Croce Martin A, Magnotti Louis J, Savage Stephanie A, Wood George W, Fabian Timothy C
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
J Am Coll Surg. 2007 May;204(5):935-9; discussion 940-2. doi: 10.1016/j.jamcollsurg.2007.01.059.
An alternative to embolization or external pelvic fixation (EPF) in patients with multiple pelvic fractures and hemorrhage is a pelvic orthotic device (POD), which may easily be placed in the resuscitation area. Little published information is available about its effectiveness. This study evaluated the efficacy of the POD compared with EPF in patients with life-threatening pelvic fractures.
We evaluated patients with blunt pelvic fractures over a 10-year period. Inclusion required multiple pelvic fractures with vascular disruption and severe retroperitoneal hematoma, open book fracture with symphysis diastasis, or sacroiliac disruption with vertical shear. Patients with EPF were compared with those in whom a POD was used. Outcomes included transfusions, hospital stay, and mortality.
There were 3,359 patients with pelvic fractures who were admitted: 186 (6%) met entry criteria; 93 had EPF and 93 had POD. There were no differences in age or shock severity. Both 24-hour (4.9 versus 17.1 U, p < 0.0001) and 48-hour transfusions (6.0 versus 18.6 U, p < 0.0001) were reduced with POD. Twenty-three percent of each group underwent pelvic angiography, and 24-hour transfusion amounts for those patients were also reduced with POD (9.9 versus 21.5 U, p < 0.007). Hospital length of stay (16.5 versus 24.4 days, p < 0.03) was less with POD. Although there was decreased mortality with POD (26%) versus EPF (37%), it was not statistically significant (p=0.11).
The therapeutic shift to POD has substantially reduced transfusion requirements and length of hospital stay, and has reduced mortality in patients with unstable pelvic fractures. POD has made a major contribution to the care of critically injured patients with the most severe pelvic fractures.
对于多发骨盆骨折并出血的患者,骨盆矫形器(POD)是栓塞或骨盆外固定(EPF)的一种替代方法,它可轻松放置于复苏区域。关于其有效性的公开信息很少。本研究评估了POD与EPF相比在危及生命的骨盆骨折患者中的疗效。
我们评估了10年间钝性骨盆骨折患者。纳入标准为多发骨盆骨折伴血管破裂和严重腹膜后血肿、耻骨联合分离的开书型骨折或垂直剪切型骶髂关节损伤。将接受EPF的患者与使用POD的患者进行比较。结果包括输血情况、住院时间和死亡率。
共收治3359例骨盆骨折患者,其中186例(6%)符合入选标准;93例采用EPF,93例采用POD。两组患者年龄和休克严重程度无差异。使用POD可减少24小时(4.9单位对17.1单位,p<0.0001)和48小时输血量(6.0单位对18.6单位,p<0.0001)。每组23%的患者接受了骨盆血管造影,这些患者使用POD后24小时输血量也减少(9.9单位对21.5单位,p<0.007)。使用POD的患者住院时间较短(16.5天对24.4天,p<0.03)。虽然使用POD的患者死亡率(26%)低于采用EPF的患者(37%),但差异无统计学意义(p=0.11)。
治疗方法向POD的转变显著减少了输血量和住院时间,并降低了不稳定骨盆骨折患者的死亡率。POD对最严重骨盆骨折的危重伤员的治疗做出了重大贡献。