Wild M, Weigand H, Steingässer C, Wenda K
Dr.-Horst-Schmidt-Kliniken Wiesbaden, Klinik für Unfall-, Hand- und Orthopädische Chirurgie, Wiesbaden.
Zentralbl Chir. 2005 Apr;130(2):170-3. doi: 10.1055/s-2005-836410.
Bleeding after instable fractures of the pelvic ring results in a mortality-rate of 7-21 percent. A 65-year-old male patient who fell from his horse and sustained an open book injury with disruption of the symphysis and iliosacral joint developed a dangerous haemorrhagic shock situation in the emergency room. A computer tomography with contrast medium was performed immediately. The outflow of contrast medium behind the symphysis indicated an acute arterial bleeding. An angiography revealed a bleeding from both Aa. obturatoriae and the right A. epigastrica inferior. The difficulty to stop the bleeding surgically resulted in the decision to embolize the vessels angiographically. This procedure terminated the acute bleeding and haemorrhagic shock situation immediately. The pelvic ring disruption was stabilized by internal fixation ten days later. The patient had an uncomplicated course.
骨盆环不稳定骨折后的出血导致死亡率为7% - 21%。一名65岁男性患者从马背上摔下，造成耻骨联合和髂骶关节分离的开放性骨盆损伤，在急诊室出现了危险的失血性休克情况。立即进行了增强计算机断层扫描。耻骨联合后方造影剂外渗提示急性动脉出血。血管造影显示闭孔动脉和右侧腹壁下动脉均有出血。手术止血困难，因此决定通过血管造影栓塞血管。该操作立即终止了急性出血和失血性休克情况。十天后通过内固定使骨盆环骨折得以稳定。患者病程顺利。
