Ben-Menachem Y, Coldwell D M, Young J W, Burgess A R
Department of Radiology, University of Washington, Harborview Medical Center, Seattle.
AJR Am J Roentgenol. 1991 Nov;157(5):1005-14. doi: 10.2214/ajr.157.5.1927786.
The high risk of exsanguinating hemorrhage in patients with pelvic ring disruption demands aggressive, yet balanced orthopedic and angiographic management as soon as patients are admitted to the emergency department. We present a perspective of our experience in two trauma centers and propose a logical approach to early prediction, diagnosis, and management of hemorrhage associated with pelvic fractures. Our method is based on knowledge of pelvic anatomy and an understanding of the mechanisms of injury and their wounding capacity, given that the mechanism of injury determines the type of pelvic ring disruption and that the probability of arterial hemorrhage is--to a great extent--a function of the type of pelvic fracture. The risks of diagnostic peritoneal lavage and of excessive radiologic studies of noncritical injuries are emphasized. The principles guiding arterial embolization and the application of external fixators are discussed.
骨盆环断裂患者发生失血性出血的风险很高，因此一旦患者被收入急诊科，就需要积极且平衡地进行骨科和血管造影处理。我们介绍了在两个创伤中心的经验，并提出一种合理的方法，用于早期预测、诊断和处理与骨盆骨折相关的出血。我们的方法基于骨盆解剖学知识以及对损伤机制及其致伤能力的理解，因为损伤机制决定了骨盆环断裂的类型，并且动脉出血的可能性在很大程度上是骨盆骨折类型的函数。文中强调了诊断性腹腔灌洗以及对非关键损伤进行过度影像学检查的风险。还讨论了指导动脉栓塞和应用外固定器的原则。
