Puchwein Paul, Hallmann Barbara, Eibinger Nicolas
Departments of Orthopaedics and Trauma Surgery.
Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Curr Opin Anaesthesiol. 2025 Jun 1;38(3):323-330. doi: 10.1097/ACO.0000000000001478. Epub 2025 Feb 28.
Bleeding complications from pelvic injuries occur after high-energy trauma as well as after low-energy trauma in elderly patients and are the main contributors to mortality. Demographic changes necessitate focussing on both entities and targeted therapies throughout the course of management.
This article reviews the recent evidence and expertise on bleeding management for haemodynamically unstable patients with pelvic fractures with insights from prehospital care to trends in resuscitation and endovascular techniques and revival of older strategies, to challenges of definitive treatment. It also takes a closer look into pelvic fractures of the elderly and their most recent treatment options.
Bleeding management in pelvic trauma begins prehospitally with targeted transportation, infusion of crystalloids and blood products, and a differentiated use of pelvic binders. In the emergency department, care involves rapid evaluation, massive transfusion protocols and computed tomography (CT) angiography. Resuscitative Endovascular Balloon Occlusion of the Aorta can serve as bridging to diagnostics and bleeding control. Bleeding control management includes mechanical stabilization, preperitoneal pelvic packing or angioembolization. In elderly patients, rigid vessels and anticoagulation contribute to bleeding complications. Selective CT angiography is advised for certain injury patterns and haemodynamic instability. Depending on bleeding localization, selective angioembolization is preferred.
骨盆损伤引起的出血并发症既发生于高能创伤后，也见于老年患者的低能创伤后，是导致死亡的主要原因。人口结构变化使得在整个治疗过程中都需要关注这两类情况及针对性治疗。
本文回顾了近期关于血流动力学不稳定的骨盆骨折患者出血管理的证据和专业知识，内容涵盖从院前急救到复苏和血管内技术的趋势以及旧有策略的复兴，再到确定性治疗的挑战。文章还深入探讨了老年患者的骨盆骨折及其最新治疗选择。
骨盆创伤的出血管理始于院前，包括有针对性的转运、晶体液和血液制品的输注以及不同方式使用骨盆固定带。在急诊科，治疗包括快速评估、大量输血方案和计算机断层扫描（CT）血管造影。主动脉内复苏性血管球囊闭塞术可作为诊断和控制出血的过渡措施。出血控制管理包括机械稳定、腹膜前骨盆填塞或血管栓塞。在老年患者中，血管硬化和抗凝会导致出血并发症。对于某些损伤类型和血流动力学不稳定情况，建议进行选择性CT血管造影。根据出血部位，优先选择选择性血管栓塞。
