Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Am J Emerg Med. 2018 Nov;36(11):1937-1942. doi: 10.1016/j.ajem.2018.02.014. Epub 2018 Feb 19.
Managing patients with open pelvic fractures continues to be challenging and requires a multidisciplinary approach. In this study, we examined the characteristics of patients with open pelvic fractures and strategies for managing such patients.
The records of patients with open pelvic fractures from January 2010 to August 2016 were retrospectively reviewed. Emergency surgery was performed to control hemorrhaging in patients with an active external hemorrhage. Transcatheter arterial embolization (TAE) was used for definitive hemostasis. The relation between cause of death and timing of death was examined. We also compared the characteristics of surviving and non-surviving patients. Furthermore, patients who received both surgery and post-operative TAE were analyzed in detail.
In total, 42 patients with open pelvic fractures were enrolled in the study. The overall mortality rate among patients with open pelvic fractures was 26.2%. Patients whose deaths were related to hemorrhaging and associated injuries died significantly earlier than patients whose deaths were related to sepsis and multiple organ failure (1.3days vs. 12.3days, p<0.001). Sixteen patients (38.1%) received TAE for hemostasis, and their systolic blood pressure (SBP) improved significantly following TAE (from 88.4mmHg to 111.6mmHg, p<0.05). In the patients who received both surgery and post-operative TAE (n=8), the SBP increased significantly after surgery (from 58.8mmHg to 81.1mmHg, p<0.05). Similarly, the patients' SBP after TAE was significantly higher than their post-operative SBP (110.5mmHg vs. 81.1mmHg, p<0.05).
Active external hemorrhaging was initially controlled when managing patients with open pelvic fractures; however, most patients also required TAE for definitive hemorrhage control. Early TAE should be considered due to the high probability of concomitant internal and external hemorrhage. Close observation and further infection control are important following the hemostatic procedure.
处理开放性骨盆骨折患者仍然具有挑战性，需要采用多学科方法。本研究旨在探讨开放性骨盆骨折患者的特征及处理策略。
回顾性分析 2010 年 1 月至 2016 年 8 月收治的开放性骨盆骨折患者的临床资料。对于活动性外出血的患者，采用急诊手术控制出血。对于明确止血的患者，采用经导管动脉栓塞术（TAE）。分析患者死亡原因与死亡时间的关系，比较存活与死亡患者的特征。详细分析接受手术与术后 TAE 的患者。
共纳入 42 例开放性骨盆骨折患者。开放性骨盆骨折患者的总死亡率为 26.2%。与出血和相关损伤相关的死亡患者的死亡时间明显早于与感染和多器官衰竭相关的死亡患者（1.3 天 vs. 12.3 天，p<0.001）。16 例（38.1%）患者接受 TAE 以止血，TAE 后收缩压（SBP）明显升高（从 88.4mmHg 升至 111.6mmHg，p<0.05）。在接受手术和术后 TAE 的 8 例患者中，手术后 SBP 明显升高（从 58.8mmHg 升至 81.1mmHg，p<0.05）。同样，TAE 后患者的 SBP 明显高于术后 SBP（110.5mmHg vs. 81.1mmHg，p<0.05）。
处理开放性骨盆骨折患者时，首先要控制活动性外出血，但大多数患者还需要 TAE 来明确止血。由于内外出血的高发生率，应尽早考虑 TAE。止血后应密切观察并进一步控制感染。
