Young-Burgess骨盆环损伤分类与需要紧急干预的伴随损伤之间的关联。
Association between Young-Burgess pelvic ring injury classification and concomitant injuries requiring urgent intervention.
作者信息
Coleman Julia R, Moore Ernest E, Vintimilla David Rojas, Parry Joshua, Nelson Jesse T, Samuels Jason M, Sauaia Angela, Cohen Mitchell J, Burlew Clay Cothren, Mauffrey Cyril
机构信息
Department of Surgery, University of Colorado-Denver, Aurora, CO, USA.
Department of Surgery, Department of Orthopaedic Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA.
出版信息
J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1099-1103. doi: 10.1016/j.jcot.2020.08.009. Epub 2020 Aug 25.
BACKGROUND
Young-Burgess classification (YB) is a mechanistic system which classifies pelvic ring injuries into anterior-posterior compression (APC), lateral compression (LC), vertical shear (VS) injuries, and combined mechanism (CM). The objective of this study was to identify associated injuries which require urgent operative intervention by YB classification. We hypothesize that YB classification is associated with 1) need for urgent intervention for pelvic fracture-related hemorrhage and 2) patterns of injury complexes requiring surgery.
METHODS
This is a retrospective study of severely injured trauma patients with pelvic ring injuries who presented to an urban Level-1 trauma center from 2007 to 2017. Associated injuries and procedures were determined by Abbreviated Injury Scale (AIS) and ICD-9/10 codes. YB classes were compared, followed by a cluster analysis to identify injury patterns and association with YB classifications.
RESULTS
Overall, 135 patients were included. 98 (72%) of patients presented with LC, 16 (12%) with APC, 8 (6%) with VS, and 13 (10%) with CM. VS and APC groups had higher rates of REBOA use compared to LC and CM groups (38% and 31% versus 11% and 0%, respectively, p = 0.01). The CM group, compared to LC, APC, and VS, had higher rates of urgent operative intervention for bleeding control (69% versus 32%, 50% and 43%, respectively, p = 0.01). 39 (29%) patients had a concomitant injury which was identified by CT scan in initial trauma work up and altered management, 46% which merited urgent intervention. On cluster analysis, there were no distinct injury complexes which required urgent operative intervention by YB class.
CONCLUSIONS
These data failed to identify unique injury complexes which merit urgent operative intervention by YB class. Nearly one in four patients had injuries identified by initial CT imaging which altered initial management, demonstrating the importance of early, full body CT imaging in severely injured patients with pelvic ring injuries.
背景
Young-Burgess分类法（YB）是一种将骨盆环损伤分为前后挤压型（APC）、侧方挤压型（LC）、垂直剪切型（VS）损伤以及复合机制型（CM）的机制性分类系统。本研究的目的是通过YB分类法确定需要紧急手术干预的相关损伤。我们假设YB分类法与以下两点相关：1）因骨盆骨折相关出血而需要紧急干预；2）需要手术的损伤复合体模式。
方法
这是一项对2007年至2017年在一家城市一级创伤中心就诊的骨盆环严重受伤创伤患者的回顾性研究。相关损伤和手术通过简明损伤定级标准（AIS）和ICD-9/10编码确定。对YB分类进行比较，随后进行聚类分析以确定损伤模式以及与YB分类的关联。
结果
总共纳入了135例患者。98例（72%）患者为LC型，16例（12%）为APC型，8例（6%）为VS型，13例（10%）为CM型。与LC型和CM型组相比，VS型和APC型组使用血管内球囊阻断术（REBOA）的比例更高（分别为38%和31%，而LC型和CM型组分别为11%和0%，p = 0.01）。与LC型、APC型和VS型相比，CM型组因控制出血而进行紧急手术干预的比例更高（分别为69%、32%、50%和43%，p = 0.01）。39例（29%）患者有在初次创伤检查时通过CT扫描发现的伴随损伤并改变了治疗方案，其中46%的损伤需要紧急干预。在聚类分析中，没有因YB分类而需要紧急手术干预的独特损伤复合体。
结论
这些数据未能确定因YB分类而值得紧急手术干预的独特损伤复合体。近四分之一的患者通过初次CT成像发现有损伤，这些损伤改变了初始治疗方案，这表明早期全身CT成像在骨盆环严重受伤患者中的重要性。
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