Montgomery K D, Geerts W H, Potter H G, Helfet D L
Department of Orthopaedic Surgery, The Hospital for Special Surgery, New York, NY, USA.
Clin Orthop Relat Res. 1996 Aug(329):68-87. doi: 10.1097/00003086-199608000-00010.
Patients with pelvic trauma are known to be at increased risk for the development of thromboembolic complications. The incidence of deep venous thrombosis in patients with pelvic fractures is 35% to 60%. Proximal deep venous thrombosis, which is most likely to result in pulmonary embolism, occurs in 25% to 35% of these patients, and almost 1/2 of all proximal thrombi will be in the pelvic veins. The incidence of symptomatic pulmonary embolism in the pelvic trauma population is 2% to 10% whereas a greater proportion of patients will have clinically silent pulmonary embolism. Fatal pulmonary embolism occurs in 0.5% to 2% of patients with pelvic trauma. The cornerstone of effective management is prophylaxis and the most commonly used forms include low dose heparin, low molecular weight heparin, mechanical devices, and in some studies, inferior vena caval filters. Based on a critical review of the literature, in algorithm is proposed for the management of thromboprophylaxis in this trauma subgroup. This includes prophylaxis, screening, and treatment when proximal thrombosis is identified. Such a systematic approach to this potentially catastrophic problem may decrease the morbidity and mortality associated with thromboembolic complications in these patients.
已知骨盆创伤患者发生血栓栓塞并发症的风险增加。骨盆骨折患者深静脉血栓形成的发生率为35%至60%。最有可能导致肺栓塞的近端深静脉血栓形成发生在25%至35%的此类患者中，并且所有近端血栓中近一半将位于盆腔静脉。骨盆创伤人群中有症状肺栓塞的发生率为2%至10%，而更大比例的患者会有临床无症状的肺栓塞。致命性肺栓塞发生在0.5%至2%的骨盆创伤患者中。有效管理的基石是预防，最常用的形式包括低剂量肝素、低分子量肝素、机械装置，在一些研究中还包括下腔静脉滤器。基于对文献的批判性综述，提出了一种针对该创伤亚组的血栓预防管理算法。这包括预防、筛查以及在发现近端血栓时进行治疗。这种针对这一潜在灾难性问题的系统方法可能会降低这些患者与血栓栓塞并发症相关的发病率和死亡率。
