Tötterman Anna, Madsen Jan Erik, Skaga Nils Oddvar, Røise Olav
Orthopedic Centre, Ullevål University Hospital, Oslo, Norway.
J Trauma. 2007 Apr;62(4):843-52. doi: 10.1097/01.ta.0000221673.98117.c9.
To describe the method of extraperitoneal pelvic packing (EPP), and to assess the impact of EPP on outcome in severely hemodynamically unstable patients after blunt pelvic trauma.
Of 661 patients treated for pelvic trauma, 18 underwent EPP as part of our protocol with the intent to control massive pelvic bleeding and constituted the study population. Data retrospectively collected from the medical records and from the Ullevål Trauma Registry included demographics, fracture classification, additional injuries, blood transfusions, surgical interventions, angiographic procedure, physiologic parameters, and survival.
Survival rate within 30 days was 72% (13/18), and correlated inversely to the age of the patient (p = 0.038). Only one of the nonsurvivors died of exsanguination. A significant increase in systolic blood pressure (BP) (p = 0.002) was observed immediately after EPP. Angiography performed after EPP was positive for arterial injury in 80% of patients. All types of pelvic ring fractures were represented.
EPP as part of a multi-interventional resuscitation protocol might be life saving in patients with life-threatening pelvic injury who are exsanguinating. However, the high rate of arterial injuries seen after EPP indicates that the procedure should be supplemented with angiography once the patient is sufficiently stabilized to tolerate transportation to the angiography suite.
描述腹膜外盆腔填塞（EPP）的方法，并评估EPP对钝性骨盆创伤后严重血流动力学不稳定患者预后的影响。
在661例接受骨盆创伤治疗的患者中，18例接受了EPP作为我们方案的一部分，目的是控制大量骨盆出血，构成了研究人群。从病历和乌勒瓦尔创伤登记处回顾性收集的数据包括人口统计学、骨折分类、其他损伤、输血、手术干预、血管造影程序、生理参数和生存率。
30天内的生存率为72%（13/18），与患者年龄呈负相关（p = 0.038）。非幸存者中只有1例死于失血。EPP后立即观察到收缩压（BP）显著升高（p = 0.002）。EPP后进行的血管造影显示80%的患者存在动脉损伤。所有类型的骨盆环骨折均有出现。
作为多介入复苏方案的一部分，EPP可能对正在失血的危及生命的骨盆损伤患者有挽救生命的作用。然而，EPP后动脉损伤的高发生率表明，一旦患者充分稳定以耐受转运至血管造影室，该 procedure应辅以血管造影。
