Buerger P M, Peoples J B, Lemmon G W, McCarthy M C
Department of Surgery, Wright State University, Miami Valley Hospital, Dayton, Ohio.
Am Surg. 1993 Aug;59(8):505-8.
Multiply-injured patients with pelvic fractures are recognized to have an increased risk of deep venous thrombosis. The incidence of pulmonary emboli in patients with this injury has been reported to range from 0.5 to 8.3 per cent in several recent reviews. One hundred ninety-eight patients with pelvic fractures treated at a regional trauma center over a 3-year period were reviewed to evaluate the factors associated with an increased risk of clinically evident pulmonary embolism. The mean age SD was 44 24 years; 51 per cent were male, and mean Injury Severity Score (ISS) was 19 15. Eighteen patients (9%) died. Mortality was significantly correlated with ISS (P < 0.05), male sex, and type and severity of fracture but not with age, mechanism of injury, or operative fixation. Four patients (2.0%) had pulmonary emboli. The occurrence of clinically apparent pulmonary emboli correlated only with ISS (ISS < 15 = 0% vs ISS > 15 = 4%, P < 0.05). During the same time period, there were eight (0.2%) pulmonary emboli in 3337 trauma patients without pelvic fracture. This difference is highly significant (P < 0.0001). Pelvic fracture is indicative of severe injury and denotes a population at higher risk for pulmonary emboli than other trauma patients. Intensive screening and prophylactic measures to prevent deep venous thrombosis and subsequent pulmonary emboli should be intensively directed at this population.
多发伤合并骨盆骨折的患者被认为深静脉血栓形成风险增加。近期多项综述报道，此类损伤患者肺栓塞的发生率在0.5%至8.3%之间。回顾了一家地区创伤中心在3年期间治疗的198例骨盆骨折患者，以评估与临床明显肺栓塞风险增加相关的因素。平均年龄标准差为44±24岁；51%为男性，平均损伤严重程度评分（ISS）为19±15。18例患者（9%）死亡。死亡率与ISS（P<0.05）、男性、骨折类型和严重程度显著相关，但与年龄、损伤机制或手术固定无关。4例患者（2.0%）发生肺栓塞。临床明显肺栓塞的发生仅与ISS相关（ISS<15=0%，而ISS>15=4%，P<0.05）。在同一时期，3337例无骨盆骨折的创伤患者中有8例（0.2%）发生肺栓塞。这种差异具有高度显著性（P<0.0001）。骨盆骨折表明损伤严重，意味着该人群发生肺栓塞的风险高于其他创伤患者。应针对这一人群加强筛查和预防措施，以预防深静脉血栓形成及随后的肺栓塞。
