臨床工作中通常將骨盆環失去穩定性的骨盆骨折稱之為重度骨盆骨折。一(yi)百多年(nian)前，malagaigne即描述(shu)了垂直分離型(xing)骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)，但時至(zhi)今日重(zhong)(zhong)(zhong)度(du)骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)仍是一(yi)個尚未圓滿解(jie)決的(de)(de)問題。骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)的(de)(de)發(fa)(fa)(fa)病(bing)率(lv)為(wei)(wei)(wei)20～35.2/10萬/年(nian)，占骨(gu)(gu)(gu)關(guan)節損傷(shang)(shang)(shang)的(de)(de)1%～3%，占住院骨(gu)(gu)(gu)折(zhe)病(bing)人的(de)(de)1.5%～4.8%，但休克發(fa)(fa)(fa)生(sheng)率(lv)高(gao)(gao)達(da)19%～50%，合(he)并(bing)傷(shang)(shang)(shang)較多(膀胱傷(shang)(shang)(shang)6%～11%，尿(niao)道傷(shang)(shang)(shang)4%～14%，直腸(chang)傷(shang)(shang)(shang)1.2%～3.4%，骨(gu)(gu)(gu)盆(pen)神(shen)經傷(shang)(shang)(shang)10%～15%，血(xue)管(guan)傷(shang)(shang)(shang)2.4%～20%，在女性生(sheng)殖(zhi)道傷(shang)(shang)(shang)13.6%～17%)，且(qie)常伴發(fa)(fa)(fa)顱腦、胸、腹或(huo)骨(gu)(gu)(gu)關(guan)節損傷(shang)(shang)(shang)。重(zhong)(zhong)(zhong)度(du)骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)系高(gao)(gao)能量外力所致，25%～84.5%為(wei)(wei)(wei)交通傷(shang)(shang)(shang)，常是有(you)(you)(you)合(he)并(bing)傷(shang)(shang)(shang)或(huo)伴發(fa)(fa)(fa)傷(shang)(shang)(shang)的(de)(de)多發(fa)(fa)(fa)傷(shang)(shang)(shang)者(zhe)(zhe)，其(qi)iss多>20或(huo)25，傷(shang)(shang)(shang)情重(zhong)(zhong)(zhong)，易引發(fa)(fa)(fa)栓塞綜合(he)征(zheng)、凝血(xue)障礙、全身炎癥(zheng)反應綜合(he)征(zheng)、感染、器官功能不(bu)(bu)全綜合(he)征(zheng)、血(xue)栓-栓塞癥(zheng)等并(bing)發(fa)(fa)(fa)癥(zheng)，危及(ji)傷(shang)(shang)(shang)員生(sheng)命，其(qi)死亡率(lv)為(wei)(wei)(wei)5%～20%;而開放性骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)可高(gao)(gao)達(da)30%～50%[5]。80年(nian)代以來重(zhong)(zhong)(zhong)度(du)骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)救(jiu)治(zhi)(zhi)效果不(bu)(bu)斷得到改善，主要有(you)(you)(you)賴(lai)于(yu)3個方面的(de)(de)進展：盡早固定(ding)(ding)不(bu)(bu)穩定(ding)(ding)骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)，控制出血(xue)，救(jiu)治(zhi)(zhi)休克;多學科(ke)(包(bao)括(kuo)sicu或(huo)ticu)協同(tong)救(jiu)治(zhi)(zhi)有(you)(you)(you)重(zhong)(zhong)(zhong)度(du)骨(gu)(gu)(gu)盆(pen)骨(gu)(gu)(gu)折(zhe)的(de)(de)多發(fa)(fa)(fa)傷(shang)(shang)(shang)者(zhe)(zhe);手術復位和固定(ding)(ding)有(you)(you)(you)明顯移(yi)位的(de)(de)不(bu)(bu)穩定(ding)(ding)型(xing)骨(gu)(gu)(gu)盆(pen)環骨(gu)(gu)(gu)折(zhe)。

