Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW 2310, Australia.
Injury. 2012 Aug;43(8):1330-4. doi: 10.1016/j.injury.2012.05.014. Epub 2012 Jun 6.
Urgent non-invasive pelvic ring stabilisation (pelvic binding, PB) in shocked patients is recommended by state and institutional guidelines regardless of the fracture pattern. The purpose of this study was to determine the adherence to the guidelines, efficacy of the technique and identification of potential adverse effects associated with PB.
A 41-month retrospective analysis of the prospective pelvic fracture database was undertaken at a level 1 trauma centre. High-energy pelvic fractures were included in the analysis with exclusion of the A type injuries (AO/OTA classification) and patients who were dead on arrival. Collected data included patient demographics, injury severity score, fracture classification, application and timing of PB, associated injuries, physiological parameters, resuscitation fluids and outcomes. Pre and post-PB radiographs were reviewed. The potential effects of the PB on soft tissue (femoral vessel, bladder and rectal injury) complications were assessed by independent experts.
115 patients with high-energy B and C type pelvic ring injuries were included. Thirty-six (31%) patients presented in haemorrhagic shock on arrival. A total of 43 pelvic bindings were performed, 18 of them on shocked patients. The adherence to the guidelines was 50% (18/36) overall. Analysing fracture types of shocked patients the adherence was: B1 80%, B2 20%, B3 20%, C1 66%, C2 86%, C3 33%. The alignment of the pelvis was improved or perfect on post-PB radiographs in 68% and had not changed in 21%. In some cases of B2 and B3 type injuries the PB increased the deformity after application (11%). There were 10 deaths (8.7%) in the study group, with 4 deaths attributed to acute pelvic bleeding. Two of these had PB applied and two were identified as potential for improvement. One femoral artery injury, four bladder injuries and three rectum injuries were identified in patients who had PB applied. Association between the PB and these injuries is unlikely.
The adherence to the guidelines should be improved with further education and system development. The good effect of the technique was evident on radiographs. Although in some lateral compression fracture patterns the deformity increased, no hazards were associated with the use of PB.
州和机构指南建议对休克患者进行紧急非侵入性骨盆环稳定（骨盆固定，PB），无论骨折类型如何。本研究的目的是确定对指南的遵守情况、该技术的疗效以及与 PB 相关的潜在不良影响。
在一家 1 级创伤中心，对前瞻性骨盆骨折数据库进行了为期 41 个月的回顾性分析。分析中包括高能骨盆骨折，但排除 A 型损伤（AO/OTA 分类）和到达时死亡的患者。收集的数据包括患者人口统计学、损伤严重程度评分、骨折分类、PB 的应用和时机、相关损伤、生理参数、复苏液和结果。审查了 PB 前后的 X 光片。独立专家评估了 PB 对软组织（股血管、膀胱和直肠损伤）并发症的潜在影响。
共纳入 115 例高能 B 型和 C 型骨盆环损伤患者。36 名（31%）患者到达时出现出血性休克。共进行了 43 次骨盆固定，其中 18 次用于休克患者。总体而言，对指南的遵守率为 50%（18/36）。分析休克患者的骨折类型，遵守率为：B1 80%，B2 20%，B3 20%，C1 66%，C2 86%，C3 33%。PB 后骨盆的对线得到改善或完美的占 68%，没有改变的占 21%。在一些 B2 和 B3 型损伤的情况下，PB 在应用后增加了畸形（11%）。研究组中有 10 人死亡（8.7%），其中 4 人归因于急性骨盆出血。这其中有 2 人接受了 PB 治疗，2 人被认为有改善的可能。接受 PB 治疗的患者中有 1 例股动脉损伤、4 例膀胱损伤和 3 例直肠损伤。PB 与这些损伤之间的关联不太可能。
应通过进一步的教育和系统开发来提高对指南的遵守率。该技术的良好效果在 X 光片上显而易见。尽管在一些侧方压缩骨折模式中，畸形增加，但 PB 的使用没有带来危害。
