cases of thoracolumbar spine fracture, 16 cases of limb fracture and 4 cases of multiple fracture. Seventeen cases of grade Ⅰ renal injury, 13 cases of grade Ⅱ renal injury, 12 cases of grade Ⅲrenal injury and 4 cases of grade Ⅳ renal injury were found. Fourteen cases of multiple rib fractures were conservatively treated with thoracic band fixation, 12 cases with thoracolumbar spine fractures were treated with open reduction and screw rod fixation, 16 cases with limb fracture were treated with open reduction and plate fixation, and 4 cases with multiple fracture were treated with open reduction and internal fixation. The patients of grade Ⅰ-Ⅲ were treated conservatively, and2 patients of grade Ⅲ with secondary hemorrhage were given surgical exploration and renal repair. Of the 4 cases of grade Ⅳrenal injury, 1 case received conservative treatment, 2 cases received emergency exploratory nephroplasty, and 1 case received nephrectomy. All the 46 patients were cured and discharged. Conclusion For fracture combined with blunt abdominal injury renal contusion, the degree of renal injury should be correctly evaluated and reasonable treatment should be selected according to imaging examination. Early treatment of fracture should be emphasized under painless and sedation. Fracture operation can be performed when the condition of renal contusion and laceration is stable and the hematoma range by imaging is not enlarged for 2 weeks. At the same time, attention should be paid to preventing venous thrombosis of lower extremities.
Objective To investigate the clinical characteristics, diagnosis and treatment methods of fracture combined with blunt abdominal injury renal contusion. Methods The causes, clinical manifestations, laboratory and imaging examinations results, diagnostic measures and treatment process of 46 cases with fracture combined with blunt abdominal injury renal contusion were retrospectively analyzed. Results Of the 46 patients in this study, patients were complicated with fracture including 14 cases of multiple rib fracture, 12 cases of thoracolumbar spine fracture, 16 cases of limb fracture and 4 cases of multiple fracture. Seventeen cases of grade Ⅰ renal injury, 13 cases of grade Ⅱ renal injury, 12 cases of grade Ⅲrenal injury and 4 cases of grade Ⅳ renal injury were found. Fourteen cases of multiple rib fractures were conservatively treated with thoracic band fixation, 12 cases with thoracolumbar spine fractures were treated with open reduction and screw rod fixation, 16 cases with limb fracture were treated with open reduction and plate fixation, and 4 cases with multiple fracture were treated with open reduction and internal fixation. The patients of grade Ⅰ-Ⅲ were treated conservatively, and2 patients of grade Ⅲ with secondary hemorrhage were given surgical exploration and renal repair. Of the 4 cases of grade Ⅳrenal injury, 1 case received conservative treatment, 2 cases received emergency exploratory nephroplasty, and 1 case received nephrectomy. All the 46 patients were cured and discharged. Conclusion For fracture combined with blunt abdominal injury renal contusion, the degree of renal injury should be correctly evaluated and reasonable treatment should be selected according to imaging examination. Early treatment of fracture should be emphasized under painless and sedation. Fracture operation can be performed when the condition of renal contusion and laceration is stable and the hematoma range by imaging is not enlarged for 2 weeks. At the same time, attention should be paid to preventing venous thrombosis of lower extremities.
引文
[1]牛艳萍,朱承云,毕亚丽.我院肾外伤发生率和伤因构成比变化趋势分析[J].解放军医药杂志,2004,16(6):448-449.
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[4]詹方勇.严重腹部损伤并多发伤的救治体会[J].吉林医学,2011,32(28):5979-5980.
[5] CARROLL PR,MCANINCH JW,WONG A,et al.Outcome after temporary vascular occlusion for the management of renal trauma[J].J Urol,1994,151(5):1171-1173.
[6]舒则荣,武良,关喜彬,等.重度肾挫裂伤合并其他脏器伤的诊断治疗[J].浙江创伤外科,2014,19(4):629-630.
[2] SCHMIDLIN F.Renal trauma.Treatment strategies and indications for surgical exploration[J].Urologe A,2005,44(8):863-869.
[3]杨军.闭合性肾损伤合并休克31例报告[J].齐齐哈尔医学院学报,2009,30(8):933-934.
[4]詹方勇.严重腹部损伤并多发伤的救治体会[J].吉林医学,2011,32(28):5979-5980.
[5] CARROLL PR,MCANINCH JW,WONG A,et al.Outcome after temporary vascular occlusion for the management of renal trauma[J].J Urol,1994,151(5):1171-1173.
[6]舒则荣,武良,关喜彬,等.重度肾挫裂伤合并其他脏器伤的诊断治疗[J].浙江创伤外科,2014,19(4):629-630.