Giordano Vincenzo, Koch Hilton Augusto, Gasparini Savino, Serrão de Souza Felipe, Labronici Pedro José, do Amaral Ney Pecegueiro
Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil.
Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Open Orthop J. 2016 Dec 20;10:772-778. doi: 10.2174/1874325001610010772. eCollection 2016.
Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval.
In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient's age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%.
Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the last outpatient visit, the Faringer classification showed statistical significance on the need of colostomy (p = 0.001) in the acute phase of treatment.
We suggest the routine use of the Jones classification for the emergency room assessment and management of all open fractures of the pelvic ring. We believe the Faringer classification seems to be useful for the abdominal surgeons for the indication of gut transit derivation but not for the acute management of the bony component of an open pelvic fracture.
开放性骨盆骨折较为罕见，但通常伴有高并发症发生率和死亡率上升。本研究的目的是回顾性评估在一家一级创伤中心接受治疗的所有连续10年间的开放性骨盆骨折患者。
在10年期间，30例诊断为开放性骨盆骨折的患者入住一家一级创伤中心。对从病历中获取的数据进行回顾性分析，这些数据包括患者的年龄、性别、损伤机制、骨盆损伤分类、损伤严重程度评分（ISS）、紧急干预措施、手术干预措施、住院时间和重症监护病房停留时间，以及并发症，包括围手术期并发症和死亡情况。采用琼斯分类法来描述骨盆创伤的能量，采用法林格分类法来确定开放性伤口的位置。在幸存者中，在最后一次门诊随访时使用欧洲五维健康量表（EuroQol EQ-5D）和布莱克问卷对结果进行评估。通过使用曼-惠特尼非参数检验确定死亡率和发病率与这些分类系统之间的关系，显著性水平为5%。
12例（40%）患者死于骨盆损伤或相关损伤。他们所有人的ISS均高于35。琼斯分类法显示与这些患者的死亡率有直接关系（p = 0.012）。在评估的其他18例（60%）患者中，平均随访时间为16.3个月，范围从24个月至112个月。11例（61%）患者预后良好。琼斯分类法显示与客观和主观结果均有统计学显著关系（p < 5%）。法林格分类法显示与主观结果有统计学显著关系，但与客观结果无关。此外，在最后一次门诊随访评估的18例患者中，法林格分类法显示在治疗急性期对结肠造口术需求方面有统计学显著性（p = 0.001）。
我们建议在急诊室对所有骨盆环开放性骨折进行评估和处理时常规使用琼斯分类法。我们认为法林格分类法似乎对腹部外科医生在肠道转流指征方面有用，但对开放性骨盆骨折的骨成分急性处理无用。
