Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark.
BGU Trauma Center Murnau, Murnau, Germany.
Injury. 2019 Nov;50(11):1959-1965. doi: 10.1016/j.injury.2019.08.039. Epub 2019 Aug 26.
Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate.
The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n = 957 with vs n = 4,542 without). Furthermore, the subgroups with secondary surgery (n = 713 vs n = 1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n = 24 vs n = 219). Calculated odds ratios were adjusted for potential confounders.
Patients treated by CC/EF were younger (45 ± 20 vs 62 ± 24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3 mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p < 0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation.
Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.
不稳定骨盆骨折常需要使用 C 形夹或外部（CC/EF）固定进行紧急稳定。然而，这种干预的效果及其相关并发症仍然存在争议。
该分析使用了德国骨盆创伤登记处的数据，研究了 5499 例患者（957 例使用 CC/EF 与 4542 例未使用）中初次使用 CC/EF 固定后的一般并发症、感染和死亡率。此外，还评估了行二次手术（713 例与 1695 例）和 C 形夹稳定后行髂骶螺钉植入术（24 例与 219 例）的亚组。计算了调整潜在混杂因素后的比值比。
接受 CC/EF 治疗的患者年龄更小（45±20 岁与 62±24 岁），C 型骨折更多（65%与 28%），ISS（≥25 分 63%与 20%）和位移（≥3mm 81%与 41%）更大，骨折更复杂（32%与 5%）。这些特征是并发症的独立危险因素（p<0.001）。虽然 CC/EF 稳定后死亡率降低了 32%（OR 0.68，95%CI 0.49-0.95），但一般并发症的风险略有增加（OR 1.25，95%CI 1.02-1.53）。在接受二次手术的患者中，CC/EF 固定对死亡率、一般并发症或感染无影响。与之前的 C 形夹稳定相关（OR 4.67，95%CI 1.06-20.64），髂骶螺钉固定的感染风险从 3.2%增加到 20.8%。
不稳定骨盆骨折的 C 形夹或外固定初次稳定与死亡率降低相关，且不是二次手术后并发症的独立危险因素。然而，C 形夹使用后，髂骶螺钉固定的感染风险增加近 5 倍。