　　1. 在院(yuan)前和(he)(he)急診科及早(zao)識別(bie)、診斷(duan)和(he)(he)固定(ding)重度(du)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)。文獻報道中12.1%～37.3%的(de)(de)(de)多發(fa)(fa)傷(shang)(shang)患者(zhe)有骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)，在早(zao)期(qi)救治階段中延遲以至遺漏骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)的(de)(de)(de)情況(kuang)仍時有發(fa)(fa)生，為(wei)此(ci)，freeland在檢查多發(fa)(fa)傷(shang)(shang)傷(shang)(shang)員(yuan)的(de)(de)(de)“crash plan”方案中將p(骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen))列入，以提醒醫師。在院(yuan)前或傷(shang)(shang)員(yuan)剛到達(da)急診科時，下(xia)(xia)列因(yin)素應(ying)作(zuo)為(wei)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)的(de)(de)(de)危(wei)險(xian)因(yin)素：(1)機動車(che)傷(shang)(shang)，坑(keng)道作(zuo)業礦車(che)傷(shang)(shang)，高能量(liang)外力(li)撞擊(ji)，砸壓骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)部位;(2)被覆骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)部位的(de)(de)(de)皮膚(fu)和(he)(he)軟組(zu)織有受(shou)力(li)痕(hen)跡或創(chuang)口;(3)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)周(zhou)圍(wei)腫(zhong)脹，有皮下(xia)(xia)出血或血腫(zhong);(4)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)擠(ji)壓、分離(li)試驗或伸(shen)膝屈(qu)髖(kuan)試驗陽性。而下(xia)(xia)列體征應(ying)視為(wei)不(bu)穩定(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)的(de)(de)(de)高危(wei)因(yin)素：①無下(xia)(xia)肢(zhi)損(sun)傷(shang)(shang)者(zhe)兩(liang)下(xia)(xia)肢(zhi)不(bu)等長或有旋(xuan)轉畸(ji)形(xing);②兩(liang)側(ce)臍與髂前上棘的(de)(de)(de)距離(li)不(bu)等長;③兩(liang)側(ce)恥(chi)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)結節間(jian)隙增寬，移位或變形(xing);④雙骶(di)髂關節后方外形(xing)不(bu)對稱;⑤肉眼可見的(de)(de)(de)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)變形(xing)。對有骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)危(wei)險(xian)因(yin)素和(he)(he)高危(wei)因(yin)素者(zhe)，特別(bie)是(shi)并(bing)發(fa)(fa)休克的(de)(de)(de)傷(shang)(shang)員(yuan)，應(ying)以抗休克褲固定(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)并(bing)盡早(zao)攝(she)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)前后位x線片，以確定(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)的(de)(de)(de)有無和(he)(he)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)類型。

　　對骨(gu)盆骨(gu)折傷(shang)(shang)員的早期救治(zhi)應注意(yi)是否存(cun)在并發和伴發損傷(shang)(shang)。因此，80年代(dai)初mcmurtry等(deng)[5]針對有(you)重度骨(gu)盆骨(gu)折的多發傷(shang)(shang)傷(shang)(shang)員，提出abcdef救治(zhi)方案。

　　a(氣(qi)道(dao))：通暢呼吸道(dao)，注(zhu)意胸部損傷(shang)，氣(qi)管插管，閉式引(yin)流等。

　　b(出血)：擴(kuo)充血容量，重者(zhe)輸o型血，輸注(zhu)5 l液體和血液后給予(yu)新(xin)鮮凍干血漿(jiang)2～3個單(dan)(dan)位(wei)(1個單(dan)(dan)位(wei)=200 ml)和血小板7～8個單(dan)(dan)位(wei)(1單(dan)(dan)位(wei)由(you)400 ml全血制備)，使(shi)用抗休克褲，監(jian)測(ce)凝血功能。

