Fu Chih-Yuan, Teng Lan-Hsuan, Liao Chien-Hung, Hsu Yu-Pao, Wang Shang-Yu, Kuo Ling-Wei, Yuan Kuo-Ching
From the Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Medicine (Baltimore). 2016 Apr;95(16):e3421. doi: 10.1097/MD.0000000000003421.
Pelvic fractures can result in life-threatening hemorrhages or other associated injuries. Therefore, computed tomography (CT) scanning plays a key role in the management of pelvic fracture patients. However, CT scanning is utilized as an adjunct in secondary survey according to traditional Advanced Trauma Life Support (ATLS) guidelines, whereas pelvic x-ray is used as a primary tool to evaluate pelvic stability and the necessity of further CT scanning. In the current study, we attempted to evaluate the role of CT scanning in the era of advanced technology. The significance of pelvic stability was also analyzed. From January 2012 to December 2014, the trauma registry and medical records of pelvic fracture patients were retrospectively reviewed. A 64-slice multidetector CT scanner was used in our emergency department as a standard diagnostic tool for evaluating trauma patients. Pelvic x-ray was used as a primary tool for screening pelvic fractures, and pelvic stability was evaluated accordingly. CT scans were performed in patients with unstable pelvic fractures, suspected associated intra-abdominal injuries (IAIs), or other conditions based on the physicians' clinical judgment. The clinical features of patients with stable and unstable pelvic fractures were compared. The patients with stable pelvic fractures were analyzed to determine the characteristics associated with retroperitoneal hemorrhage (RH) or IAIs. Patients with stable pelvic fractures were also compared based on whether they underwent a CT scan. A total of 716 patients were enrolled in this study. There were 533 (74.4%) patients with stable pelvic fractures. Of these patients, there were 66 (12.4%) and 50 (9.4%) patients with associated RH and IAI, respectively. There were no significant differences between the patients with associated RH based on their primary evaluation (vital signs, volume of blood transfusion, and hemoglobin level). Similarly, the demographics and the primary evaluation results (symptoms, coma scale, and white blood cell counts) of the patients with associated IAIs were also not significantly different from the patients without associated IAIs. Furthermore, the time to definitive hemostasis (surgery or angioembolization) was not significantly different between the unstable patients who underwent a CT scan or those who did not.In the management of pelvic fracture patients, the role of pelvic stability is not significant in the evaluation of associated RH or IAI. Routine CT scanning is suggested for pelvic fracture patients because of the rapid scanning time and sufficient information produced.
骨盆骨折可导致危及生命的出血或其他相关损伤。因此，计算机断层扫描（CT）在骨盆骨折患者的治疗中起着关键作用。然而，根据传统的高级创伤生命支持（ATLS）指南，CT扫描在二次评估中作为辅助手段使用，而骨盆X线则作为评估骨盆稳定性及进一步进行CT扫描必要性的主要工具。在本研究中，我们试图评估CT扫描在先进技术时代的作用。同时也分析了骨盆稳定性的意义。回顾性分析2012年1月至2014年12月骨盆骨折患者的创伤登记资料和病历。在我们急诊科，64排多层螺旋CT扫描仪被用作评估创伤患者的标准诊断工具。骨盆X线作为筛查骨盆骨折的主要工具，并据此评估骨盆稳定性。对于骨盆骨折不稳定、怀疑有腹腔内联合损伤（IAIs）或基于医生临床判断的其他情况的患者进行CT扫描。比较稳定型和不稳定型骨盆骨折患者的临床特征。对稳定型骨盆骨折患者进行分析，以确定与腹膜后出血（RH）或IAIs相关的特征。稳定型骨盆骨折患者也根据是否接受CT扫描进行比较。本研究共纳入716例患者。其中533例（74.4%）为稳定型骨盆骨折患者。在这些患者中，分别有66例（12.4%）和50例（9.4%）伴有RH和IAIs。伴有RH的患者在初次评估（生命体征、输血量和血红蛋白水平）方面无显著差异。同样，伴有IAIs的患者与无IAIs的患者在人口统计学和初次评估结果（症状、昏迷评分和白细胞计数）方面也无显著差异。此外，接受CT扫描的不稳定患者与未接受CT扫描的不稳定患者在确定止血（手术或血管栓塞）的时间上无显著差异。在骨盆骨折患者的治疗中，骨盆稳定性在评估相关RH或IAIs方面作用不显著。由于扫描时间短且能提供足够的信息，建议对骨盆骨折患者进行常规CT扫描。
