Benders Kim E M, Leenen Luke P H
Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Front Surg. 2020 Dec 4;7:601321. doi: 10.3389/fsurg.2020.601321. eCollection 2020.
Hemodynamically unstable pelvic fractures are challenging high-energy traumas. In many cases, these severely injured patients have additional traumatic injuries that also require a trauma surgeon's attention. However, these patients are often in extremis and require a multidisciplinary approach that needs to be set up in minutes. This calls for an evidence-based treatment algorithm. We think that the treatment of hemodynamically unstable pelvic fractures should primarily involve thorough resuscitation, mechanical stabilization, and preperitoneal pelvic packing. Angioembolization should be considered in patients that remain hemodynamically unstable. However, it should be used as an adjunct, rather than a primary means to achieve hemodynamic stability as most of the exsanguinating bleeding sources in pelvic trauma are of venous origin. Time is of the essence in these patients and should therefore be used appropriately. Hence, the hemodynamic status and physiology should be the driving force behind each decision-making step within the algorithm.
血流动力学不稳定的骨盆骨折是具有挑战性的高能创伤。在许多情况下，这些严重受伤的患者还伴有其他创伤，也需要创伤外科医生的关注。然而，这些患者往往情况危急，需要在几分钟内建立多学科治疗方案。这就需要一个基于证据的治疗算法。我们认为，血流动力学不稳定骨盆骨折的治疗应主要包括彻底复苏、机械稳定和腹膜前骨盆填塞。对于血流动力学仍不稳定的患者，应考虑血管栓塞治疗。然而，它应作为辅助手段，而不是实现血流动力学稳定的主要方法，因为骨盆创伤中大多数出血致死的来源是静脉性的。对这些患者来说，时间至关重要，因此应合理利用时间。因此，血流动力学状态和生理状况应是该算法中每个决策步骤的驱动力。
