Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO.
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO.
Injury. 2021 Oct;52(10):2685-2692. doi: 10.1016/j.injury.2020.07.027. Epub 2020 Jul 11.
There exists substantial variability in the management of pelvic ring injuries among pelvic trauma surgeons. The objective of this study was to perform a comprehensive survey on the management of pelvic ring injuries among an international group of pelvic trauma surgeons to determine areas of agreement and disagreement.
A 45-item questionnaire was developed using an online survey platform and distributed to 30 international pelvic trauma surgeons. The survey consisted of general questions on the acute management of pelvic ring injuries and questions regarding 5 cases: Lateral compression (LC) type 1 injury, LC-3, Anterior-posterior compression (APC) type 3 injury, a combined vertical shear (VS) injury through the sacrum, and VS injury through sacroiliac joint. Respondents were shown blinded anteroposterior pelvis radiographs and axial computed tomography (CT) images for each case and asked if the injury needed fixation, the type of fixation, the order of fixation, and postoperative weight-bearing status. The Kappa statistic was calculated to assess agreement between respondents for each question.
Nineteen out of 30 pelvic trauma surgeons completed the survey. Respondents practiced in Brazil (n = 1), Germany (n = 1), India (n = 1), Italy (n = 1) United Kingdom (n = 1), and the United States (n = 14). Of the 45 questions in this survey, 38 (84%) had minimal to no agreement among the respondents. There was moderate agreement, for performing lumbopelvic fixation when indicated, for anterior and posterior fixation of the LC-3 injury, and on forgoing EUA or stress X-rays for the APC-3 injury. There was strong agreement for open reduction and internal fixation of the anterior pelvic ring in the APC-3 injury and the VS injury through the SI joint. In contrast, LC-1 injury and combined VS pelvic ring injury through the sacrum had no areas of moderate to strong agreement.
This study identified specific areas of pelvic ring injury management with minimal to no agreement among pelvic trauma surgeons. Future research should target these areas with a lack of agreement to decrease practice variability and improve patient outcomes.
骨盆创伤外科医生在骨盆环损伤的处理方面存在很大的差异。本研究的目的是对国际骨盆创伤外科医生群体进行骨盆环损伤处理的综合调查，以确定共识和分歧领域。
使用在线调查平台开发了 45 项问卷，并分发给 30 名国际骨盆创伤外科医生。该调查包括骨盆环损伤急性处理的一般问题，以及 5 个病例的问题：侧向压缩（LC）1 型损伤、LC-3、前后压缩（APC）3 型损伤、经骶骨的垂直剪切（VS）联合损伤，以及经骶髂关节的 VS 损伤。为每个病例展示了盲目的前后骨盆 X 射线和轴向 CT 图像，并询问损伤是否需要固定、固定的类型、固定的顺序以及术后负重状态。计算 Kappa 统计量评估每个问题受访者之间的一致性。
30 名骨盆创伤外科医生中有 19 名完成了调查。受访者分别在巴西（n=1）、德国（n=1）、印度（n=1）、意大利（n=1）、英国（n=1）和美国（n=14）执业。在这项调查的 45 个问题中，有 38 个（84%）问题受访者之间几乎没有或没有达成共识。在以下方面存在中度一致性：当需要时进行腰骶固定、LC-3 损伤的前后固定，以及对 APC-3 损伤避免行 EUA 或应力 X 射线检查。对于 APC-3 损伤和经 SI 关节的 VS 损伤的前骨盆环切开复位内固定有强烈的一致性。相比之下，LC-1 损伤和经骶骨的联合 VS 骨盆环损伤没有中度到强烈的一致性。
本研究确定了骨盆环损伤处理方面存在最小到几乎没有共识的特定领域。未来的研究应该针对这些缺乏共识的领域，以减少实践的差异，改善患者的预后。
