Liñán-Padilla A, Giráldez-Sánchez M Á, Serrano-Toledano D, Lázaro-Gonzálvez A, Cano-Luís P
Servicio de Cirugía Ortopédica y Traumatología, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
Rev Esp Cir Ortop Traumatol. 2013 Nov-Dec;57(6):429-33. doi: 10.1016/j.recot.2013.07.002. Epub 2013 Sep 4.
The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing. We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis? From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability.
骨盆创伤患者的多学科管理改善了预后，但死亡率仍然很高。合适的治疗策略仍存在争议，尤其是对于通过血管造影或盆腔填塞来控制临床情况极为危急患者的出血方面。我们建议使用循证医学工具（CAT），针对特定临床情况中的特定临床问题，来评估盆腔填塞的益处。对于处于极端血流动力学不稳定状态的骨盆骨折患者，腹膜外盆腔填塞或血管造影，哪种方法最适合控制出血？从这项研究中我们可以得出结论，血管造影可能会改善动脉出血且血流动力学稳定患者的出血控制，但对于骨盆骨折且血流动力学不稳定的患者，填塞应优先考虑。
