Riemer B L, Butterfield S L, Diamond D L, Young J C, Raves J J, Cottington E, Kislan K
Department of Orthopaedic Surgery, Allegheny General Hospital, Medical College of Pennsylvania, Pittsburgh.
J Trauma. 1993 Nov;35(5):671-5; discussion 676-7. doi: 10.1097/00005373-199311000-00003.
To analyze the effect on mortality of a protocol for early mobilization with external fixation of patients with pelvic ring injuries.
From 1981 through 1988, 605 patients with pelvic ring fractures and dislocations were treated. In 1982, a protocol for early external fixation of hemodynamically unstable patients and those with structurally unstable pelvic fracture patterns to achieve early mobilization to an upright chest position was initiated. Mortality rates were compared between 1981 (pre-protocol), 1982 (transitional), and 1983 through 1988, after initiation of a protocol of care that included external fixation of the pelvic injury. No statistical changes occurred from 1983 through 1988.
Mortality rates in pelvic ring injury patients fell from 26% in 1981, to 6% in 1983 through 1988 (p < 0.001), whereas during the study period the mean injury Severity Score (ISS), 23, did not change. The mortality rate of a group of consecutive patients with comparable ISSs, but without pelvic ring injuries did not change. The mortality rate in patients with systolic blood pressure < 100 mm Hg at admission fell from 41% in 1981 to 21% 1983 through 1988 (p = 0.0001). Mortality in patients with closed head injuries associated with pelvic ring injuries fell from 43% in 1981 to 7% from 1983 through 1988 (p = 0.0001). The proportion of patients undergoing external fixation rose from 3% in 1981 to 31% in 1983 through 1988 (p = 0.0001).
An organized protocol including external fixation and early patient mobilization to an upright chest position reduced mortality associated with injuries of the pelvic ring. Orthopedic stabilization of major skeletal injuries should be viewed as part of patient resuscitation, not reconstruction.
分析骨盆环损伤患者早期外固定并早期活动方案对死亡率的影响。
1981年至1988年期间，共治疗了605例骨盆环骨折和脱位患者。1982年，启动了一项方案，对血流动力学不稳定的患者以及骨盆骨折结构不稳定的患者进行早期外固定，以实现早期活动至直立胸部位置。比较了1981年（方案实施前）、1982年（过渡阶段）以及1983年至1988年（实施包括骨盆损伤外固定的护理方案后）的死亡率。1983年至1988年期间未发生统计学变化。
骨盆环损伤患者的死亡率从1981年的26%降至1983年至1988年的6%（p < 0.001），而在研究期间，平均损伤严重程度评分（ISS）为23，未发生变化。一组具有可比ISS但无骨盆环损伤的连续患者的死亡率未发生变化。入院时收缩压<100 mmHg的患者死亡率从1981年的41%降至1983年至1988年的21%（p = 0.0001）。与骨盆环损伤相关的闭合性颅脑损伤患者的死亡率从1981年的43%降至1983年至1988年的7%（p = 0.0001）。接受外固定的患者比例从1981年的3%升至1983年至1988年的31%（p = 0.0001）。
包括外固定和早期患者活动至直立胸部位置的有组织方案降低了与骨盆环损伤相关的死亡率。主要骨骼损伤的骨科稳定应被视为患者复苏的一部分，而非重建。
