Weinlein John C, Mashru Rakesh P, Perez Edward A, Johnson Sara E
Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN.
Elvis Presley Trauma Center, Regional One Health, Memphis, TN.
J Orthop Trauma. 2018 Feb;32(2):100-103. doi: 10.1097/BOT.0000000000001030.
To determine whether certain patterns of pelvic ring injury are associated with more frequent intrauterine fetal demise (IUFD).
Retrospective review.
Level 1 trauma center.
PATIENTS/PARTICIPANTS: Of 44 pregnant patients with pelvic and/or acetabular fractures, 40 had complete records that allowed determination of fetal viability. χ2 tests were used for categorical variables (Fisher exact tests when expected cell counts were fewer than 5), and t tests were used for continuous variables.
Fetal or maternal death.
Sixteen patients had isolated acetabular fractures, 25 had isolated pelvic ring injuries, and 3 had acetabular fractures with concomitant pelvic ring injuries. Maternal and fetal mortality were 2% and 40%, respectively. No patients with isolated acetabular fractures experienced IUFD, compared with 68% (15/22) of those with isolated pelvic ring injuries (P < 0.0001). Eight (53%) of 15 IUFDs were associated with lateral compression (LC)-I pelvic ring injuries (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 61-B2). Of the 13 LC-I pelvic ring injuries, 8 (62%) resulted in IUFD. Pelvic ring stability, Young-Burgess classification, and operative treatment were not associated with IUFD. Maternal Glasgow Coma Scale (average 13.2) and Injury Severity Score (average 18.2) at admission were predictive of IUFD.
The most frequent pelvic fractures in gravid trauma patients are LC-I. Although the rate of maternal mortality was low, the risk of IUFD was quite high (40%). LC-I pelvic ring injuries often had catastrophic outcomes, with IUFD in 62% of cases.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定某些骨盆环损伤模式是否与更频繁的宫内胎儿死亡（IUFD）相关。
回顾性研究。
一级创伤中心。
患者/参与者：44例患有骨盆和/或髋臼骨折的孕妇中，40例有完整记录，可用于确定胎儿的生存能力。分类变量采用χ2检验（预期单元格计数少于5时采用Fisher精确检验），连续变量采用t检验。
胎儿或母亲死亡。
16例患者为单纯髋臼骨折，25例为单纯骨盆环损伤，3例为髋臼骨折合并骨盆环损伤。母亲和胎儿死亡率分别为2%和40%。单纯髋臼骨折患者未发生IUFD，而单纯骨盆环损伤患者中有68%（15/22）发生IUFD（P<0.0001）。15例IUFD中有8例（53%）与侧方压缩（LC）-I型骨盆环损伤（骨科创伤协会/骨科学术问题协作组61-B2）相关。13例LC-I型骨盆环损伤中，8例（62%）导致IUFD。骨盆环稳定性、Young-Burgess分类和手术治疗与IUFD无关。入院时母亲的格拉斯哥昏迷量表评分（平均13.2）和损伤严重程度评分（平均18.2）可预测IUFD。
妊娠创伤患者中最常见的骨盆骨折为LC-I型。尽管母亲死亡率较低，但IUFD风险相当高（40%）。LC-I型骨盆环损伤往往导致灾难性后果，62%的病例发生IUFD。
预后III级。有关证据级别的完整描述，请参阅作者须知。
