University Hospital of Wales, Cardiff, 12 The Terrace, Creigiau, Cardiff, CF15 9NG, UK.
Injury. 2011 Oct;42(10):1008-11. doi: 10.1016/j.injury.2010.11.062. Epub 2011 Jan 17.
In the emergency management of patients with pelvic fractures, there is ongoing debate about the roles of angiography and open pelvic packing. It is agreed that some form of haemorrhage control is required for patients who are haemo-dynamically unstable despite resuscitation. We set out to determine whether on-call general and orthopaedic surgeons would feel able to perform emergency surgical procedures for these patients and whether vascular radiology was available to them.
Surveys were sent to all 221 general and orthopaedic surgeons in Wales. Questions included: sub-speciality interest, geographical region, whether there is a pelvic binder in their hospital, availability of interventional radiology, and whether surgeons would perform a range of procedures to control haemorrhage in the emergency setting.
There were 141 responses to the survey, giving a 64% response rate. Only 18% reported that their unit had a formal rota for interventional radiology out of hours. 16% did not know. 96% of orthopaedic surgeons would perform external fixation, although only 49% would use a C-clamp. 90% of general surgeons would be able to pack the pelvis from within the abdominal compartment and 84% would be prepared to cross-clamp the aorta if the situation required. Despite being widely recommended in the literature as a method of haemorrhage control, our survey revealed only 45% would perform extra(pre)-peritoneal packing of the pelvis (58% of general surgeons; 34% of orthopaedic surgeons) and only 12% had received formal training in this procedure.
With appropriately targeted training it is likely that the care of patients with pelvic fractures can be significantly improved.
在骨盆骨折患者的急救管理中，关于血管造影和开放性骨盆填塞的作用仍存在争议。人们普遍认为，对于那些尽管经过复苏仍存在血流动力学不稳定的患者，需要进行某种形式的止血。我们旨在确定随叫随到的普通外科和骨科医生是否有能力为这些患者实施紧急手术，以及血管放射科是否为他们提供服务。
向威尔士的 221 名普通外科和骨科医生发送了调查。问题包括：亚专科兴趣、地理位置、他们所在医院是否有骨盆固定带、介入放射学的可用性，以及外科医生是否能够在紧急情况下进行一系列控制出血的手术。
共有 141 名医生对调查做出了回应，回应率为 64%。只有 18%的人报告说他们的单位有介入放射科的小时外正式轮班。16%的人不知道。96%的骨科医生会进行外固定，但只有 49%的人会使用 C 形夹。90%的普通外科医生可以从腹部腔内进行骨盆填塞，如果情况需要，84%的人愿意夹闭主动脉。尽管在文献中广泛推荐作为一种止血方法，但我们的调查显示，只有 45%的人会进行骨盆外（前）腹膜填塞（58%的普通外科医生；34%的骨科医生），只有 12%的人接受过这种手术的正规培训。
通过有针对性的培训，骨盆骨折患者的护理质量很可能得到显著提高。
