Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Injury. 2011 Oct;42(10):1020-6. doi: 10.1016/j.injury.2010.09.011. Epub 2010 Oct 8.
The role of pelvic circumferential compression devices (PCCDs) is to temporarily stabilise a pelvic fracture, reduce the volume and tamponade the bleeding. Tissue damage may occur when PCCDs are left in place longer than a few hours. The aim of this randomised clinical trial was to quantify the pressure at the region of the greater trochanters (GTs) and the sacrum, induced by PCCDs in healthy volunteers.
In a crossover study, the Pelvic Binder(®), SAM-Sling(®) and T-POD(®) were applied successively onto 80 healthy participants in random order. The pressure was measured using a pressure mapping system, with the volunteers in supine position on a spine board and on a hospital bed. Data were analysed using Mixed Linear Modelling.
On a spine board, the pressure exceeded the tissue damaging threshold at the GTs and the sacrum. Pressure at the GTs was highest with the Pelvic Binder(®), and lowest with the SAM-Sling(®). Pressure at the sacrum was highest with the Pelvic Binder(®). The pressure at the GTs and sacrum was reduced significantly for all three PCCDs upon transfer to a hospital bed.
The results of this randomised clinical trial in healthy volunteers showed that patients with pelvic fractures, temporarily stabilised with a PCCD, are at risk for developing pressure sores. The pressure on the skin exceeded the tissue damaging threshold and is, besides PCCD type, influenced by BMI, waist size and age. Regardless with which PCCD trauma patients are stabilised, early transfer from the spine board is of key importance to reduce the pressure to a level below the tissue damaging threshold. Clinicians should be aware of the potential deleterious effects associated with the application of a PCCD, and every effort must be made to remove the PCCD once haemodynamic resuscitation has been established.
盆腔环形压缩装置（PCCD）的作用是暂时稳定骨盆骨折，减少出血量并填塞止血。当 PCCD 留置超过几个小时时，可能会发生组织损伤。本随机临床试验的目的是量化健康志愿者中 PCCD 在大转子（GT）和骶骨区域产生的压力。
在一项交叉研究中，Pelvic Binder(®)、SAM-Sling(®)和 T-POD(®) 依次以随机顺序应用于 80 名健康参与者。使用压力映射系统测量压力，志愿者仰卧在脊柱板和医院病床上。使用混合线性模型分析数据。
在脊柱板上，GT 和骶骨处的压力超过了组织损伤阈值。GT 处的压力 Pelvic Binder(®)最高，SAM-Sling(®)最低。骶骨处的压力 Pelvic Binder(®)最高。当所有三种 PCCD 转移到医院病床上时，GT 和骶骨处的压力均显著降低。
这项在健康志愿者中的随机临床试验结果表明，暂时用 PCCD 稳定的骨盆骨折患者有发生压疮的风险。皮肤压力超过组织损伤阈值，除了 PCCD 类型外，还受 BMI、腰围和年龄的影响。无论使用哪种 PCCD 稳定创伤患者，从脊柱板早期转移对于将压力降低到组织损伤阈值以下至关重要。临床医生应意识到应用 PCCD 相关的潜在有害影响，一旦血流动力学复苏建立，必须尽一切努力移除 PCCD。
