Ramasamy Boopalan, Thewlis Dominic, Moss Mary J, Fraysse Francois, Rickman Mark, Solomon Lucian Bogdan
Department of Orthopaedics 3, Paul Brand Building, Christian Medical College, Vellore, 632004, Tamil Nadu, India; Centre for Stem Cell Research (A unit of inStem), Christian Medical College, Vellore 632002, Tamil Nadu, India.
Centre for Orthopaedic & Trauma Research and Discipline of Orthopaedics and Trauma, The University of Adelaide, Adelaide, SA 5000, Australia.
Injury. 2017 Dec;48(12):2724-2729. doi: 10.1016/j.injury.2017.10.038. Epub 2017 Oct 28.
Trans arterial embolization (TAE) can stem uncontrolled bleeding associated with pelvic fractures, but is associated with potential complications. This study investigated and compared the early to midterm complications in two patient cohorts: one who did and one who did not undergo TAE.
The results of 14 patients who underwent TAE in the resuscitation phase, and then had their pelvic fractures managed non-operatively, the study group (Group 1), were compared with those of a control group (Group 2) of 14 patients matched for age, sex, injury and management, that did not undergo TAE. All patients were examined clinically and answered a questionnaire on bowel and urinary function, pain and limp. Gluteus medius structure and volume were assessed on MRI. The hip girdle muscle function was assessed using a hand held dynamometer, surface electromyography as well as quantitative gait analysis.
Seven patients in Group 1 (50%), but none in Group 2, had persistent urological dysfunctions, in the absence of any recognized previous pathology or urologic trauma at the time of injury. No gluteal muscle demonstrated fibrosis or fatty infiltration. The median gluteal muscle volume was not significantly decreased compared with the uninjured side in either group (P=0.421). The muscle strengths of gluteus maximus, gluteus medius, tensor fasciae latae and iliopsoas when compared to the uninjured side were significantly less in Group 1 compared to Group 2. However, no patient had a discernable limp and gait analysis showed no significant differences between the left and right sides in the study and control groups in the gluteal activation timing (p=0.171 and 0.354) and duration (p=0.622 and 0.435). There were no skin complications, and no patient reported any persistent bowel dysfunction.
TAE was associated with a high rate of persistent urological dysfunction. TAE could lead to decreased hip muscles strength, however this does not seem to affect gait.
经动脉栓塞术（TAE）可阻止与骨盆骨折相关的失控性出血，但存在潜在并发症。本研究调查并比较了两个患者队列的早期至中期并发症：一组接受了TAE，另一组未接受TAE。
将复苏阶段接受TAE治疗，随后非手术治疗骨盆骨折的14例患者（研究组，第1组）的结果，与14例年龄、性别、损伤情况及治疗方式相匹配但未接受TAE的对照组（第2组）患者的结果进行比较。所有患者均接受临床检查，并回答有关肠道和泌尿功能、疼痛及跛行的问卷。通过磁共振成像（MRI）评估臀中肌的结构和体积。使用手持测力计、表面肌电图以及定量步态分析评估髋部肌肉功能。
第1组中有7例患者（50%）存在持续性泌尿系统功能障碍，而第2组中无此情况，这些患者在受伤时均无任何已知的既往病史或泌尿系统创伤。未发现臀肌有纤维化或脂肪浸润。与未受伤侧相比，两组的臀肌体积中位数均无显著下降（P = 0.421）。与第2组相比时，第1组中臀大肌、臀中肌、阔筋膜张肌和髂腰肌相对于未受伤侧的肌肉力量明显较小。然而，没有患者有明显跛行，步态分析显示，研究组和对照组在臀肌激活时间（p = 0.171和0.354）和持续时间（p = 0.622和0.435）方面，左右两侧无显著差异。未出现皮肤并发症，也没有患者报告任何持续性肠道功能障碍。
TAE与较高的持续性泌尿系统功能障碍发生率相关。TAE可能导致髋部肌肉力量下降，但这似乎并不影响步态。
