Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA.
Am J Surg. 2022 Jul;224(1 Pt B):489-493. doi: 10.1016/j.amjsurg.2022.01.009. Epub 2022 Jan 31.
The primary aim of this study was to evaluate the role of the initial pelvic X-ray in identifying significant pelvic fractures, which could result in changes in the management of the patient.
Patients admitted to a level I trauma center (2010-2019) with a severe blunt pelvic fracture (AIS ≥3) were identified. Included in the analysis were patients who underwent emergency department pelvic X-ray followed by CT scan. A control group of patients without pelvic fractures was also included in the study. All investigations were reviewed by a blinded attending trauma radiologist. Pelvic X-ray findings and CT scan reports were compared according to the specific pelvic fracture location, and severity.
Overall, pelvic X-ray was diagnosed 252 of the 285 pelvic fractures (sensitivity 88.4%) and wrongly diagnosed a facture in 3 of 97 patients without a fracture (specificity 96.9%). In 29/184 (15.8%) of patients with pelvic fracture AIS 3, the pelvic X-ray was read as normal, missing the fracture, compared with 4/101 (4.0%) in the AIS 4/5 group (p = 0.003). Pelvic X-ray had the lowest sensitivity in ischial (10.7%), iliac (28.7%), acetabular (42.4%), and sacral fractures (49.1%) and was best for detecting symphysis diastasis (89.8%).
Pelvic X-ray is useful in identifying pubic symphysis diastasis. However, it misses or underestimates a significant number of fractures. CT scan evaluation should be performed in patients with a suspicious mechanism or clinical suspicion of pelvic fracture.
本研究的主要目的是评估初始骨盆 X 射线在识别可能导致患者治疗方式改变的显著骨盆骨折中的作用。
确定 2010 年至 2019 年期间因严重钝性骨盆骨折（AIS≥3）入住一级创伤中心的患者。分析包括接受急诊室骨盆 X 射线检查后进行 CT 扫描的患者。还纳入了无骨盆骨折的对照组患者。所有检查均由一位盲法创伤放射科医生进行审查。根据特定骨盆骨折部位和严重程度比较骨盆 X 射线检查结果和 CT 扫描报告。
总体而言，骨盆 X 射线诊断出 285 例骨盆骨折中的 252 例（敏感性 88.4%），在 97 例无骨折患者中误诊断 3 例骨折（特异性 96.9%）。在 29/184（15.8%）骨盆骨折 AIS 3 的患者中，骨盆 X 射线被读为正常，漏诊骨折，而在 AIS 4/5 组的 4/101（4.0%）患者中（p=0.003）。骨盆 X 射线对坐骨（10.7%）、髂骨（28.7%）、髋臼（42.4%）和骶骨骨折（49.1%）的敏感性最低，对耻骨联合分离的敏感性最高（89.8%）。
骨盆 X 射线在识别耻骨联合分离方面是有用的。然而，它会漏诊或低估大量骨折。对于可疑机制或临床怀疑骨盆骨折的患者，应进行 CT 扫描评估。
