背景:由于高能量创伤的增加,伴有损伤的骨盆骨折(PF)呈上升趋势。与年龄相关的合并症的老年人口的增加进一步使管理复杂化。由于靠近骨盆骨,腹部器官损伤与PF有关。PF患者在计算机断层扫描中存在对比液(CB)被认为是活动性出血的迹象。然而,其临床意义和与结局的关联尚有争议.
目的:分析多发性创伤伴PF患者,重点是老年人群,共同伤害和对比腮红的价值。
方法:这项回顾性队列研究包括1级创伤中心收治的558例PF患者(2017年01月至2023年01月)。分析变量包括:年龄,性别,损伤机制(MOI),损伤严重程度评分(ISS),格拉斯哥昏迷量表(GCS),缩写伤害量表(AIS),共同受伤,输血要求,盆腔血管造影,栓塞,剖腹手术,骨科骨盆手术,重症监护室和住院时间,出院处置和死亡率。这项研究比较了老年患者和非老年患者,有和没有CB和腹部共同损伤的患者。比较组实施倾向评分匹配。
结果:PF占所有创伤入院的4%。89例患者有CB。286例(52%)患者合并受伤,其中93例(17%)腹部合并受伤。老年患者与非老年患者相比跌倒更多,因为MOI,下ISS和AIS骨盆,更高的GCS,腹部共同受伤较少,相似的CB和血管栓塞率,骨科骨盆手术较少,住院时间较短,死亡率较高。在倾向匹配之后,骨科骨盆手术率仍然较低(8%对19%,P<0.001),住院时间缩短,死亡率更高(13%对4%,老年患者的P<0.001)。在89例CB患者中,45例(51%)栓塞。在倾向匹配之后,与没有CB的患者相比,有CB的患者有更多的盆腔血管造影(71%vs12%,P<0.001),较高的栓塞率(64%vs22%,P=0.02)和相当的死亡率。
结论:一半的PF患者有伴随的共同损伤,包括17%的腹部共同受伤。同样受伤的老年患者死亡率更高。一半的CB患者需要栓塞。
BACKGROUND: Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones. Presence of contrast blush (CB) on computed tomography in patients with PF is considered a sign of active bleeding, however, its clinical significance and association with outcomes is debatable.
OBJECTIVE: To analyze polytrauma patients with PF with a focus on the geriatric population, co-injuries and the value of contrast blush.
METHODS: This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center (01/2017-01/2023). Analyzed variables included: Age, sex, mechanism of injury (MOI), injury severity score (ISS), Glasgow coma scale (GCS), abbreviated injury scale (AIS), co-injuries, transfusion requirements, pelvic angiography, embolization, laparotomy, orthopedic pelvic surgery, intensive care unit and hospital lengths of stay, discharge disposition and mortality. The study compared geriatric and non-geriatric patients, patients with and without CB and abdominal co-injuries. Propensity score matching was implemented in comparison groups.
RESULTS: PF comprised 4% of all trauma admissions. 89 patients had CB. 286 (52%) patients had concomitant injuries including 93 (17%) patients with abdominal co-injuries. Geriatric patients compared to non-geriatric had more falls as MOI, lower ISS and AIS pelvis, higher GCS, less abdominal co-injuries, similar CB and angio-embolization rates, less orthopedic pelvic surgeries, shorter lengths of stay and higher mortality. After propensity matching, orthopedic pelvic surgery rates remained lower (8% vs 19%, P < 0.001), hospital length of stay shorter, and mortality higher (13% vs 4%, P < 0.001) in geriatric patients. Out of 89 patients with CB, 45 (51%) were embolized. After propensity matching, patients with CB compared to without CB had more pelvic angiography (71% vs 12%, P < 0.001), higher embolization rates (64% vs 22%, P = 0.02) and comparable mortality.
CONCLUSIONS: Half of the patients with PF had concomitant co-injuries, including abdominal co-injuries in 17%. Similarly injured geriatric patients had higher mortality. Half of the patients with CB required an embolization.