Cullinane Daniel C, Schiller Henry J, Zielinski Martin D, Bilaniuk Jaroslaw W, Collier Bryan R, Como John, Holevar Michelle, Sabater Enrique A, Sems S Andrew, Vassy W Matthew, Wynne Julie L
Departments of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Trauma. 2011 Dec;71(6):1850-68. doi: 10.1097/TA.0b013e31823dca9a.
Hemorrhage from pelvic fracture is common in victims of blunt traumatic injury. In 2001, the Eastern Association for the Surgery of Trauma (EAST) published practice management guidelines for the management of hemorrhage in pelvic trauma. Since that time there have been new practice patterns and larger experiences with older techniques. The Practice Guidelines Committee of EAST decided to replace the 2001 guidelines with an updated guideline and systematic review reflecting current practice.
Building on the previous systematic literature review in the 2001 EAST guidelines, a systematic literature review was performed to include references from 1999 to 2010. Prospective and retrospective studies were included. Reviews and case reports were excluded. Of the 1,432 articles identified, 50 were selected as meeting criteria. Nine Trauma Surgeons, an Interventional Radiologist, and an Orthopedic Surgeon reviewed the articles. The EAST primer was used to grade the evidence.
Six questions regarding hemorrhage from pelvic fracture were addressed: (1) Which patients with hemodynamically unstable pelvic fractures warrant early external mechanical stabilization? (2) Which patients require emergent angiography? (3) What is the best test to exclude extrapelvic bleeding? (4) Are there radiologic findings which predict hemorrhage? (5) What is the role of noninvasive temporary external fixation devices? and (6) Which patients warrant preperitoneal packing?
Hemorrhage due to pelvic fracture remains a major cause of morbidity and mortality in the trauma patient. Strong recommendations were made regarding questions 1 to 4. Further study is needed to answer questions 5 and 6.
骨盆骨折出血在钝性创伤患者中很常见。2001年，东部创伤外科学会（EAST）发布了骨盆创伤出血管理的实践管理指南。自那时以来，出现了新的实践模式，并且对旧技术有了更多的经验。EAST实践指南委员会决定用一份反映当前实践的更新指南和系统评价取代2001年的指南。
在2001年EAST指南先前的系统文献综述基础上，进行了一项系统文献综述，纳入1999年至2010年的参考文献。纳入前瞻性和回顾性研究。排除综述和病例报告。在识别出的1432篇文章中，50篇被选为符合标准。9名创伤外科医生、1名介入放射科医生和1名骨科医生对这些文章进行了评审。使用EAST引物对证据进行分级。
针对骨盆骨折出血提出了六个问题：（1）哪些血流动力学不稳定的骨盆骨折患者需要早期外部机械稳定？（2）哪些患者需要紧急血管造影？（3）排除盆腔外出血的最佳检查是什么？（4）是否有预测出血的影像学表现？（5）无创临时外固定装置的作用是什么？以及（6）哪些患者需要腹膜前填塞？
骨盆骨折导致的出血仍然是创伤患者发病和死亡的主要原因。针对问题1至4提出了强烈建议。需要进一步研究以回答问题5和6。
