Aoki Makoto, Matsushima Kazuhide, Matsumoto Shokei
Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
Division of Acute Care Surgery, Department of Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA.
Am J Surg. 2023 Feb;225(2):408-413. doi: 10.1016/j.amjsurg.2022.09.003. Epub 2022 Sep 8.
Whether AE or PPP would be associated with survival among hemodynamically unstable pelvic fracture remains controversial.
This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database from 2016 to 2018. Patients >16 years with a severe pelvic fracture (abbreviated injury scale 3-5) who underwent AE or PPP were recruited. The primary outcome was in-hospital survival. Data were evaluated using a propensity-score matching (PSM) analysis.
A total of 1123 patients met our inclusion criteria. Of these, AE and PPP were performed in 964 (85.8%) and 159 (14.2%) patients, respectively. Concomitant hemorrhage control laparotomy was performed in 25.6% and 82.4% of AE and PPP patients, respectively. In 220 PSM patients, the mortality rate between AE and PPP groups was not significantly different (30.9% vs. 38.2%, P = 0.321).
Though patients' characteristics differed between AE and PPP groups, comparable propensity-matched patients with severe pelvic fractures showed no significant difference in in-hospital survival. PPP was more likely to be selected for severe pelvic fractures necessitating laparotomy.
在血流动力学不稳定的骨盆骨折患者中，急性栓塞（AE）或盆腔血管造影栓塞术（PPP）是否与生存相关仍存在争议。
这是一项回顾性队列研究，使用了美国外科医师学会创伤质量改进计划数据库2016年至2018年的数据。招募了年龄大于16岁、患有严重骨盆骨折（简明损伤分级3 - 5级）且接受了AE或PPP的患者。主要结局是院内生存率。数据采用倾向评分匹配（PSM）分析进行评估。
共有1123例患者符合我们的纳入标准。其中，分别有964例（85.8%）和159例（14.2%）患者接受了AE和PPP。AE组和PPP组分别有25.6%和82.4%的患者同时进行了出血控制剖腹手术。在220例PSM患者中，AE组和PPP组之间的死亡率无显著差异（30.9%对38.2%，P = 0.321）。
尽管AE组和PPP组患者的特征有所不同，但倾向评分匹配的严重骨盆骨折患者在院内生存率方面无显著差异。对于需要剖腹手术的严重骨盆骨折患者，PPP更有可能被选用。