　　c(中樞神經系(xi)統)：過度通(tong)氣，保持paco2在30～35 mm hg(1 mm hg=0.133 kpa)，應(ying)用腎上腺皮質激素。

　　e(排泄)：尿道、膀胱損傷。

　　f(骨折)：其他部位骨與關節損傷(shang)。

　　骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)中(zhong)(zhong)(zhong)(zhong)休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)的(de)(de)(de)(de)(de)發生(sheng)(sheng)率可(ke)高達(da)30%～58%，出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)量>2 000 ml者(zhe)按簡(jian)明損傷(shang)(shang)(shang)(shang)標準(ais)列為危(wei)重(zhong)級(ji)(5分)，以(yi)表示其(qi)傷(shang)(shang)(shang)(shang)情嚴重(zhong)程度。moreno等(deng)[7]報(bao)(bao)告320例(li)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)中(zhong)(zhong)(zhong)(zhong)42例(li)(13.1%)并(bing)發大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)，其(qi)中(zhong)(zhong)(zhong)(zhong)6例(li)(14.3%)死(si)于(yu)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)。不穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)性骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)引發大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)和(he)(he)(he)(he)嚴重(zhong)休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)是(shi)傷(shang)(shang)(shang)(shang)后早(zao)(zao)期(qi)致死(si)原因。在(zai)(zai)急診科(ke)除(chu)實行(xing)(xing)液體(ti)復(fu)蘇(su)(su)(su)救治(zhi)(zhi)休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)外，及時有(you)(you)(you)效(xiao)(xiao)的(de)(de)(de)(de)(de)控(kong)制(zhi)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)是(shi)降低重(zhong)度骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)死(si)亡(wang)率的(de)(de)(de)(de)(de)首(shou)要環(huan)節。骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)來源(yuan)(yuan)有(you)(you)(you)：(1)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)部位：構成(cheng)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)環(huan)的(de)(de)(de)(de)(de)松(song)質骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)運豐富，骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)端持續或反(fan)復(fu)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)是(shi)主要的(de)(de)(de)(de)(de)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)來源(yuan)(yuan)。(2)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)內(nei)靜(jing)(jing)脈(mo)(mo)(mo)(mo)(mo)(mo)和(he)(he)(he)(he)靜(jing)(jing)脈(mo)(mo)(mo)(mo)(mo)(mo)叢：伴隨(sui)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)內(nei)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)走行(xing)(xing)的(de)(de)(de)(de)(de)兩條同名靜(jing)(jing)脈(mo)(mo)(mo)(mo)(mo)(mo)和(he)(he)(he)(he)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)多個靜(jing)(jing)脈(mo)(mo)(mo)(mo)(mo)(mo)叢血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)管(guan)(guan)壁薄，易受損傷(shang)(shang)(shang)(shang)。破裂的(de)(de)(de)(de)(de)靜(jing)(jing)脈(mo)(mo)(mo)(mo)(mo)(mo)收(shou)縮力差，其(qi)周圍(wei)組(zu)織(zhi)結構松(song)軟，難以(yi)產生(sheng)(sheng)壓(ya)迫止(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)作用(yong)(yong)(yong)(yong)，因而損傷(shang)(shang)(shang)(shang)的(de)(de)(de)(de)(de)靜(jing)(jing)脈(mo)(mo)(mo)(mo)(mo)(mo)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)是(shi)另一重(zhong)要出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)來源(yuan)(yuan)。(3)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)內(nei)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)：動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)管(guan)(guan)壁厚(hou)，富有(you)(you)(you)彈(dan)性，骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)傷(shang)(shang)(shang)(shang)及動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)造成(cheng)大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)概率較(jiao)(jiao)低。經(jing)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)造影或尸檢證實骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)來自動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)者(zhe)為2.4%～18%。但(dan)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)破裂出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)洶涌，可(ke)危(wei)及生(sheng)(sheng)命。(4)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)壁軟組(zu)織(zhi)和(he)(he)(he)(he)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)內(nei)臟(zang)器(qi)(qi)：骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)合(he)并(bing)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)周圍(wei)皮(pi)下和(he)(he)(he)(he)筋膜大(da)(da)面(mian)積(ji)剝脫(morel-lavalle lesion)或并(bing)發盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)內(nei)臟(zang)器(qi)(qi)損傷(shang)(shang)(shang)(shang)者(zhe)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)較(jiao)(jiao)多。