Ruchholtz Steffen, Waydhas Christian, Lewan Ulrike, Pehle Birte, Taeger Georg, Kühne Christian, Nast-Kolb Dieter
Department of Trauma Surgery, University Hospital of Essen, Germany.
J Trauma. 2004 Aug;57(2):278-85; discussion 285-7. doi: 10.1097/01.ta.0000133840.44265.ca.
In unstable pelvic ring fractures free abdominal fluid on ultrasound (US) may be caused by retroperitoneal hematoma that passes into the abdominal cavity or by an additional intraabdominal lesion. In this study a clinical pathway for the therapy of potentially combined lesions was analyzed.
All patients treated in the ED for severe trauma underwent basic sonographical and radiologic diagnostics within 15 minutes. of admission. Data were prospectively documented. According to the treatment protocol unstable pelvic ring fractures with initial free fluid on US received laparotomy. Patients with stable vital conditions had abdominal CT-Scan before surgery.
1472 consecutive severely injured patients (ISS 20, age: 39 years) were included. Eighty subjects had sustained type B (47) or C (33) pelvic ring fracture. Early free abdominal fluid on US was absent in 49 cases. Three patients in this group required celiotomy later on, during ICU treatment. In 31 patients free fluid was present. All of them had laparotomy. Only one patient showed retroperitoneal hematoma alone, while all others had one or more significant lesions (rupture) that required surgical repair. Simultaneously with laparotomy pelvic stabilization was performed by external (19) or internal (6) fixation. In all cases with massive pelvic hemorrhage and free fluid in US bleeding was controlled by internal tamponade and external fixation.
The finding of intraperitoneal fluid on US in the emergency department strongly correlates with significant intraabdominal lesions requiring surgical intervention. Early laparotomy appears indicated in these cases. Shock control in pelvic bleeding can be sufficiently achieved by internal tamponade and external fixation.
在不稳定骨盆环骨折中，超声检查发现的腹腔游离液体可能是由进入腹腔的腹膜后血肿或额外的腹腔内病变引起的。在本研究中，分析了潜在合并损伤的治疗临床路径。
所有在急诊科接受严重创伤治疗的患者在入院后15分钟内接受了基本的超声和放射学诊断。数据进行前瞻性记录。根据治疗方案，超声检查最初发现有游离液体的不稳定骨盆环骨折患者接受剖腹手术。生命体征稳定的患者在手术前进行腹部CT扫描。
纳入1472例连续的严重受伤患者（损伤严重度评分20，年龄：39岁）。80例患者发生B型（47例）或C型（33例）骨盆环骨折。49例患者超声检查未发现早期腹腔游离液体。该组中有3例患者后来在重症监护病房治疗期间需要进行剖腹手术。31例患者存在游离液体。他们全部接受了剖腹手术。只有1例患者仅表现为腹膜后血肿，而其他所有患者都有一个或多个需要手术修复的严重病变（破裂）。在进行剖腹手术的同时，通过外固定（19例）或内固定（6例）进行骨盆稳定。在所有超声检查显示有大量骨盆出血和游离液体的病例中，通过内填塞和外固定控制出血。
急诊科超声检查发现腹腔内有液体与需要手术干预的严重腹腔内病变密切相关。在这些病例中，早期剖腹手术似乎是必要的。通过内填塞和外固定可以充分控制骨盆出血导致的休克。
