Lunsjo Karl, Tadros Ayman, Hauggaard Anders, Blomgren Rolf, Kopke John, Abu-Zidan Fikri M
Department of Orthopaedics, Faculty of Medicine and Health Sciences, UAE Univeristy, Al Ain, UAE.
J Trauma. 2007 Mar;62(3):687-91. doi: 10.1097/01.ta.0000203591.96003.ee.
Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality.
There were 100 consecutive patients (77 males, mean age of 31 [3-73] years) studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, Injury Severity Score (ISS), Revised Trauma Score, blood transfusions, and mortality. The fractures were classified according to instability, where type O is stable, type R is rotationally unstable, and type RV is both rotationally and vertically unstable. Because a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients.
There were 77 fractures caused by road traffic collisions. Type O fractures (n = 63) had lower median ISS (13 [4-48]) than type R (n = 19) (18 [9-75]) and type RV (n = 18) (18 [6-66]) (p = 0.019, Kruskall Wallis). There was no significant difference in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality.
ISS is the most important predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.
骨盆骨折不稳定性与钝性多发伤患者死亡率之间是否存在关联仍存在争议。这是第一项针对骨盆骨折患者的前瞻性研究，旨在探究骨盆骨折类型是否会影响死亡率。
在2003年9月至2004年10月期间，连续研究了100例患者（77例男性，平均年龄31岁[3 - 73岁]）。收集了有关损伤机制、合并伤、损伤严重程度评分（ISS）、修订创伤评分、输血情况和死亡率的数据。根据不稳定性对骨折进行分类，其中O型为稳定型，R型为旋转不稳定型，RV型为旋转和垂直均不稳定型。由于单纯髋臼骨折是骨盆环的单一骨折，我们将其归类为O型。73例患者使用计算机断层扫描进行骨折分类，27例患者使用普通X线片进行分类。
77例骨折由道路交通事故引起。O型骨折（n = 63）的ISS中位数（13[4 - 48]）低于R型（n = 19）（18[9 - 75]）和RV型（n = 18）（18[6 - 66]）（p = 0.019，Kruskal Wallis检验）。R型和RV型骨折之间的ISS无显著差异。逻辑回归模型显示，ISS是预测死亡率的唯一重要因素。
在确定骨盆骨折患者的死亡率时，ISS是最重要的预测指标，而非骨盆不稳定性类型。
