Scolaro John A, Wilson David J, Routt Milton Lee Chip, Firoozabadi Reza
University of California, Irvine, Orange, CA, USA.
Madigan Army Medical Center, Tacoma, WA, USA.
Injury. 2015 Oct;46(10):1999-2002. doi: 10.1016/j.injury.2015.06.045. Epub 2015 Jul 10.
Open pelvic disruptions represent high-energy injuries. The prompt identification and management of these injuries decreases their associated morbidity and mortality. Computed tomography (CT) scans are routinely obtained in the initial evaluation of patients with pelvic injuries. The purpose of this study is to identify the incidence and source of air densities noted on computed tomography (CT) scans of the abdominal and pelvic region in patients with pelvic fractures and evaluate the use of initial CT imaging as an adjunctive diagnostic tool to identify open injuries. A retrospective review of a prospectively collected database was performed at a single institution. Seven hundred and twenty-two consecutive patients with a pelvic disruption over a two-year period were included. Review of initial injury CT scans was performed using bone and lung viewing algorithms to identify the presence of extra-luminal air. The primary outcome was the presence, location and source of air identified on pre-operative CT scans. Secondary measurements were identification of air by plain radiograph and correlation between identified air densities on CT and clinically diagnosed open pelvic fractures. Ninety-eight patients were identified as having extra-luminal air densities on CT scans. Eighty-one patients were included in the final analysis following application of inclusion and exclusion criteria. Air was noted by the radiologist in forty-five (55.6%) instances. Six patients (7.4%) were clinically diagnosed with an open pelvic ring disruption; in two patients (2.4%) this diagnosis was delayed. In all patients, the CT was able to track air from its origin. In patients with pelvic disruptions, the injury CT should also be evaluated for the presence and source of extra-luminal air. In some patients, this finding may represent an open pelvic ring disruption. A complete physical exam and CT evaluation should be used to decrease the missed or delayed diagnosis of an open pelvic ring injury.
开放性骨盆损伤属于高能损伤。对这些损伤进行及时识别和处理可降低其相关的发病率和死亡率。在骨盆损伤患者的初始评估中，通常会进行计算机断层扫描（CT）。本研究的目的是确定骨盆骨折患者腹部和骨盆区域CT扫描中所发现的空气密度的发生率和来源，并评估初始CT成像作为识别开放性损伤的辅助诊断工具的应用价值。在单一机构对前瞻性收集的数据库进行了回顾性研究。纳入了两年期间连续的722例骨盆损伤患者。使用骨窗和肺窗观察算法对初始损伤CT扫描进行回顾，以识别管腔外空气的存在。主要结局是术前CT扫描中所识别的空气的存在、位置和来源。次要测量指标是通过X线平片识别空气以及CT上所识别的空气密度与临床诊断的开放性骨盆骨折之间的相关性。98例患者在CT扫描中被确定存在管腔外空气密度。应用纳入和排除标准后，81例患者纳入最终分析。放射科医生在45例（55.6%）中发现了空气。6例患者（7.4%）临床诊断为开放性骨盆环损伤；2例患者（2.4%）诊断延迟。在所有患者中，CT能够追踪空气的来源。对于骨盆损伤患者，还应评估损伤CT上管腔外空气的存在和来源。在一些患者中，这一发现可能代表开放性骨盆环损伤。应进行全面的体格检查和CT评估，以减少开放性骨盆环损伤的漏诊或延迟诊断。
