小儿Morel-Lavallee损伤的治疗体会
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摘要
目的探讨小儿Morel-Lavallee损伤的诊断与治疗。方法 2010年3月-2016年3月收治小儿Morel-Lavallee损伤患儿22例,包括大转子部7例,侧腰部4例,环骨盆环5例,腰骶部2例,臀部4例。所有病例均合并骨盆骨折,并合并不同程度会阴部损伤。主要治疗方法包括彻底清创、骨折固定、生殖器重建、肛门造瘘、负压真空封闭式引流(VSD)、功能恢复。观察患儿的手术情况、阴部创面愈合时间、住院时间及术后随访时间、预后情况、Majeed评分判定患儿的骨盆骨折愈合情况。结果 1例死亡,死因:感染中毒性休克;2例截肢。手术次数平均(3.7±0.4)次,平均住院天数(53.1±2.6)天,平均阴部创面愈合时间(9.5±0.9)月,平均术后随访时间(6.2±0.9)个月,平均Majeed评分(86.7±2.7)分。结论小儿患者因皮下脂肪丰富,症状容易忽视而使病程延长,病情加重,早期彻底清创+负压真空封闭式引流效果明显。
Objective To investigate the diagnosis and treatment of Morel-Lavallee injury in children. Methods From March 2016 to March 2010,22 children with Morel-Lavallee injury were admitted,including 7 cases in the great trochanter,4 cases in the lateral waist,5 cases in the pelvic ring,2 cases in lumbosacral region and 4 in the buttocks. All cases were consistent with pelvic fractures and combined with varying degrees of perineal injuries. The main treatments include thorough debridement,fracture fixation,genital organs reconstruction,anal fistula,vacuum sealing drainage( VSD),and functional recovery. The operation of children,the healing time of the pudendal wound,the time of hospitalization,the postoperative follow-up time,the prognosis and the Majeed score were evaluated to determine the healing status of the pelvic fracture in children. Results 1 case died from septic shock,and 2 cases had amputations. The average number of operations was( 3. 7 ± 0. 4) times. The mean time of postoperative hospital stay was( 53. 1 ± 2. 6) times. The average perineal wound healing time was( 9. 5 ± 0. 9) months. The average postoperative follow-up time was( 6. 2 ± 0. 9) months and the average Majeed score was( 86. 7 ± 2. 7). Conclusion Symptoms in children with abundant subcutaneous fat are easier to be ignored,which results in the prolonging and aggravation of disease. The early thorough debridement and negative pressure vacuum closed drainage is effective.
Objective To investigate the diagnosis and treatment of Morel-Lavallee injury in children. Methods From March 2016 to March 2010,22 children with Morel-Lavallee injury were admitted,including 7 cases in the great trochanter,4 cases in the lateral waist,5 cases in the pelvic ring,2 cases in lumbosacral region and 4 in the buttocks. All cases were consistent with pelvic fractures and combined with varying degrees of perineal injuries. The main treatments include thorough debridement,fracture fixation,genital organs reconstruction,anal fistula,vacuum sealing drainage( VSD),and functional recovery. The operation of children,the healing time of the pudendal wound,the time of hospitalization,the postoperative follow-up time,the prognosis and the Majeed score were evaluated to determine the healing status of the pelvic fracture in children. Results 1 case died from septic shock,and 2 cases had amputations. The average number of operations was( 3. 7 ± 0. 4) times. The mean time of postoperative hospital stay was( 53. 1 ± 2. 6) times. The average perineal wound healing time was( 9. 5 ± 0. 9) months. The average postoperative follow-up time was( 6. 2 ± 0. 9) months and the average Majeed score was( 86. 7 ± 2. 7). Conclusion Symptoms in children with abundant subcutaneous fat are easier to be ignored,which results in the prolonging and aggravation of disease. The early thorough debridement and negative pressure vacuum closed drainage is effective.
引文
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[7]秦涛.骨盆骨折合并Morel-Lavallee损伤1例报告.山东医药,2013,53(14):11.
[8]张弛,仲飙.临床病例讨论—延迟诊断Morel-Lavallee损伤的治疗[J].中华创伤骨科杂志,2011,13(11):1099-1101.
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[2]POWERS M L,HATEM S F,SUNDARAM M.Morel-Lavallee lesion[J].Orthopedics,2007,30(4):250,322-323.
[3]CIASCHINI M,SUNDARAM M.Radiologic case study.Prepatellar Morel-Lavallée lesion[J].Orthopedics,2008,31(7):626,719-721.
[4]SUZUKI T,HAK D J,ZIRAN B H,et al.Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures[J].Injury,2009,40(4):405-409.
[5]SUZUKI T,MORGAN S J,SMITH W R,et al.Postoperative surgical site infection following acetabular fracture fixation[J].Injury,2010,41(4):396-399.
[6]刘宗和.经髂腹股沟入路重建钢板内固定治疗骨盆骨折的临床效果分析[J].当代医学,2016,22(31):21-22.
[7]秦涛.骨盆骨折合并Morel-Lavallee损伤1例报告.山东医药,2013,53(14):11.
[8]张弛,仲飙.临床病例讨论—延迟诊断Morel-Lavallee损伤的治疗[J].中华创伤骨科杂志,2011,13(11):1099-1101.
[9]裘华德,宋九宏.负压封闭引流技术[M].2版.北京:人民卫生出版社,2008:2-5.