Kataoka Yuichi, Maekawa Kazuhiko, Nishimaki Hiroshi, Yamamoto Shinichiro, Soma Kazui
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
J Trauma. 2005 Apr;58(4):704-8; discussion 708-10. doi: 10.1097/01.ta.0000159346.62183.8f.
Major pelvic venous injuries secondary to blunt trauma can be a difficult problem in diagnosis and management. This study aimed to elucidate the clinical significance of iliac vein injuries demonstrated by venography in patients with blunt pelvic injuries who remained unstable even after transcatheter arterial embolization (TAE).
We reviewed the records of 72 patients with unstable pelvic fracture who presented with shock at our center after blunt trauma from 1999 through 2003. The average Injury Severity Score was 34.3 in this study population.
TAE was the first method of choice to control bleeding from pelvic fracture in 61 patients. Thirty-six patients recovered from shock after TAE. Eighteen of 25 who did not recover from shock died. In 11 of these 25, transfemoral venography with a balloon catheter was performed, revealing significant venous extravasation in 9: common iliac vein in 5, internal iliac vein in 3, and external iliac vein in 1. The average Injury Severity Score of patients with iliac vein injury was 45.8. Treatments for venous injuries were laparotomy for hemostasis (n = 1, survivors = 0), retroperitoneal gauze packing (n = 3, survivors = 1), and endovascular stent placement (n = 3, survivors = 3). Two patients suffered from cardiac arrest before treatment for venous injury. External fixations were performed after TAE according to fracture type.
The iliac vein injury is the principal cause of hemorrhagic shock in some patients with unstable pelvic fractures after blunt trauma. Venography is useful for identifying iliac vein injuries.
钝性创伤继发的主要盆腔静脉损伤在诊断和处理上可能是个难题。本研究旨在阐明静脉造影显示的髂静脉损伤在钝性盆腔损伤患者中的临床意义，这些患者即使在经导管动脉栓塞术（TAE）后仍不稳定。
我们回顾了1999年至2003年在我们中心因钝性创伤后出现休克的72例不稳定骨盆骨折患者的记录。本研究人群的平均损伤严重度评分是34.3。
TAE是61例患者控制骨盆骨折出血的首选方法。36例患者在TAE后休克得到纠正。25例未从休克中恢复的患者中有18例死亡。在这25例患者中的11例进行了经股静脉气囊导管造影，9例显示有明显的静脉外渗：5例为髂总静脉，3例为髂内静脉，1例为髂外静脉。髂静脉损伤患者的平均损伤严重度评分为45.8。静脉损伤的治疗方法为剖腹止血（n = 1，存活 = 0）、腹膜后纱布填塞（n = 3，存活 = 1）和血管内支架置入（n = 3，存活 = 3）。2例患者在静脉损伤治疗前发生心脏骤停。根据骨折类型在TAE后进行外固定。
髂静脉损伤是一些钝性创伤后不稳定骨盆骨折患者失血性休克的主要原因。静脉造影有助于识别髂静脉损伤。
