Purcell Richard L, Donohue Michael A, Saxena Sameer K, Gordon Wade T, Lewandowski Louis L
Department of Orthopaedics, Walter Reed National Military Medical Center, United States.
Department of Orthopaedics, Walter Reed National Military Medical Center, United States.
Injury. 2018 Feb;49(2):290-295. doi: 10.1016/j.injury.2017.11.035. Epub 2017 Dec 2.
Since the onset of the Global War on Terror close to 50,000 United States service members have been injured in combat, many of these injuries would have previously been fatal. Among these injuries, open acetabular fractures are at an increased number due to the high percentage of penetrating injuries such as high velocity gunshot wounds and blast injuries. These injuries lead to a greater degree of contamination, and more severe associated injuries. There is a significantly smaller proportion of the classic blunt trauma mechanism typically seen in civilian trauma.
We performed a retrospective review of the Department of Defense Trauma Registry into which all US combat-injured patients are enrolled, as well as reviewed local patient medical records, and radiologic studies from March 2003 to April 2012. Eighty seven (87) acetabular fractures were identified with 32 classified as open fractures. Information regarding mechanism of injury, fracture pattern, transfusion requirements, Injury Severity Score (ISS), and presence of lower extremity amputations was analyzed.
The mechanism of injury was an explosive device in 59% (n=19) of patients with an open acetabular fracture; the remaining 40% (n=13) were secondary to ballistic injury. In contrast, in the closed acetabular fracture cohort 38% (21/55) of fractures were due to explosive devices, and all remaining (n=34) were secondary to blunt trauma such as falls, motor vehicle collisions, or aircraft crashes. Patients with open acetabular fractures required a median of 17units of PRBC within the first 24h after injury. The mean ISS was 32 in the open group compared with 22 in the closed group (p=0.003). In the open fracture group nine patients (28%) sustained bilateral lower extremity amputations, and 10 patients (31%) ultimately underwent a hip disarticulation or hemi-pelvectomy as their final amputation level.
Open acetabular fractures represent a significant challenge in the management of combat-related injuries. High ISS and massive transfusion requirements are common in these injuries. This is one of the largest series reported of open acetabular fractures. Open acetabular fractures require immediate damage control surgery and resuscitation as well as prolonged rehabilitation due to their severity. The dramatic number of open acetabular fractures (37%) in this review highlights the challenge in treatment of combat related acetabular fractures.
自全球反恐战争爆发以来，近50000名美国军人在战斗中受伤，其中许多伤势若在以前可能会致命。在这些损伤中，开放性髋臼骨折的数量有所增加，这是因为诸如高速枪伤和爆炸伤等穿透伤的比例较高。这些损伤会导致更高程度的污染以及更严重的相关损伤。与 civilian trauma 中常见的典型钝性创伤机制相比，其比例要小得多。
我们对国防部创伤登记处进行了回顾性研究，所有美国战斗受伤患者均被纳入该登记处，同时还查阅了当地患者的病历以及2003年3月至2012年4月的放射学研究资料。共识别出87例髋臼骨折，其中32例被归类为开放性骨折。分析了有关损伤机制、骨折类型、输血需求、损伤严重程度评分（ISS）以及下肢截肢情况的信息。
在开放性髋臼骨折患者中，59%（n = 19）的损伤机制为爆炸装置；其余40%（n = 13）继发于弹道伤。相比之下，在闭合性髋臼骨折队列中，38%（21/55）的骨折是由爆炸装置所致，其余所有（n = 34）均继发于钝性创伤，如跌倒、机动车碰撞或飞机坠毁。开放性髋臼骨折患者在受伤后的头24小时内，PRBC的中位数需求量为17单位。开放性骨折组的平均ISS为32，而闭合性骨折组为22（p = 0.003）。在开放性骨折组中，9名患者（28%）双侧下肢截肢，10名患者（31%）最终接受了髋关节离断术或半骨盆切除术作为最终的截肢水平。
开放性髋臼骨折是战斗相关损伤治疗中的一项重大挑战。这些损伤中，高ISS和大量输血需求很常见。这是所报道的最大规模的开放性髋臼骨折系列之一。由于其严重性，开放性髋臼骨折需要立即进行损伤控制手术和复苏，以及长期康复治疗。本综述中开放性髋臼骨折的惊人数量（37%）凸显了治疗战斗相关髋臼骨折的挑战。
