Pohlemann T, Bosch U, Gänsslen A, Tscherne H
Unfallchirurgische Klinik, Medizinischen Hochschule Hannover, Germany.
Clin Orthop Relat Res. 1994 Aug(305):69-80.
Between 1972 and 1993, 1899 patients with fractures of the pelvis were treated at the authors institution. The pelvic ring was fractured in 1479 patients, and 1029 sustained polytrauma. A retrospective study included four parts: (1) Demographic analysis of 1409 patients showed an increase in the severity of pelvic and general trauma during this period. The 17.7% mortality rate was predicted by the Hannover Polytrauma Score and associated extrapelvic blunt trauma. (2) Residual displacement after operative treatment of the pelvis was analyzed in 221 patients. In C type (Tile) fractures residual displacement correlated with external fixation and solely anterior stabilization. (3) Outcome after operative treatment was analyzed in a consecutive series of 58 patients an average of 2.2 years after trauma. Pelvic pain was frequent (Type B 11%, Type C 66%) and correlated with posterior displacement over 5 mm and primary neurological injuries. (4) Mortality after complex pelvic trauma (pelvic fracture with soft tissue injury) decreased from 48.1% to 29.6% during these years. Standardized protocols for primary care and operative procedures of pelvic injuries optimize therapy. Complex pelvic trauma requires early, aggressive surgical management with surgical hemostasis. Further developments in open reduction and internal fixation of the pelvis focus on minimizing additional soft tissue trauma and implants.
1972年至1993年间，作者所在机构共治疗了1899例骨盆骨折患者。其中1479例患者骨盆环骨折，1029例为多发伤。一项回顾性研究包括四个部分：（1）对1409例患者的人口统计学分析显示，在此期间骨盆及全身创伤的严重程度有所增加。汉诺威多发伤评分及相关骨盆外钝性创伤可预测17.7%的死亡率。（2）对221例患者骨盆手术治疗后的残余移位情况进行了分析。在C型（Tile分型）骨折中，残余移位与外固定及单纯前路稳定相关。（3）对连续58例患者创伤后平均2.2年的手术治疗结果进行了分析。骨盆疼痛很常见（B型为11%，C型为66%），且与超过5mm的后移位及原发性神经损伤相关。（4）这些年复杂骨盆创伤（伴有软组织损伤的骨盆骨折）的死亡率从48.1%降至29.6%。骨盆损伤的初级护理和手术操作标准化方案可优化治疗。复杂骨盆创伤需要早期积极的手术治疗以实现手术止血。骨盆切开复位内固定的进一步发展集中在尽量减少额外的软组织创伤和植入物。
