Cheng Mina, Lee Kin-Yan, Chang Annice-M L, Ho Hiu-Fai, Chan Lily-P S, Lee Kin-Bong, Kwok Philip-C H, Lee Alexander-C W, Wong Kevin-Y K, Kam Chak-Wah, Leung Gilberto-K K, Wong John-K S, Cheung Nai-Kwong, Yeung Janice-H H, Tang Ning, Choi Shing-Hing, Lau Tak-Wing, Wong Heidi-H T, Leung Ming
Department of Surgery, Queen Elizabeth Hospital, 33 Gascoigne Road, Kowloon, Hong Kong.
Department of Accident and Emergency, Queen Elizabeth Hospital, 33 Gascoigne Road, Kowloon, Hong Kong.
Int Orthop. 2018 Oct;42(10):2459-2466. doi: 10.1007/s00264-018-3842-x. Epub 2018 Feb 27.
The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period.
This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities).
Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol.
Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.
血流动力学不稳定的骨盆骨折患者死亡率高达40%-60%。尽管香港创伤中心正处于创伤护理的新进展阶段，但血流动力学不稳定骨盆骨折的治疗仍存在差异。本研究旨在回顾香港五年期间血流动力学不稳定骨盆骨折患者的治疗结果。
这是一项对2010年1月1日至2014年12月31日期间血流动力学和机械性不稳定骨盆骨折患者进行的回顾性多中心队列研究。研究的主要结局是患者的死亡率（包括总体死亡率、30天死亡率、7天死亡率和24小时死亡率）。
实施三合一骨盆损伤控制方案被确定为总体、30天、7天和24小时死亡率的显著独立预测因素。采用三合一方案治疗的患者总体住院死亡率和30天死亡率为12.5%，7天死亡率为11%，24小时死亡率为6%。采用或未采用三合一方案治疗的患者在人口统计学特征、生理测量、骨盆骨折类型、损伤严重程度和机制方面无显著差异。
实施多学科三合一骨盆损伤控制方案可降低死亡率，因此应强烈推荐。由于消除了我们之前单中心试验的局限性，结果令人信服。
