Metzger Felix, Höch A, Herath S C, Buschbeck S, Huber S F, Schweigkofler U
Department of Trauma Surgery and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstrasse 430, 60389, Frankfurt am Main, Germany.
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany.
Eur J Trauma Emerg Surg. 2025 Apr 3;51(1):159. doi: 10.1007/s00068-025-02836-4.
BACKGROUND/PURPOSE: Partially unstable- and unstable pelvic ring injuries (PRI) can result in massive hemorrhage. Early detection and appropriate management are of utmost importance. This retrospective study, utilizing data from the German Pelvis Registry (GPR), evaluates bleeding complications (BC), the effect of pelvic circumferential compression devices (PCCDs) on transfusion requirements and outcomes, and the role of acute measures such as pelvic clamps, external fixators, pelvic tamponade and embolization.
Inclusion criteria: Adults (≥ 17 and ≤ 64 years) with partially unstable or unstable PRI (Tile type B and C), with (BC) or without bleeding complications (nBC) recorded in the GPR between July 2018 and February 2023. BC was defined as significant pelvis-related bleeding requiring blood transfusions and/or resulting in systolic blood pressure < 100 mmHg. Bleeding complications were identified by transfusions within 3 h of admission, the occurrence of bleeding during the hospital stay, or pre-hospital/ER systolic blood pressure < 100 mmHg.
Patients ≤ 17 or ≥ 64 years, Tile type A-, acetabular-, combined pelvic-acetabular injuries, and inter-hospital transfers.
Of 477 cases, 335 (70.2%) met inclusion criteria, with 133 (39.7%) having bleeding complications (BC) and 202 (60.3%) without (nBC). BC occurred more frequently in patients with Tile types B2-C3 injuries, who also had more concomitant injuries, higher ISS, NISS, and RISC II scores. These patients required more blood transfusions during admission and surgery, had longer ICU and hospital stays, and had worse outcomes with higher mortality rates (21.1%). Most patients with bleeding complications (BC) were stabilized with a PCCD (85%). Those with a PCCD had higher ISS but did not require more blood transfusions compared to patients without a PCCD. There were no differences in ICU or hospital stay duration, though outcomes were worse; however, mortality (23%) was not significantly higher. Pelvic tamponade was performed in 3.8% of cases, and embolization in 0.8%, both deemed 100% effective. Stabilization was done in 57.6% of cases, with pelvic clamps applied in 1.5% in the ER and 6.8% in the OR. External fixators were used in 48.9%, percutaneous osteosynthesis in 8.3%, open osteosynthesis in 2.3%, and combined measures in 12.8%. Effectiveness rates were 77.8% for pelvic clamps, 93.8% for external fixators, 100% for percutaneous osteosynthesis, and 66.7% for open osteosynthesis.
Bleeding complications occurred in 39.7%, mostly in Tile B2-C3 injuries, with 85% receiving PCCD stabilization. Mortality and transfusion rates were similar to those without PCCD, indicating that injury severity and surgical care quality were more impactful than PCCD use. External fixators were the most commonly used measure and demonstrated high effectiveness. While less frequent, pelvic tamponade and embolization also proved to be effective.
背景/目的：部分不稳定型和不稳定型骨盆环损伤（PRI）可导致大量出血。早期发现和适当处理至关重要。这项回顾性研究利用德国骨盆登记处（GPR）的数据，评估出血并发症（BC）、骨盆环周压缩装置（PCCD）对输血需求和结局的影响，以及骨盆钳、外固定架、骨盆填塞和栓塞等急救措施的作用。
纳入标准：年龄在17至64岁之间、患有部分不稳定型或不稳定型PRI（Tile B型和C型）、在2018年7月至2023年2月期间GPR记录中有（BC）或无出血并发症（nBC）的成年人。BC定义为需要输血和/或导致收缩压<100 mmHg的与骨盆相关的大量出血。通过入院后3小时内输血、住院期间出血的发生情况或院前/急诊室收缩压<100 mmHg来确定出血并发症。
年龄≤17岁或≥64岁的患者、Tile A型、髋臼、骨盆 - 髋臼联合损伤以及院间转运患者。
477例病例中，335例（70.2%）符合纳入标准，其中133例（39.7%）有出血并发症（BC），202例（60.3%）无出血并发症（nBC）。BC在Tile B2 - C3型损伤患者中更常见，这些患者合并伤更多，ISS、NISS和RISC II评分更高。这些患者在入院和手术期间需要更多输血，ICU和住院时间更长，结局更差，死亡率更高（21.1%）。大多数有出血并发症（BC）的患者通过PCCD得到稳定（85%）。与未使用PCCD的患者相比，使用PCCD的患者ISS更高，但输血需求并不更多。ICU或住院时间无差异，尽管结局更差；然而，死亡率（23%）并未显著更高。3.8%的病例进行了骨盆填塞，0.8%的病例进行了栓塞，两者均被认为100%有效。57.6%的病例实现了稳定，急诊室1.5%的病例和手术室6.8%的病例应用了骨盆钳。48.9%的病例使用了外固定架，8.3%的病例使用了经皮骨固定术，2.3%的病例使用了切开骨固定术，12.8%的病例采用了联合措施。骨盆钳的有效率为77.8%，外固定架为93.8%，经皮骨固定术为100%，切开骨固定术为66.7%。
39.7%的患者发生出血并发症，主要发生在Tile B2 - C3型损伤中，85%的患者通过PCCD实现稳定。死亡率和输血率与未使用PCCD的患者相似，表明损伤严重程度和手术护理质量比PCCD的使用更具影响力。外固定架是最常用的措施，显示出高有效性。虽然骨盆填塞和栓塞使用频率较低，但也被证明是有效的。