經(jing)x線證實為骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)前、后環(huan)均有(you)(you)(you)損傷(shang)(shang)(shang)(shang)的(de)(de)(de)(de)(de)不穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)型骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)，及早(zao)(zao)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)是(shi)控(kong)制(zhi)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)有(you)(you)(you)效(xiao)(xiao)措施。早(zao)(zao)期(qi)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)的(de)(de)(de)(de)(de)方(fang)(fang)法有(you)(you)(you)：(1)抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)褲(ku)(ku)不僅(jin)能(neng)(neng)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)，且(qie)有(you)(you)(you)抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)作用(yong)(yong)(yong)(yong)。mcmurtry等(deng)[5]將抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)褲(ku)(ku)列為其(qi)救治(zhi)(zhi)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)方(fang)(fang)案(an)的(de)(de)(de)(de)(de)內(nei)容(rong)(rong)，直到(dao)1998年(nian)meighan等(deng)[8]仍將抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)褲(ku)(ku)列入(ru)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)早(zao)(zao)期(qi)救治(zhi)(zhi)訓練內(nei)容(rong)(rong)。北(bei)京礦務局總醫(yi)院創傷(shang)(shang)(shang)(shang)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)科(ke)近20年(nian)來應(ying)用(yong)(yong)(yong)(yong)抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)褲(ku)(ku)的(de)(de)(de)(de)(de)實踐(jian)表明，合(he)并(bing)休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)的(de)(de)(de)(de)(de)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)傷(shang)(shang)(shang)(shang)員(yuan)，在(zai)(zai)液體(ti)復(fu)蘇(su)(su)(su)的(de)(de)(de)(de)(de)同時給予抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)褲(ku)(ku)，傷(shang)(shang)(shang)(shang)員(yuan)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)壓(ya)多可(ke)于(yu)30 min內(nei)迅速回升。(2)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)器(qi)(qi)是(shi)通過連接(jie)棒(bang)將把持穿于(yu)兩側髂骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)嵴中(zhong)(zhong)(zhong)(zhong)2～3個螺(luo)紋針的(de)(de)(de)(de)(de)針夾(jia)連為一體(ti)，達(da)到(dao)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)環(huan)的(de)(de)(de)(de)(de)效(xiao)(xiao)果。通過調整連接(jie)棒(bang)還有(you)(you)(you)糾正骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)旋轉移位的(de)(de)(de)(de)(de)作用(yong)(yong)(yong)(yong)。自70年(nian)代中(zhong)(zhong)(zhong)(zhong)期(qi)，骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)器(qi)(qi)用(yong)(yong)(yong)(yong)于(yu)臨(lin)床后表明，外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)器(qi)(qi)在(zai)(zai)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)不穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)同時具有(you)(you)(you)控(kong)制(zhi)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)作用(yong)(yong)(yong)(yong)。因此，至(zhi)90年(nian)代針對不穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)傷(shang)(shang)(shang)(shang)后大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)，提(ti)出(chu)(chu)(chu)(chu)(chu)早(zao)(zao)期(qi)應(ying)用(yong)(yong)(yong)(yong)外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)器(qi)(qi)以(yi)控(kong)制(zhi)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)主張。例(li)如1993年(nian)riemer等(deng)[9]將外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)納入(ru)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)救治(zhi)(zhi)方(fang)(fang)案(an)后，傷(shang)(shang)(shang)(shang)員(yuan)早(zao)(zao)期(qi)死(si)亡(wang)率自22%降至(zhi)8%。多種(zhong)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)器(qi)(qi)均可(ke)用(yong)(yong)(yong)(yong)于(yu)早(zao)(zao)期(qi)控(kong)制(zhi)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)，單(dan)邊(bian)外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)器(qi)(qi)使用(yong)(yong)(yong)(yong)方(fang)(fang)便是(shi)其(qi)優點;ganz等(deng)[10]設計的(de)(de)(de)(de)(de)ao骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)c形(xing)鉗和(he)(he)(he)(he)browner的(de)(de)(de)(de)(de)ace鉗固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)后環(huan)更為有(you)(you)(you)效(xiao)(xiao)。