R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, School of Medicine, 6th Floor, Suite 300, 110 S. Paca St, Baltimore, MD 21201, United States.
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, School of Medicine, 6th Floor, Suite 300, 110 S. Paca St, Baltimore, MD 21201, United States.
Injury. 2020 Mar;51(3):699-704. doi: 10.1016/j.injury.2020.01.030. Epub 2020 Jan 23.
In polytrauma patients with unstable pelvic ring injuries, pelvic binders interfere with femoral arterial access and are frequently removed for emergent endovascular and abdominal procedures. The 'trochanteric C-clamp' (T-clamp) is a novel technique described for rapid stabilization of the pelvis without fluoroscopic imaging, while ensuring adequate access to the groin. This case series reports the feasibility and safety following T-clamp application for unstable pelvic ring injuries in patients requiring simultaneous endovascular intervention. Between May 2018 - May 2019, seventeen patients with unstable pelvic ring injuries were treated with a T-clamp in conjunction with other emergent endovascular or intra-abdominal procedures. Nine presented with unstable APC injuries, seven with unstable LC injuries and one with a vertical shear pattern. Complications related to the T-clamp were prospectively collected. Following T-clamp application, there were two cases of intraoperative over-reduction, one of which required exchange for an anterior external fixator. This was the result of a concomitant acetabulum fracture leading to iatrogenic acetabular protrusion secondary to the T-clamp. Twelve cases maintained the T-clamp fixation postoperatively ranging from 1-3 days. One postoperative loss of reduction was noted and required exchange for anterior external fixator. In hemodynamically unstable patients who require emergent endovascular procedures, such as pelvic angiography and REBOA, T-clamp application offers a reasonably safe and effective method for expeditious stabilization of the pelvis while allowing unimpeded access to the abdomen, groin and pelvis. Caution should also be applied in patients with concomitant acetabulum fracture for risk of malreduction. Additionally, its prolonged postoperative use should be limited to patients who are not immediately suitable for fixation of the pelvis.
在不稳定骨盆环损伤的多发创伤患者中，骨盆固定带会干扰股动脉入路，并且经常在紧急血管内和腹部手术中被移除。“转子 C 形夹”（T 形夹）是一种新的技术，用于在不进行荧光透视成像的情况下快速稳定骨盆，同时确保腹股沟有足够的进入通道。本病例系列报告了在需要同时进行血管内干预的不稳定骨盆环损伤患者中，应用 T 形夹的可行性和安全性。在 2018 年 5 月至 2019 年 5 月期间，17 例不稳定骨盆环损伤患者采用 T 形夹治疗，同时进行其他紧急血管内或腹腔内手术。9 例为 APC 不稳定损伤，7 例为 LC 不稳定损伤，1 例为垂直剪力模式。前瞻性收集与 T 形夹相关的并发症。应用 T 形夹后，有 2 例术中过度复位，其中 1 例需要更换前路外固定器。这是由于髋臼骨折导致医源性髋臼突出，继发于 T 形夹。12 例术后 T 形夹固定 1-3 天。1 例术后复位丢失，需要更换前路外固定器。对于需要紧急血管内手术（如骨盆血管造影和 REBOA）的血流动力学不稳定患者，T 形夹应用为快速稳定骨盆提供了一种合理安全且有效的方法，同时允许不受阻碍地进入腹部、腹股沟和骨盆。对于合并髋臼骨折的患者，也应谨慎使用，以防复位不良。此外，应将其术后长期使用限制在不适合立即固定骨盆的患者。
