Black Emily Anne, Lawson Christy M, Smith Scott, Daley Brian J
Divisions of Trauma and Critical Care and Orthopaedics, Department of Surgery, The University of Tennessee Medical Center at Knoxville, Knoxville, TN, USA.
Iowa Orthop J. 2011;31:193-8.
Open fractures of the pelvis remain a devastating injury with a high mortality and morbidity. Such injuries require an aggressive treatment plan and the coordination of trauma and orthopaedic surgeons to achieve the best outcomes. We report our experience at the University of Tennessee Medical Center at Knoxville with open pelvic fractures over the last ten years.
After IRB and institutional approval, we reviewed patients admitted with a diagnosis of open fracture of the pelvis from 1999 to 2009. Demographic and admission data were recorded in the trauma registry (TRACS) of the Level I Trauma Center, serving the 1.2 million people living in the regions of east Tennessee, western North Carolina and southeastern Kentucky. Data on fractures were obtained from review of the medical records and radiographs within the chart.
There were 3053 pelvic fractures from January 1999 to December 2009. There were 231 deaths in this group (6%) and ages ranged from 18 to 89 years old and Injury Severity Scores ranged from 4 to 75, with a mean of 18.3. Seventy five percent of patients were able to be discharged home. Fifty-two fractures were open. There were 43 men and the mean age was 39 years old. Average ISS was 23 and ranged from 5 to 50. There were 10 deaths (19%) and eight patients underwent angioembolization for control of bleeding (3 deaths). Motorcycle crashes were the most frequent cause of an open fracture, with lateral compression injuries representing 71%. A defined algorithm for fracture management has been in place and employed to assure adequate resuscitation and fracture care and is presented.
Open pelvic fractures are usually the result of a high energy transfer, and convey a high morbidity and mortality. A defined resuscitation and fixation strategy improves outcome from historical reports. Injuries from penetrating mechanisms are associated with less morbidity and lower mortality.
骨盆开放性骨折仍然是一种具有高死亡率和高发病率的严重损伤。此类损伤需要积极的治疗方案以及创伤外科医生和骨科医生的协作，以取得最佳治疗效果。我们报告了过去十年间在诺克斯维尔的田纳西大学医学中心治疗骨盆开放性骨折的经验。
经机构审查委员会（IRB）和机构批准后，我们回顾了1999年至2009年期间诊断为骨盆开放性骨折的住院患者。人口统计学和入院数据记录在一级创伤中心的创伤登记系统（TRACS）中，该中心服务于田纳西州东部、北卡罗来纳州西部和肯塔基州东南部地区的120万人口。骨折数据通过查阅病历和图表中的X光片获得。
1999年1月至2009年12月期间共有3053例骨盆骨折。该组中有231例死亡（6%），年龄范围为18至89岁，损伤严重度评分范围为4至75分，平均为18.3分。75%的患者能够出院回家。有52例骨折为开放性骨折。其中男性43例，平均年龄为39岁。平均损伤严重度评分为23分，范围为5至50分。有10例死亡（19%），8例患者接受了血管栓塞术以控制出血（3例死亡）。摩托车碰撞是开放性骨折最常见的原因，侧方挤压伤占71%。已制定并采用了明确的骨折治疗算法，以确保充分的复苏和骨折护理，并予以展示。
骨盆开放性骨折通常是高能量转移的结果，具有高发病率和高死亡率。从既往报告来看，明确的复苏和固定策略可改善治疗效果。穿透性机制造成的损伤发病率较低，死亡率也较低。
