背景:开放性骨盆骨折通常会危及生命,无法控制的出血。尽管已经建立了骨盆损伤相关出血的管理方法,开放性骨盆骨折的早期死亡率仍然很高.本研究旨在确定开放性骨盆骨折的死亡率预测因素和有效的治疗方法。
方法:我们将开放性骨盆骨折定义为开放性伤口直接连接到邻近软组织的骨盆骨折,生殖器,会阴,或肛门直肠结构,造成软组织损伤.这项研究是针对2011年至2021年在单个创伤中心因钝器受伤的创伤患者(年龄≥15岁)进行的。我们收集并分析了伤害严重度评分(ISS)的数据,修订创伤评分(RTS),创伤和损伤严重程度评分(TRISS),住院时间,重症监护病房住院时间,输血,腹膜前盆腔填塞(PPP),复苏血管内球囊阻断主动脉(REBOA),治疗性血管栓塞,剖腹手术,粪便改道,和死亡率。
结果:纳入47例钝性开放性骨盆骨折患者。中位年龄为45岁(四分位距,27-57岁),ISS中位数为34(24-43)。最常见的治疗方法是剖腹手术(53%)和骨盆粘合剂(53%),其次是粪便改道(40%)和PPP(38%)。PPP是存活组以更高比率进行出血控制的唯一方法(41%vs.30%)。在一个接受PPP的病例中存在出血性死亡率。总死亡率为21%。在单变量逻辑回归分析中,初始收缩压(SBP),TRISS,RTS,第一个24小时的红细胞输注,和碱基过量表现出统计学意义(p<0.05)。在多元逻辑回归模型中,初始SBP被确定为死亡的独立危险因素(比值比,0.943;95%置信区间,0.907-0.980;p=0.003)。
结论:较低的初始SPB可能是开放性骨盆骨折患者死亡率的独立预测因子。我们的研究结果表明,PPP可能是一种可行的方法来降低开放性骨盆骨折的出血性死亡率。尤其是初始SBP低的血流动力学不稳定患者。需要进一步的研究来验证这些临床发现。
BACKGROUND: Open pelvic fractures are commonly associated with life-threatening, uncontrollable haemorrhages. Although management methods for pelvic injury-associated haemorrhage have been established, the early mortality rate associated with open pelvic fractures remains high. This study aimed to identify predictors of mortality and effective treatment methods for open pelvic fractures.
METHODS: We defined open pelvic fractures as pelvic fractures with an open wound directly connected to the adjacent soft tissue, genitals, perineum, or anorectal structures, resulting in soft tissue injuries. This study was performed on trauma patients (age ≥15 years) injured by a blunt mechanism between 2011 and 2021 at a single trauma centre. We collected and analysed the data on the Injury Severity Score (ISS), the Revised Trauma Score (RTS), the Trauma and Injury Severity Score (TRISS), length of hospital stay, length of intensive care unit stay, transfusion, preperitoneal pelvic packing (PPP), resuscitative endovascular balloon occlusion of the aorta (REBOA), therapeutic angio-embolisation, laparotomy, faecal diversion, and mortality.
RESULTS: Forty-seven patients with blunt open pelvic fractures were included. The median age was 45 years (interquartile range, 27-57 years) and median ISS was 34 (24-43). The most frequently performed treatment methods were laparotomy (53%) and pelvic binder (53%), followed by faecal diversion (40%) and PPP (38%). PPP was the only method performed at a higher rate in the survival group for haemorrhagic control (41% vs. 30%). Haemorrhagic mortality was present in one case that received PPP. The overall mortality was 21%. In the univariate logistic regression analysis, initial systolic blood pressure (SBP), TRISS, RTS, packed red blood cell transfusion for the first 24 h, and base excess showed statistical significance (p<0.05). In the multivariate logistic regression model, initial SBP was identified as an independent risk factor for mortality (odds ratio, 0.943; 95% confidence interval, 0.907-0.980; p = 0.003).
CONCLUSIONS: A low initial SPB may be an independent predictor of mortality in patients with open pelvic fractures. Our findings suggest that PPP might be a feasible method to decrease haemorrhagic mortality from open pelvic fractures, especially for haemodynamically unstable patients with low initial SBP. Further studies are required to validate these clinical findings.