From the The Royal British Legion Centre for Blast Injury Studies, Department of Bioengineering (I.A.R., C.E.W., I.G., J.C.C., S.D.M.), Imperial College London, London; and Centre for Defence Radiology (I.G.), HMS Nelson, Portsmouth, United Kingdom.
J Trauma Acute Care Surg. 2020 Jun;88(6):832-838. doi: 10.1097/TA.0000000000002659.
Pelvic trauma has emerged as one of the most severe injuries to be sustained by the victim of a blast insult. The incidence and mortality due to blast-related pelvic trauma is not known, and no data exist to assess the relative risk of clinical or radiological indicators of mortality.
The UK Joint Theater Trauma Registry was interrogated to identify those sustaining blast-mediated pelvic fractures during the conflicts in Iraq and Afghanistan, from 2003 to 2014, with subsequent computed tomography image analysis. Casualties that sustained more severe injuries remote to the pelvis were excluded.
One hundred fifty-nine casualties with a 36% overall mortality rate were identified. Pelvic vascular injury, unstable pelvic fracture patterns, traumatic amputation, and perineal injury were higher in the dismounted fatality group (p < 0.05). All fatalities sustained a pelvic vascular injury. Pelvic vascular injury had the highest relative risk of death for any individual injury and an associated mortality of 56%. Dismounted casualties that sustained unstable pelvic fracture patterns, traumatic amputation, and perineal injury were at three times greater risk (relative risk, 3.00; 95% confidence interval, 1.27-7.09) to have sustained a pelvic vascular injury than those that did not sustain these associated injuries. Opening of the pubic symphysis and at least one sacroiliac joint was significantly associated with pelvic vascular injury (p < 0.001), and the lateral displacement of the sacroiliac joints was identified as a fair predictor of pelvic vascular injury (area under the receiver operating characteristic curve, 0.73).
Dismounted blast casualties with pelvic fracture are at significant risk of a noncompressible pelvic vascular injury. Initial management of these patients should focus upon controlling noncompressible pelvic bleeding. Clinical and radiological predictors of vascular injury and mortality suggest that mitigation strategies aiming to attenuate lateral displacement of the pelvis following blast are likely to result in fewer fatalities and a reduced injury burden.
Prognostic, level III.
骨盆创伤已成为爆炸冲击受害者最严重的损伤之一。由于爆炸相关的骨盆创伤导致的发病率和死亡率尚不清楚，也没有数据评估临床或影像学死亡率指标的相对风险。
通过查询英国联合战区创伤登记处，确定了 2003 年至 2014 年期间在伊拉克和阿富汗冲突中因爆炸导致骨盆骨折的患者，并对其随后的计算机断层扫描图像进行了分析。排除了骨盆以外部位严重损伤的伤员。
共确定了 159 例伤员，总死亡率为 36%。在下车死亡组中，骨盆血管损伤、不稳定骨盆骨折模式、创伤性截肢和会阴损伤的发生率更高（p<0.05）。所有死亡者均发生骨盆血管损伤。骨盆血管损伤是任何单一损伤中死亡的相对风险最高，其相关死亡率为 56%。下车后发生不稳定骨盆骨折模式、创伤性截肢和会阴损伤的伤员发生骨盆血管损伤的风险是未发生这些相关损伤的伤员的三倍（相对风险，3.00；95%置信区间，1.27-7.09）。耻骨联合开放和至少一个骶髂关节与骨盆血管损伤显著相关（p<0.001），并且骶髂关节的侧向移位被确定为骨盆血管损伤的一个公平预测因子（受试者工作特征曲线下面积，0.73）。
骨盆骨折的下车爆炸伤员有发生不可压缩骨盆血管损伤的高风险。这些患者的初始治疗应集中于控制不可压缩性骨盆出血。血管损伤和死亡率的临床和影像学预测指标表明，旨在减轻爆炸后骨盆侧向移位的缓解策略可能会导致更少的死亡和降低损伤负担。
预后，III 级。
