Burkhardt Markus, Kristen Alexander, Culemann Ulf, Koehler Daniel, Histing Tina, Holstein Joerg H, Pizanis Antonius, Pohlemann Tim
Department of Trauma, Orthopaedic and Hand Surgery, Protestant City Hospital, Großherzog-Friedrich-Straße 44, 66111 Saarbrücken, Germany.
Department of Trauma Surgery, General Hospital Celle, Siemensplatz 4, 29223 Celle, Germany.
Injury. 2014 Oct;45 Suppl 3:S70-5. doi: 10.1016/j.injury.2014.08.021.
Until today the mortality of complex pelvic trauma remains unacceptably high. On the one hand this could be attributed to a biological limit of the survivable trauma load, on the other hand side an ongoing inadequate treatment might be conceivable too. For the management of multiple trauma patients with life-threatening pelvic fractures, there is ongoing international debate on the adequate therapeutic strategy, e.g. arterial embolization or pelvic packing, as well as aggressive or restrained volume therapy. Whereas traditional pelvis-specific trauma algorithms still recommend massive fluid resuscitation, there is upcoming evidence that a restrained volume therapy in the preclinical setting may improve trauma outcomes. Less intravenous fluid administration may also reduce haemodilution and concomitant trauma-associated coagulopathy. After linking the data of the TraumaRegister DGU(®) and the German Pelvic Injury Register, for the first time, the initial fluid management for complex pelvic traumas as well as for different Tile/OTA types of pelvic ring fractures could be addressed. Unfortunately, the results could not answer the question of the adequate fluid resuscitation but confirmed the actuality of massive fluid resuscitation in the prehospital and emergency room setting. Low-volume resuscitation seems not yet accepted in practice in managing multiple trauma patients with pelvic fractures at least in Germany. Nevertheless, prevention of exsanguination and of complications like multiple organ dysfunction syndrome still poses a major challenge in the management of complex pelvic ring injuries. Even nowadays, fluid management for trauma, not only for pelvic fractures, remains a controversial area and further research is mandatory.
直至今日，复杂骨盆创伤的死亡率仍高得令人难以接受。一方面，这可能归因于可承受创伤负荷的生物学极限，另一方面，也可能存在治疗一直不充分的情况。对于伴有危及生命的骨盆骨折的多发伤患者的治疗，关于适当的治疗策略，如动脉栓塞或骨盆填塞，以及积极或限制性容量治疗，国际上仍在进行争论。传统的针对骨盆创伤的算法仍推荐大量液体复苏，然而，新出现的证据表明，在临床前环境中采用限制性容量治疗可能会改善创伤结局。减少静脉输液量还可能减少血液稀释及伴随的创伤相关凝血病。在将创伤注册数据库DGU(®)和德国骨盆损伤注册中心的数据相链接后，首次能够探讨复杂骨盆创伤以及不同Tile/OTA类型骨盆环骨折的初始液体管理。遗憾的是，结果未能回答适当液体复苏的问题，但证实了在院前和急诊室环境中大量液体复苏的现状。至少在德国，低容量复苏在骨盆骨折多发伤患者的治疗实践中似乎尚未被接受。然而，在复杂骨盆环损伤的治疗中，防止失血和多器官功能障碍综合征等并发症仍然是一项重大挑战。即便在当今，创伤的液体管理，不仅是骨盆骨折的液体管理，仍然是一个有争议的领域，进一步的研究必不可少。
