Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, 8 Xishiku Street, Beijing, 100034, China.
Department of Orthopedic, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong, China.
J Orthop Traumatol. 2022 Jul 7;23(1):29. doi: 10.1186/s10195-022-00647-6.
To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability.
Three databases-PubMed, Embase and the Cochrane Library-were systematically searched to identify studies presenting comparisons between a protocol including PP and a protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) and standard mean difference (SMD), along with their confidence intervals (CIs), were used as the pooled statistical indices.
Eight studies involving 480 patients were identified as being eligible for meta-analysis. PP usage was associated with significantly reduced overall mortality (RR = 0.61, 95% CI = 0.47-0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.26-0.69, p < 0.01) and due to hemorrhage (RR = 0.26, 95% CI = 0.14-0.50, p < 0.01). The usage of PP also decreased the need for pre-operative transfusion (SMD = - 0.44, 95% CI = - 0.69 to - 0.18, p < 0.01), but had no influence on total transfusion during the first 24 h after admission (SMD = 0.05, 95% CI = - 0.43-0.54, p = 0.83) and length of hospitalization (ICU stay and total stay).
This meta-analysis indicates that a treatment protocol including PP could reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability vs. angiography and embolization. This latter technique could be used as a feasible and complementary technique afterwards.
评估骨盆填塞（PP）在血流动力学不稳定骨盆骨折患者中的疗效。
系统检索了 PubMed、Embase 和 Cochrane 图书馆三个数据库，以确定比较包含 PP 方案和不包含 PP 方案的研究。提取并汇总死亡率、输血需求和住院时间进行荟萃分析。使用相对风险（RR）和标准均数差（SMD）及其置信区间（CI）作为汇总统计指标。
确定了 8 项涉及 480 名患者的研究符合荟萃分析的条件。PP 的使用与总体死亡率显著降低相关（RR=0.61，95%CI=0.47-0.79，p<0.01），以及入院后 24 小时内死亡率降低（RR=0.42，95%CI=0.26-0.69，p<0.01）和因出血导致的死亡率降低（RR=0.26，95%CI=0.14-0.50，p<0.01）。PP 的使用还降低了术前输血的需求（SMD=-0.44，95%CI=-0.69 至-0.18，p<0.01），但对入院后 24 小时内的总输血量没有影响（SMD=0.05，95%CI=-0.43 至 0.54，p=0.83）和住院时间（ICU 住院时间和总住院时间）。
这项荟萃分析表明，与血管造影和栓塞相比，包含 PP 的治疗方案可降低血流动力学不稳定骨盆骨折患者干预前的死亡率和输血需求。后者可以作为一种可行的补充技术。
