Inaba Kenji, Sharkey Philip W, Stephen David J G, Redelmeier Donald A, Brenneman Frederick D
Trauma Program, Departments of Surgery and Medicine, Sunnybrook and Women's College Health Sciences Centre, C-135, 2075 Bayview Avenue, Toronto, Ont., Canada M4N 3M5.
Injury. 2004 Aug;35(8):759-65. doi: 10.1016/S0020-1383(03)00308-5.
Pelvic fractures constitute a major cause of death and residual disability in motor vehicle collisions (MVC). To date there has been poor documentation of the epidemiology of severe pelvic injuries. A detailed retrospective examination of all abbreviated injury score (AIS) > or = 4 pelvic fractures sustained in occupants of MVCs seen at this lead trauma hospital over the last 12 years and in the province of Ontario over the last 6 years was completed.
The regional trauma centre registry and provincial database were used to obtain demographics, injuries, course in hospital and crash data on patients sustaining AIS > or = 4 pelvic injuries between May 1988 and April 2000. Data was analysed for drivers (D), front (FP) and rear (RP) passengers in 4-year blocks. Means (S.D.) with t-test for continuous and chi2 for categorical data were used for analysis.
AIS > or = 4 pelvic fractures increased significantly in D and FP over 12 years and in RP over the last 8 years. Similar significant increases were seen throughout the province over the last 6 years. No significant change in age, sex, ISS or referral patterns was seen. Lateral impact collisions also increased over the study duration. Occupants with pelvic injury compared to all MVC survivors ISS > or = 16 during the same study period had a higher ISS (P < 0.001), utilised more blood in 24h and in total (P < 0.001) and died more frequently (P < 0.001). However, significantly fewer required ICU support (P < 0.01) which may reflect the associated injuries. Patients with pelvic fractures had significantly fewer head and chest injuries as well as fewer face and neck injuries. They did have significantly more injuries in the region of the pelvis including lumbar and sacral spine fractures, genitourinary, liver, spleen and lower extremity blood vessel, nerve and bone injuries.
This study documented an increasing incidence of severe pelvic injury resulting from MVCs. This may be related to an associated increase in the incidence of lateral impact collisions. The role of side impact protection and side airbags, introduced to decrease injury severity in lateral impact collisions will require further study.
骨盆骨折是机动车碰撞（MVC）导致死亡和遗留残疾的主要原因。迄今为止，严重骨盆损伤的流行病学资料记载甚少。对过去12年在这家主要创伤医院以及过去6年在安大略省，机动车碰撞事故中乘客所遭受的所有简明损伤定级标准（AIS）≥4级的骨盆骨折进行了详细的回顾性研究。
利用地区创伤中心登记处和省级数据库获取1988年5月至2000年4月期间遭受AIS≥4级骨盆损伤患者的人口统计学资料、损伤情况、住院病程和碰撞事故数据。对驾驶员（D）、前排乘客（FP）和后排乘客（RP）的数据按4年时间段进行分析。连续数据采用均值（标准差）和t检验，分类数据采用卡方检验进行分析。
在12年期间，驾驶员和前排乘客中AIS≥4级骨盆骨折显著增加，在过去8年中后排乘客中此类骨折也显著增加。在过去6年中，全省范围内也出现了类似的显著增加。年龄、性别、损伤严重度评分（ISS）或转诊模式未见显著变化。在研究期间，侧面碰撞事故也有所增加。与同一研究期间所有ISS≥16的机动车碰撞事故幸存者相比，骨盆损伤的乘客ISS更高（P<0.001），24小时内及总共使用的血液更多（P<0.001），死亡频率更高（P<0.001）。然而，需要重症监护支持的患者明显较少（P<0.01），这可能反映了相关损伤情况。骨盆骨折患者头部和胸部损伤以及面部和颈部损伤明显较少。他们在骨盆区域的损伤明显更多，包括腰椎和骶骨骨折、泌尿生殖系统、肝脏、脾脏以及下肢血管、神经和骨骼损伤。
本研究记录了机动车碰撞导致的严重骨盆损伤发病率上升。这可能与侧面碰撞事故发生率的相应增加有关。为降低侧面碰撞事故中损伤严重度而引入的侧面碰撞保护和侧面安全气囊的作用需要进一步研究。
