Pavić Roman, Margetić Petra
University of Zagreb, University Hospital of Traumatology, Zagreb, Croatia.
Coll Antropol. 2012 Dec;36(4):1445-52.
Unstable pelvic fractures very frequently occur with haemorrhage, not only from the broken pelvis but from the presacral venous plexus and/or iliac arterial or venous branches which may cause hypotension and increases the mortality rate. Very often this type of injury is concurrent with injuries in other organ systems. The compounded nature of these injuries makes it necessary for doctors who may encounter this type of patient to be educated in the techniques to effectively stabilise and treat the patient's complex injuries. After completing the international standard ATLS (Advanced Trauma Life Support) primary survey to identify a haemodinamically unstable patient with pelvic fracture, we discuss adequate replenishment of lost blood volume and standards of care for such a patient. The best diagnostics are described from transport immobilisation to the placement of external fixators or C-clamps. Likewise indication for intervention of pelvic angiography and therapeutic embolisation are also discussed. The direct surgical hemostasis method of pelvic packing is described in detail. All presented methods are mutually complementary in today's treatment of these patients.
不稳定骨盆骨折常伴有出血，不仅来自骨折的骨盆，还来自骶前静脉丛和/或髂动脉或静脉分支，这可能导致低血压并增加死亡率。这类损伤常与其他器官系统的损伤同时发生。这些损伤的复杂性使得可能遇到这类患者的医生有必要接受有效稳定和治疗患者复杂损伤技术的培训。在完成国际标准的ATLS（高级创伤生命支持）初步检查以确定一名血流动力学不稳定的骨盆骨折患者后，我们讨论了失血量的充分补充以及此类患者的护理标准。描述了从转运固定到放置外固定器或C形夹的最佳诊断方法。同样，也讨论了骨盆血管造影和治疗性栓塞的干预指征。详细描述了骨盆填塞的直接手术止血方法。在当今对这些患者的治疗中，所有提出的方法相互补充。
