Fokin Alexander A, Wycech Knight Joanna, Tharp Madison E, Brinton Kyler C, Gallagher Phoebe K, Xie Justin Fengyuan, Weisz Russell D, Puente Ivan
Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States.
Charles E Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, FL 33431, United States.
World J Orthop. 2024 May 18;15(5):418-434. doi: 10.5312/wjo.v15.i5.418.
Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones. Presence of contrast blush (CB) on computed tomography in patients with PF is considered a sign of active bleeding, however, its clinical significance and association with outcomes is debatable.
To analyze polytrauma patients with PF with a focus on the geriatric population, co-injuries and the value of contrast blush.
This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center (01/2017-01/2023). Analyzed variables included: Age, sex, mechanism of injury (MOI), injury severity score (ISS), Glasgow coma scale (GCS), abbreviated injury scale (AIS), co-injuries, transfusion requirements, pelvic angiography, embolization laparotomy, orthopedic pelvic surgery, intensive care unit and hospital lengths of stay, discharge disposition and mortality. The study compared geriatric and non-geriatric patients, patients with and without CB and abdominal co-injuries. Propensity score matching was implemented in comparison groups.
PF comprised 4% of all trauma admissions. 89 patients had CB. 286 (52%) patients had concomitant injuries including 93 (17%) patients with abdominal co-injuries. Geriatric patients compared to non-geriatric had more falls as MOI, lower ISS and AIS pelvis, higher GCS, less abdominal co-injuries, similar CB and angio-embolization rates less orthopedic pelvic surgeries, shorter lengths of stay and higher mortality. After propensity matching orthopedic pelvic surgery rates remained lower (8% 19%, < 0.001) hospital length of stay shorter, and mortality higher (13% 4%, < 0.001) in geriatric patients. Out of 89 patients with CB, 45 (51%) were embolized. After propensity matching patients with CB compared to without CB had more pelvic angiography (71% 12%, < 0.001), higher embolization rates (64% 22%, = 0.02) and comparable mortality.
Half of the patients with PF had concomitant co-injuries, including abdominal co-injuries in 17%. Similarly injured geriatric patients had higher mortality. Half of the patients with CB required an embolization.
由于高能创伤的增加，伴有合并伤的骨盆骨折（PF）呈上升趋势。老年人口增加以及与年龄相关的合并症使治疗更加复杂。由于腹部器官与骨盆骨相邻，腹部器官损伤与PF相关。PF患者计算机断层扫描上出现造影剂外渗（CB）被认为是活动性出血的迹象，然而，其临床意义以及与预后的关联存在争议。
分析多发伤的PF患者，重点关注老年人群、合并伤以及造影剂外渗的价值。
这项回顾性队列研究纳入了558例入住一级创伤中心的PF患者（2017年1月至2023年1月）。分析的变量包括：年龄、性别、损伤机制（MOI）、损伤严重程度评分（ISS）、格拉斯哥昏迷量表（GCS）、简明损伤量表（AIS）、合并伤、输血需求、骨盆血管造影、栓塞、剖腹手术、骨科骨盆手术、重症监护病房和住院时间、出院处置和死亡率。该研究比较了老年和非老年患者、有和无CB以及腹部合并伤的患者。在比较组中实施倾向评分匹配。
PF占所有创伤入院患者的4%。89例患者有CB。286例（52%）患者有合并伤，其中93例（17%）患者有腹部合并伤。与非老年患者相比，老年患者的MOI更多为跌倒，骨盆的ISS和AIS更低，GCS更高，腹部合并伤更少，CB和血管栓塞率相似，骨科骨盆手术更少，住院时间更短，死亡率更高。倾向匹配后，老年患者的骨科骨盆手术率仍然较低（8%对19%，<0.001），住院时间更短，死亡率更高（13%对4%，<0.001）。在89例有CB的患者中，45例（51%）接受了栓塞。倾向匹配后，有CB的患者与无CB的患者相比，骨盆血管造影更多（71%对12%，<0.001），栓塞率更高（64%对22%，=0.02），死亡率相当。
一半的PF患者有合并伤，其中17%有腹部合并伤。同样受伤的老年患者死亡率更高。一半有CB的患者需要栓塞。
