Burgess A R, Eastridge B J, Young J W, Ellison T S, Ellison P S, Poka A, Bathon G H, Brumback R J
Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
J Trauma. 1990 Jul;30(7):848-56.
From January 1, 1985, to September 10, 1988, 210 consecutive patients with high-energy pelvic ring disruptions (exclusive of acetabular fractures) were admitted to a statewide referral center for adult multiple trauma. They were treated by one of four attending orthopaedic traumatologists per protocol as determined by their injury classification and hemodynamic status; the injury classification system was based on the vector of force involved and the quantification of disruption from that force, i.e., lateral compression, anteroposterior compression, vertical shear, and combined mechanical injury. Of the 210 patients, 162 had complete charts: 126 (78.0%) were admitted directly from the scene, 110 (67.9%) were injured in motor vehicle or motorcycle accidents, 25 (15.0%) were admitted in shock (blood pressure less than 90 mm Hg), the average Glasgow Coma Score was 13.2, and the average Injury Severity Score was 25.8. Treatment of the pelvic fracture included the following methods (alone or in combination): acute external fixation (45.0; 28.0%), open reduction/internal fixation (22; 13.5%), acute arterial embolization (11; 7.0%), and bedrest (68; 42.0%). Overall blood replacement averaged 5.9 units (lateral compression, 3.6 units; anteroposterior compression, 14.8 units; vertical shear, 9.2 units; combined mechanical, 8.5 units). Overall mortality was 8.6% (lateral compression, 7.0%; anteroposterior, 20.0%, vertical shear, 0%; combined mechanical, 18.0%). The cause of death was associated with the pelvic fracture in less than 50%; no patient with an isolated or vertical shear pelvic injury died. We conclude that the predictive value of our classification system (incorporating appreciation of the causative forces and resulting injury patterns) and our classification-based treatment protocols reduce the morbidity and mortality related to pelvic ring disruption.
1985年1月1日至1988年9月10日期间，210例连续的高能骨盆环损伤患者（不包括髋臼骨折）被收治于一家全州范围的成人多发伤转诊中心。根据损伤分类和血流动力学状态，按照方案由四位骨科创伤主治医生之一对他们进行治疗；损伤分类系统基于所涉及的力的矢量以及该力造成的破坏程度，即侧方挤压、前后挤压、垂直剪切和复合机械损伤。在这210例患者中，162例有完整病历：126例（78.0%）直接从现场入院，110例（67.9%）在机动车或摩托车事故中受伤，25例（15.0%）入院时处于休克状态（血压低于90 mmHg），格拉斯哥昏迷评分平均为13.2，损伤严重程度评分平均为25.8。骨盆骨折的治疗方法包括以下几种（单独或联合使用）：急性外固定（45例；28.0%）、切开复位/内固定（22例；13.5%）、急性动脉栓塞（11例；7.0%）和卧床休息（68例；42.0%）。总体输血量平均为5.9单位（侧方挤压，3.6单位；前后挤压，14.8单位；垂直剪切，9.2单位；复合机械损伤，8.5单位）。总体死亡率为8.6%（侧方挤压，7.0%；前后挤压，20.0%；垂直剪切，0%；复合机械损伤，18.0%）。死亡原因与骨盆骨折相关的不到50%；没有单纯或垂直剪切骨盆损伤的患者死亡。我们得出结论，我们的分类系统（结合对致伤力和由此产生的损伤模式的评估）以及基于分类的治疗方案降低了与骨盆环损伤相关的发病率和死亡率。
