Agri Fabio, Bourgeat Mylène, Becce Fabio, Moerenhout Kevin, Pasquier Mathieu, Borens Olivier, Yersin Bertrand, Demartines Nicolas, Zingg Tobias
Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Department of Emergency Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
BMC Surg. 2017 Nov 9;17(1):104. doi: 10.1186/s12893-017-0299-6.
Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures.
Single-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed.
The present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates.
Tile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.
骨盆骨折是严重损伤，常伴有多系统创伤，死亡率高。骨盆骨折类型对预测输血需求和死亡率的价值尚不完全清楚。为解决骨盆损伤出血问题，目前建议早期应用骨盆固定带，动脉血管栓塞术也广泛用于控制动脉出血。我们的目的是评估根据Tile分类系统的骨盆骨折类型与输血需求和死亡率之间的关联，并评估骨盆固定带和动脉血管栓塞术的使用与骨盆骨折患者死亡率之间的相关性。
单中心回顾性队列研究，纳入2008年1月至2015年6月期间所有连续性骨盆骨折患者。所有放射学骨折类型均由独立观察者根据Tile分类系统进行复查和分组。从机构创伤登记处提取患者人口统计学数据、骨盆固定带和动脉血管栓塞术的使用情况、输血需求和死亡率，并进行分析。
本研究纳入228例患者。患者中位年龄为43.5岁，男性占68.9%。两名独立观察者确定了105例Tile C型骨折（46.1%）、71例Tile B型骨折（31.1%）和52例Tile A型骨折（22.8%），观察者间一致性从实质到几乎完美（Kappa值0.70 - 0.83）。与Tile A型或B型骨折相比，Tile C型骨折的死亡率更高（p = 0.001），输血需求也更高（p < 0.0001）。骨盆出血的动脉血管栓塞术（p = 0.05）和院前骨盆固定带放置（p = 0.5）与死亡率差异无关。
与Tile A型或B型骨折相比，Tile C型骨盆骨折的输血需求更高，死亡率也更高。在这组骨盆骨折患者中，未观察到骨盆固定带或动脉血管栓塞术的使用与生存率之间存在关联。
