多发伤合并骨盆损伤患者的血栓栓塞性并发症：识别可能需要个体化预防的危险因素。
Thromboembolic complications among multiple injured patients with pelvic injuries: identifying risk factors for possible patient-tailored prophylaxis.
机构信息
Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Health, Ostmerheimer Str. 200, 51109, Köln, Germany.
出版信息
World J Emerg Surg. 2021 Aug 26;16(1):42. doi: 10.1186/s13017-021-00388-7.
BACKGROUND
Patients with pelvic and/or acetabular fractures are at high risk of developing thromboembolic (TE) complications. In our study we investigate TE complications and the potential negative effects of concomitant pelvic or acetabular injuries in multiple injured patients according to pelvic/acetabular injury severity and fracture classification.
METHODS
The TraumaRegister DGU® was analyzed between 2010 and 2019. Multiple injured patients with pelvic and/or acetabular fractures with ISS ≥ 16 suffering from TE complications were identified. We conducted a univariate and multivariate analysis with TE events as independent variable to examine potential risk factors and contributing factors.
RESULTS
10.634 patients met our inclusion criteria. The overall TE incidence was 4.9%. Independent risk factors for the development of TE complications were sepsis, ≥ 10 operative interventions, mass transfusion (≥ 10 PRBCs), age ≥ 65 years and AIS ≥ 3 (all p < 0.001). No correlation was found for overall injury severity (ISS), moderate traumatic brain injury, additional injury to lower extremities, type B and C pelvic fracture according to Tile/AO/OTA and closed or open acetabular fracture.
CONCLUSIONS
Multiple injured patients suffering from pelvic and/or acetabular fractures are at high risk of developing thromboembolic complications. Independent risk factors for the development of thromboembolic events in our study cohort were age ≥ 65 years, mass transfusion, AIS ≥ 3, sepsis and ≥ 10 surgery procedures. Among multiple injured patients with acetabular or pelvic injuries the severity of these injuries seems to have no further impact on thromboembolic risk. Our study, however, highlights the major impact of early hemorrhage and septic complications on thromboembolic risk in severely injured trauma patients. This may lead to individualized screening examinations and a patient-tailored thromboprophylaxis in high-risk patients for TE. Furthermore, the number of surgical interventions should be minimized in these patients to reduce thromboembolic risk.
背景
骨盆和/或髋臼骨折患者发生血栓栓塞（TE）并发症的风险较高。在我们的研究中，我们根据骨盆/髋臼损伤严重程度和骨折分类，研究了多发伤患者中同时存在骨盆或髋臼损伤的 TE 并发症及潜在的负面影响。
方法
2010 年至 2019 年，分析了创伤登记处 DGU®的数据。确定了 ISS≥16 且患有 TE 并发症的骨盆和/或髋臼骨折的多发伤患者。我们进行了单变量和多变量分析，以 TE 事件为自变量，检查潜在的危险因素和促成因素。
结果
10634 名患者符合纳入标准。TE 总发生率为 4.9%。TE 并发症发生的独立危险因素为脓毒症、≥10 次手术干预、大量输血（≥10 单位红细胞）、年龄≥65 岁和 AIS≥3（均 p<0.001）。总体损伤严重程度（ISS）、中度创伤性脑损伤、下肢附加损伤、根据Tile/AO/OTA 分类的 B 型和 C 型骨盆骨折以及闭合或开放性髋臼骨折与 TE 无相关性。
结论
患有骨盆和/或髋臼骨折的多发伤患者发生血栓栓塞并发症的风险较高。在我们的研究队列中，发生血栓栓塞事件的独立危险因素为年龄≥65 岁、大量输血、AIS≥3、脓毒症和≥10 次手术。在髋臼或骨盆损伤的多发伤患者中，这些损伤的严重程度似乎对血栓栓塞风险没有进一步影响。然而，我们的研究强调了早期出血和脓毒症并发症对严重创伤患者血栓栓塞风险的重大影响。这可能导致对 TE 高危患者进行个体化筛查检查和个体化的血栓预防。此外，应尽量减少这些患者的手术干预次数，以降低血栓栓塞风险。
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