From the School of Medicine and Public Health (G.L.D., J.B., K.L.K., Z.J.B.), University of Newcastle; and Department of Traumatology (K.L.K., Z.J.B.), John Hunter Hospital, Newcastle, New South Wales, Australia.
J Trauma Acute Care Surg. 2020 Oct;89(4):730-735. doi: 10.1097/TA.0000000000002860.
The timing of definitive surgical stabilization is a controversial topic of pelvic and acetabular fracture (PAF) management. Historically, staged care with delayed definitive fixation was recommended; however, more recently, some centers have shown early definitive fixation to be feasible in most patients. We hypothesized that time to definitive fixation of PAF decreased without adverse outcomes.
A level 1 trauma center's prospective pelvic fracture database was retrospectively analyzed. A total of 341 of the 1,270 consecutive PAF patients had surgery between January 2009 and December 2018. Demographics, polytrauma status, hemodynamic stability, time to definitive operation, length of intensive care unit stay, hospital length of stay, mortality were recorded. Data is presented as mean ± SD, percentages. Statistical significance was determined at p < 0.05.
There were 34 ± 8 per year operatively treated PAF patients during the study period. The demographics (age, 44.1 ± 18 years; 74.5% males) and injury severity (Injury Severity Score, 20; interquartile range, 16-29) did not change. Time to definitive fixation on average was 85 ± 113 hours (range, 0.8-1286 hours). Linear regression analysis demonstrated a decrease in time to definitive fixation considering all patients (β = -0.186, p = 0.003). pelvic ring fractures with polytrauma (β = -1.404, p = 0.03). and hemodynamically unstable patients (β = -1.428, p = 0.037). There was no significant change in mortality, length of stay, or intensive care unit length of stay for the overall cohort or any subgroup.
Time to definitive fixation in PAF has decreased during the last decade, with the largest decrease in time to fixation occurring in the hemodynamically unstable and pelvic fracture with polytrauma cohorts. The timely definitive internal fixation is achievable without increased length of stay.
Therapeutic/care management, level IV.
骨盆和髋臼骨折（PAF）治疗中，确定性手术固定的时机是一个有争议的话题。历史上，推荐分期治疗和延迟确定性固定；然而，最近，一些中心已经表明，大多数患者都可以进行早期确定性固定。我们假设 PAF 的确定性固定时间缩短不会带来不良结果。
回顾性分析了一家 1 级创伤中心的前瞻性骨盆骨折数据库。在 2009 年 1 月至 2018 年 12 月期间，连续 1270 例 PAF 患者中有 341 例接受了手术。记录了患者的人口统计学、多发伤状态、血流动力学稳定性、确定性手术时间、重症监护病房住院时间、住院时间、死亡率等数据。数据以平均值±标准差和百分比表示。p<0.05 表示有统计学意义。
研究期间，每年有 34±8 例 PAF 患者接受手术治疗。患者的人口统计学（年龄，44.1±18 岁；74.5%为男性）和损伤严重程度（损伤严重度评分，20；四分位距，16-29）没有变化。确定性固定的平均时间为 85±113 小时（范围，0.8-1286 小时）。线性回归分析表明，考虑所有患者时，确定性固定时间呈下降趋势（β=-0.186，p=0.003）。合并多发伤的骨盆环骨折（β=-1.404，p=0.03）和血流动力学不稳定的患者（β=-1.428，p=0.037）的确定性固定时间下降更为显著。整体队列或任何亚组的死亡率、住院时间或重症监护病房住院时间均无显著变化。
在过去十年中，PAF 的确定性固定时间有所缩短，血流动力学不稳定和合并多发伤的骨盆骨折患者的固定时间缩短最为显著。在不延长住院时间的情况下，可以实现及时的确定性内固定。
治疗/护理管理，IV 级。
