Open Pelvic fracture

开放性骨盆骨折
  • 文章类型: Journal Article
    2017年,世界急诊外科学会(WSES)建立了骨盆损伤的新分类。我们使用全国范围的实际数据验证了其有效性。还评估了相关血管损伤和开放性骨折在该系统中的作用。
    对2015年国家创伤数据库数据集中的骨盆骨折患者进行了回顾性研究。首先,通过WSES分类比较了死亡率.第二,使用多变量逻辑回归模型评估死亡率的独立预测因子.比较有和没有相关血管损伤的患者以及相同的血流动力学和骨盆环稳定性状态。将相关血管损伤的患者与未幸存者和不稳定骨盆环损伤的幸存者的比例进行比较。第三,比较轻度开放性骨盆骨折和闭合性骨盆骨折患者的结局,中度和重度WSES类。
    在12个月的研究期间,包括44,163例钝性骨盆骨折患者。死亡率为1.8%,3.8%,轻度为10.6%,中度和重度WSES课程,分别(p<0.001)。MLR分析显示不稳定骨盆环损伤对死亡率无显著影响(p=0.549),而开放性骨盆骨折和相关血管损伤是死亡率的独立预测因子(死亡率几率:开放性骨盆骨折1.630,p<0.001;相关血管损伤1.602,p<0.001).相关血管损伤患者显示,不稳定骨盆环损伤患者的比例在幸存者和非幸存者之间没有显着差异(37.2%vs.32.7%,p=0.323)。在所有三个班级中,开放性骨盆骨折患者的死亡率和感染率明显高于闭合性骨折患者(死亡率:轻微3.5%vs.1.8%,p=0.009,适中的11.2%与3.3%,p<0.001,严重23.8%vs.9.8%,p<0.001;感染率:轻微3.3%vs.0.7%,p<0.001,适度6.7%与2.1%,p<0.001,严重的7.9%与2.8%,p<0.001)。
    根据这项全国性的研究,WSES指南提供了准确且可重复的骨盆骨折分类.建议将开放性/闭合性骨折和相关血管损伤作为WSES分类的补充进行评估。
    In 2017, a novel classification for pelvic injuries was established by the World Society of Emergency Surgery (WSES). We validated its effectiveness using nationwide real-world data. The roles of associated vascular injury and open fracture in this system were also evaluated.
    Patients with pelvic fractures in the National Trauma Data Bank 2015 dataset were retrospectively studied. First, the mortality rates were compared by WSES classification. Second, independent predictors of mortality were evaluated using a multivariate logistic regression model. Patients with and without associated vascular injuries and the same hemodynamic and pelvic ring stability statuses were compared. Patients with associated vascular injuries were compared to the proportion of nonsurvivors and survivors with unstable pelvic ring injuries. Third, the outcomes were compared between patients with open pelvic fracture and closed pelvic fracture in the mild, moderate and severe WSES classes.
    During the 12-month study period, 44,163 blunt pelvic fracture patients were included. The mortality rates were 1.8%, 3.8% and 10.6% for the mild, moderate and severe WSES classes, respectively (p < 0.001). MLR analysis showed that unstable pelvic ring injury did not significantly affect mortality (p = 0.549), whereas open pelvic fracture and associated vascular injury were independent predictors of mortality (odds of mortality: open pelvic fracture 1.630, p < 0.001; associated vascular injury 1.602, p < 0.001). Patients with associated vascular injuries showed that there was no significant difference in the proportion of patients with unstable pelvic ring injuries between survivors and nonsurvivors (37.2% vs. 32.7%, p = 0.323). In all three classes, patients with open pelvic fractures had significantly higher mortality rates and infection rates than patients with closed fractures (mortality rates: minor 3.5% vs. 1.8%, p = 0.009, moderate 11.2% vs. 3.3%, p < 0.001, severe 23.8% vs. 9.8%, p < 0.001; infection rates: minor 3.3% vs. 0.7%, p < 0.001, moderate 6.7% vs. 2.1%, p < 0.001, severe 7.9% vs. 2.8%, p < 0.001).
    Based on this nationwide study, the WSES guideline provides an accurate and reproducible classification of pelvic fractures. It is recommended that open/closed fractures and associated vascular injuries be evaluated as supplements of the WSES classification.
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  • 文章类型: Journal Article
    本研究旨在探讨其临床特征,当前的管理策略,开放性骨盆骨折患者的预后。
    我们对创伤中心收治的5年(2013年1月至2017年12月)闭合性创伤和开放性骨盆骨折患者的数据进行了回顾性分析。人口统计以及包括损伤机制在内的临床数据,损伤严重程度评分(ISS),骨折分类,输血要求,干预措施,住院和重症监护病房(ICU)住院时间,并对预后进行了调查。使用单因素分析和二元逻辑回归来确定死亡风险变量。最后,我们进行了简短的文献综述,以了解此类损伤目前的治疗能力和预后.
    这项研究纳入了46名患者(36名男性和10名女性)。平均年龄43.2±14.2岁。总死亡率为17.4%;43.5%的患者在到达时出现低血压(收缩压(SBP)<90mmHg)。平均ISS为31.7±6.7,前24小时平均充血红细胞(PRBC)为9.6±7.4单位。5例(10.9%)在治疗的早期接受了经导管动脉栓塞。平均住院时间和ICU住院时间分别为53.0±37.6天和14.3±15.3天,分别。在国际空间站发现了统计学上的显著差异,前24小时收到的PRBC单位,SBP,入院时乳酸和基数过量,死亡组和存活组比较,损伤机制(p<0.05)。发现ISS和入院时的乳酸是死亡的独立危险因素。
    开放性骨盆骨折的死亡率仍然很高。ISS和入院时乳酸是死亡的独立危险因素。优化创伤护理算法以早期识别和治疗这种损伤可能是降低死亡率的关键。
    This study aimed to investigate the clinical features, current management strategies, and outcomes of open pelvic fracture patients.
    We performed a retrospective review of data on patients with blunt trauma and open pelvic fractures admitted to our trauma center over a 5-year period (January 2013 to December 2017). Demographic as well as clinical data including injury mechanism, injury severity score (ISS), fracture classifications, transfusion requirements, interventions, length of hospital and intensive care unit (ICU) stay, and prognosis were investigated. Univariate analysis and binary logistic regression were used to identify the risk variables of death. Finally, a brief literature review was performed to understand the current capacity of treatment and prognosis of this type of injury.
    Forty-six patients (36 male and 10 female) were included in this study, mean age 43.2 ± 14.2 years. The overall mortality rate was 17.4%; 43.5% of the patients were hypotensive (systolic blood pressure (SBP) <90 mmHg) on arrival. The average ISS was 31.7 ± 6.7, and the average packed red blood cell (PRBC) transfusion during the first 24 h was 9.6 ± 7.4 units. Five patients (10.9%) underwent transcatheter arterial embolization in the early stage of management. The average hospital and ICU length of stay were 53.0 ± 37.6 days and 14.3 ± 15.3 days, respectively. Statistically significant differences were found in ISS, PRBC units received with the first 24 h, SBP, lactate and base excess on admission, and mechanism of injury when comparing between the death and the survival groups (p < 0.05). ISS and lactate on admission were found to be the independent risk factors for mortality.
    The mortality rate of open pelvic fractures remains high. ISS and lactate on admission were the independent risk factors for mortality. Optimization of the trauma care algorithms for early identification and treatment of this injury could be the key to decreasing mortality.
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