Gänsslen A, Hildebrand F, Pohlemann T
Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany.
Acta Chir Orthop Traumatol Cech. 2012;79(3):193-202.
The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure .70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission. The sources of pelvic bleeding is in approximately 80-90% of venous origin and relevant arterial bleeding accounts for 10-20%. Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources. In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels.
骨盆环损伤患者的血流动力学状态是直接死亡风险的主要预后因素。特别是，“濒死”患者死亡风险很高。该患者群体的特征是生命体征消失或处于严重休克状态，初始收缩压<70mmHg，和/或在入院后两小时内尽管输注超过12单位血液仍需要机械复苏或使用儿茶酚胺。骨盆出血来源约80-90%为静脉源性，相关动脉出血占10-20%。初始治疗概念的重要部分包括机械性骨盆环稳定结合出血控制概念。根据当地可用资源，通过应用骨盆固定带进行无创机械稳定，或通过经典前路骨盆固定或后路骨盆C形夹进行有创机械稳定。对于“濒死”患者，建议采用直接腹膜外骨盆填塞的概念，而对于中度不稳定患者或尽管进行了休克治疗、机械稳定和骨盆填塞仍持续存在血流动力学不稳定的患者，通过血管造影排除动脉损伤，随后对骨盆血管进行选择性栓塞。
