早期 CT 检查显示骨盆“晕征”的骨盆环骨折患者的处理。
Management of pelvic ring fracture patients with a pelvic "blush" on early computed tomography.
机构信息
From the Trauma Unit, Department of Surgery (D.O.F.V., K.J.P., J.C.G.) and Department of Radiology (I.A.J.Z., C.V.D.L., O.M.V.D.). Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands.
出版信息
J Trauma Acute Care Surg. 2014 Feb;76(2):374-9. doi: 10.1097/TA.0000000000000094.
BACKGROUND
The sliding computed tomographic (CT) scanner in our trauma resuscitation room can be used early in the assessment of pelvic ring fracture patients. We determined the association between the presence of a pelvic blush on CT scan and the need for pelvic hemorrhage control (PHC). We hypothesized that many pelvic blushes found early in the resuscitation phase can be safely managed without intervention.
METHODS
Contrast-enhanced CT scans of pelvic ring fracture (pelvic ring disruption) patients admitted from January 1, 2004, to June 31, 2012, were reviewed for the presence of a pelvic blush. PHC was defined as requiring a surgical or radiologic intervention for pelvic bleeding. A subanalysis was performed in "isolated" pelvic fracture/ blush patients (absence of a major nonpelvic bleeding source).
RESULTS
Overall, 68 (42%) of 162 pelvic ring fracture patients and 53 (40%) of 134 isolated pelvic fracture patients had a pelvic blush. Of those 32 (47%) and 27 (51%) patients, respectively, required PHC. In the absence of a pelvic blush, 87 (93%) of 94 of all and 77 (95%) of 81 of isolated pelvic fracture patients did not require PHC. Of all patients with a pelvic blush and of isolated pelvic blush, those with PHC had a higher Injury Severity Score (ISS) (p = 0.01 and p = 0.05), base deficit (p = 0.03 and p = 0.01), as well as 24-hour and any packed red blood cells requirement (p <0.001 and p = 0.05; p <0.001 and p = 0.02). In isolated pelvic blush patients, there was a trend toward a higher hospital and hemorrhage-related mortality in patients with PHC (p = 0.06 and p = 0.06).
CONCLUSION
In pelvic ring fracture patients, a pelvic blush on early contrast-enhanced CT is a frequent finding. Many patients with (particularly isolated) pelvic blushes have stable vital signs and can be managed without surgical or radiologic PHC. The need for an intervention for a pelvic blush seems to be determined by the presence of clinical signs of ongoing bleeding.
LEVEL OF EVIDENCE
Therapeutic study, level IV. Prognostic/epidemiologic study, level III.
背景
我们创伤复苏室的滑环 CT 扫描仪可在骨盆环骨折患者的评估早期使用。我们确定 CT 扫描中骨盆血肿与骨盆出血控制（PHC）需求之间的关联。我们假设，在复苏阶段早期发现的许多骨盆血肿可以安全地无需干预而得到处理。
方法
对 2004 年 1 月 1 日至 2012 年 6 月 31 日收治的骨盆环骨折（骨盆环中断）患者的增强 CT 扫描进行回顾性分析，以确定是否存在骨盆血肿。PHC 定义为需要进行手术或放射学干预以控制骨盆出血。对“孤立性”骨盆骨折/血肿患者（无主要非骨盆出血源）进行亚分析。
结果
共有 162 例骨盆环骨折患者中 68 例（42%）和 134 例孤立性骨盆骨折患者中 53 例（40%）存在骨盆血肿。分别有 32 例（47%）和 27 例（51%）患者需要 PHC。在没有骨盆血肿的情况下，所有 94 例患者中有 87 例（93%）和所有 81 例孤立性骨盆骨折患者中有 77 例（95%）不需要 PHC。所有有骨盆血肿的患者和孤立性骨盆血肿患者中，需要 PHC 的患者损伤严重程度评分（ISS）更高（p=0.01 和 p=0.05），基础缺失（p=0.03 和 p=0.01）以及 24 小时和任何浓缩红细胞需求更高（p<0.001 和 p=0.05；p<0.001 和 p=0.02）。在孤立性骨盆血肿患者中，有 PHC 的患者的住院和出血相关死亡率呈上升趋势（p=0.06 和 p=0.06）。
结论
在骨盆环骨折患者中，早期对比增强 CT 上出现骨盆血肿是常见的发现。许多（特别是孤立性）骨盆血肿患者的生命体征稳定，可以无需手术或放射学 PHC 进行处理。对骨盆血肿进行干预的需求似乎取决于是否存在持续出血的临床体征。
证据水平
治疗性研究，IV 级；预后/流行病学研究，III 级。
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