From the Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL.
J Am Acad Orthop Surg. 2022 Sep 15;30(18):888-895. doi: 10.5435/JAAOS-D-21-01018. Epub 2022 May 24.
Traumatic hemipelvectomy (THP) is a catastrophic injury associated with high-energy trauma and high mortality. THP has been defined as a complete dislocation of the hemipelvis, often with disruption through the symphysis pubis and sacroiliac joint with concurrent traumatic rupture of the iliac vessels. Despite recent advances in prehospital resuscitative techniques, the true incidence of THP is difficult to ascertain because many patients die before hospital arrival. The leading causes of death associated with THP include blood loss, infection, and multiple system organ failure. Recognition and immediate intervention for these injuries is imperative for survival. The initial assessment includes a thorough physical examination assessing for signs of arterial damage and other associated injuries. Hemorrhage control and vigorous resuscitation should be prioritized to combat impending exsanguination. Emergent amputation has been found to be a lifesaving operation in these patients. The basis of this approach is rooted in achieving complete hemostasis while reducing complication rates. Understanding the nature of these massive pelvic injuries, the role of early amputation, and the importance of subspecialty communication can improve survivability and optimize patient outcomes.
创伤性半骨盆切除术（THP）是一种与高能创伤和高死亡率相关的灾难性损伤。THP 被定义为髋关节完全脱位，常伴有耻骨联合和骶髂关节的破裂，同时伴有髂血管的创伤性破裂。尽管最近在院前复苏技术方面取得了进展，但由于许多患者在到达医院之前就已经死亡，因此很难确定 THP 的真实发生率。与 THP 相关的主要死亡原因包括失血、感染和多系统器官衰竭。识别和立即干预这些损伤对于生存至关重要。初步评估包括全面的体格检查，评估动脉损伤和其他相关损伤的迹象。应优先控制出血和积极复苏，以防止即将发生的失血。在这些患者中，紧急截肢已被发现是一种救命的手术。这种方法的基础是在实现完全止血的同时降低并发症发生率。了解这些巨大骨盆损伤的性质、早期截肢的作用以及专科沟通的重要性，可以提高生存率并优化患者的结局。