heini等(deng)[11]報(bao)(bao)告30例(li)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)不穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)多發傷(shang)(shang)(shang)(shang)者(zhe)，平均iss為29，平均輸血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)、新(xin)鮮凍干血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)漿和(he)(he)(he)(he)(或)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)小板24個單(dan)位。應(ying)用(yong)(yong)(yong)(yong)ao骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)c形(xing)鉗后，20例(li)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)環(huan)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)達(da)到(dao)解剖復(fu)位;18例(li)并(bing)發循環(huan)不穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)者(zhe)有(you)(you)(you)10例(li)循環(huan)狀態得以(yi)穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)，仍有(you)(you)(you)4例(li)在(zai)(zai)到(dao)達(da)醫(yi)院后6 h內(nei)死(si)于(yu)失(shi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)性休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)。抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)褲(ku)(ku)和(he)(he)(he)(he)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)器(qi)(qi)雖均有(you)(you)(you)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)、控(kong)制(zhi)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)效(xiao)(xiao)用(yong)(yong)(yong)(yong)，但(dan)難以(yi)控(kong)制(zhi)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)內(nei)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)損傷(shang)(shang)(shang)(shang)造成(cheng)的(de)(de)(de)(de)(de)大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)，因此對積(ji)極進行(xing)(xing)液體(ti)復(fu)蘇(su)(su)(su)和(he)(he)(he)(he)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)后仍處于(yu)休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)狀態的(de)(de)(de)(de)(de)傷(shang)(shang)(shang)(shang)員(yuan)，在(zai)(zai)除(chu)外胸、腹(fu)內(nei)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)前提(ti)下，應(ying)行(xing)(xing)經(jing)股動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)插管(guan)(guan)髂動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)造影術(shu)(shu)。若發現動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)，立(li)即對出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)管(guan)(guan)行(xing)(xing)栓塞(sai)(sai)(sai)術(shu)(shu)。栓塞(sai)(sai)(sai)術(shu)(shu)止(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)成(cheng)功(gong)率為50%～87.1%。北(bei)京軍區(qu)總醫(yi)院用(yong)(yong)(yong)(yong)明膠海綿碎(sui)屑栓塞(sai)(sai)(sai)髂內(nei)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)3例(li)，臀上、臀下動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)各1例(li)，5例(li)均獲(huo)成(cheng)功(gong)。需要用(yong)(yong)(yong)(yong)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)造影和(he)(he)(he)(he)栓塞(sai)(sai)(sai)術(shu)(shu)止(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)的(de)(de)(de)(de)(de)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)者(zhe)為數不多，如moreno等(deng)[7]報(bao)(bao)告320例(li)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)，其(qi)中(zhong)(zhong)(zhong)(zhong)43例(li)(13.4%)有(you)(you)(you)大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)，2例(li)行(xing)(xing)栓塞(sai)(sai)(sai)止(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)，均獲(huo)成(cheng)功(gong)。perez等(deng)[13]報(bao)(bao)告721例(li)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)，僅(jin)14例(li)做了(le)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)造影，其(qi)中(zhong)(zhong)(zhong)(zhong)8例(li)可(ke)見盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)內(nei)動(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(mo)(mo)破裂，4例(li)需栓塞(sai)(sai)(sai)止(zhi)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)，2例(li)成(cheng)功(gong)。這說(shuo)明骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)大(da)(da)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)者(zhe)，多數經(jing)液體(ti)復(fu)蘇(su)(su)(su)、抗休(xiu)(xiu)(xiu)(xiu)(xiu)克(ke)(ke)(ke)褲(ku)(ku)和(he)(he)(he)(he)外固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)的(de)(de)(de)(de)(de)救治(zhi)(zhi)出(chu)(chu)(chu)(chu)(chu)血(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)即能(neng)(neng)得到(dao)控(kong)制(zhi)，同時也表明早(zao)(zao)期(qi)固(gu)(gu)(gu)定(ding)(ding)(ding)(ding)(ding)(ding)不穩(wen)定(ding)(ding)(ding)(ding)(ding)(ding)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)盆(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)(pen)骨(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)(gu)折(zhe)(zhe)(zhe)(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)重(zhong)要性。

　　應著重指出，不(bu)(bu)穩定骨(gu)盆骨(gu)折(zhe)，特別是合并(bing)有循環不(bu)(bu)穩定者，必須在(zai)傷后早期妥善固定這(zhe)一概念(nian)和(he)做法仍(reng)未(wei)得到足夠的重視，致使(shi)部分骨(gu)盆骨(gu)折(zhe)大出血(xue)(xue)得不(bu)(bu)到控制，以至(zhi)休克程度加重，引發(fa)脂肪栓(shuan)塞(sai)綜合征(zheng)、彌(mi)漫性血(xue)(xue)管內凝(ning)血(xue)(xue)、多器官功能不(bu)(bu)全綜合征(zheng)等嚴重并(bing)發(fa)癥，甚至(zhi)死(si)亡。因此，強調在(zai)院前(qian)急(ji)救和(he)急(ji)診(zhen)科救治時及早固定不(bu)(bu)穩定型骨(gu)盆骨(gu)折(zhe)至(zhi)關(guan)重要。

　　2. 多(duo)學科(ke)協同(tong)(tong)救治：有合并(bing)傷(shang)(shang)(shang)(shang)和(he)(he)伴發(fa)傷(shang)(shang)(shang)(shang)的(de)重(zhong)度(du)骨(gu)盆骨(gu)折者應由(you)(you)急(ji)診(zhen)科(ke)醫(yi)師負責(ze)傷(shang)(shang)(shang)(shang)員(yuan)的(de)急(ji)救、復蘇，并(bing)進(jin)行必要的(de)檢查并(bing)作出初步(bu)診(zhen)斷，然后(hou)再根(gen)據傷(shang)(shang)(shang)(shang)員(yuan)情況(kuang)邀(yao)請有關(guan)科(ke)室(shi)醫(yi)師會診(zhen)，通過特殊檢查，進(jin)一(yi)步(bu)明確(que)(que)診(zhen)斷并(bing)作相應的(de)緊急(ji)處理。最后(hou)由(you)(you)急(ji)診(zhen)科(ke)負責(ze)醫(yi)師牽(qian)頭，有關(guan)外(wai)科(ke)專業醫(yi)師共同(tong)(tong)討論(lun)確(que)(que)定傷(shang)(shang)(shang)(shang)員(yuan)全身傷(shang)(shang)(shang)(shang)情和(he)(he)部位(wei)傷(shang)(shang)(shang)(shang)的(de)嚴重(zhong)程度(du)和(he)(he)總體(ti)治療(liao)方案，須(xu)優先治療(liao)的(de)部位(wei)傷(shang)(shang)(shang)(shang)以(yi)及進(jin)入icu加強醫(yi)療(liao)等。由(you)(you)此可見，救治重(zhong)度(du)骨(gu)盆骨(gu)折的(de)多(duo)發(fa)傷(shang)(shang)(shang)(shang)者是(shi)一(yi)個多(duo)學科(ke)協同(tong)(tong)診(zhen)療(liao)的(de)過程[7]。

　　3. 手術復位固定不穩定型骨盆環骨折：直到70年代，骨盆骨折仍以臥床、骨盆懸吊牽引、股骨髁上牽引和手法復位等傳統的非手術療法進行治療。由于上述保守治療難以整復和固定有明顯移位的骨盆環骨折，致使傷者遺有種種嚴重后遺癥。有文獻報道5%～52%此類患者遺有腰、步態異常、骶髂或髖關節骨關節炎，以及(ji)其他影響(xiang)作和(he)(he)正常生活的后遺癥。因此(ci)(ci)，80年(nian)代(dai)，學者(zhe)們在深入研(yan)究(jiu)骨(gu)盆(pen)環(huan)(huan)生物力學和(he)(he)骨(gu)盆(pen)骨(gu)折(zhe)(zhe)創傷解(jie)剖的基礎(chu)上，根據損傷的部(bu)位(wei)和(he)(he)骨(gu)折(zhe)(zhe)脫(tuo)位(wei)的程度(du)，著眼于骨(gu)盆(pen)環(huan)(huan)的完(wan)整(zheng)程度(du)，用立體概(gai)念判(pan)斷損傷的骨(gu)盆(pen)環(huan)(huan)是否穩定(ding)(ding)和(he)(he)在哪個軸向喪失穩定(ding)(ding)性，并據此(ci)(ci)提出對骨(gu)盆(pen)環(huan)(huan)不穩定(ding)(ding)型(xing)骨(gu)折(zhe)(zhe)中脫(tuo)位(wei)明(ming)顯的骨(gu)盆(pen)骨(gu)折(zhe)(zhe)應爭取(qu)解(jie)剖復位(wei)和(he)(he)手術(shu)固(gu)定(ding)(ding)。自70年(nian)代(dai)末應用外(wai)固(gu)定(ding)(ding)器、80年(nian)代(dai)實行(xing)切(qie)開復位(wei)內固(gu)定(ding)(ding)等手術(shu)治療后，重度(du)骨(gu)盆(pen)骨(gu)折(zhe)(zhe)的療效明(ming)顯改善，遺有(you)(you)腰背痛(tong)者(zhe)占5%，10%有(you)(you)步態異常，手術(shu)治療的滿意(yi)率達76%～80%[14-16];而傷后早期手術(shu)固(gu)定(ding)(ding)不穩定(ding)(ding)型(xing)骨(gu)盆(pen)環(huan)(huan)骨(gu)折(zhe)(zhe)更(geng)有(you)(you)減(jian)少(shao)