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首页> 外文期刊>Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology >A treatment protocol for abdomino-pelvic injuries
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A treatment protocol for abdomino-pelvic injuries

机译：腹部骨盆损伤的治疗方案

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Background Abdomino-pelvic injuries often present a challenge for the emergency department. Although literature reports several protocols on the treatment of abdomino-pelvic injuries aiming at defining the most advisable treatment line, optimal treatment is still controversial. This paper describes a protocol that has been used to treat abdomino-pelvic injuries in our hospital since 2002. Materials and methods In literature different protocol of abdomino-pelvic injuries are described and comparing them most of the difference are the timing of CT scan, the angiography and the laparotomy when treating a lesion of pelvic ring. If patient is haemodynamically instable and presents a lesion of pelvic ring our protocol suggest the simplest and fastest stabilization (pelvic external fixator) in emergency room and delay exam such as CT scan as second level exam. In the presence of an abdominal injury, with a positive focused assessment with sonography for trauma test, the first step should be a pelvic ring stabilization, as laparotomy decreases the abdominal pressure and reduces the tamponade effect on the retroperitoneum. According to presented protocol the angiography is not be a first choice treatment. This protocol was applied to 58 cases of abdomino-pevic injury with unstable pelvic lesions from October 2002 to December 2005. Mean injury severity score was 27.2 (CI 24.1-30.3). Results Five patients (8%) died, three due to haemor-rhagic shock and two due to pulmonary embolization. Four patients (6.9%) had a partial or complete cauda equina syndrome, four patients (6.9%) complained of mild incontinence, whilst 1 (1.7%) complained of urinary retention with multiple cystitis. Two patients (3.4%) with retention and multiple cystitis, had a malunion and a painful non-union of the fracture. Seven patients (12.3%) had neurological impairment: 5 (8.6%) sciatic nerve palsy, 1 (1.7%) lumbosacral root lesions in a C2-type fracture and there was one case (1.7%) of inconstant lumbago with sciatic pain. Twelve patients reported different levels of sexual dysfunction (20.7%). Conclusions Although validation with a larger cohort is required, our preliminary clinical data are similar to, or better than, those reported in the most recent publications on this question, suggesting that this protocol could well reduce both the mortality rate and the long term complications of abdominopelvic injuries.
机译：背景腹部骨盆受伤经常给急诊科带来挑战。尽管文献报道了几种针对腹盆腔损伤的治疗方案，旨在确定最可取的治疗方案，但最佳治疗方案仍存在争议。本文介绍了自2002年以来在我院用于治疗腹盆腔损伤的方案。材料和方法在文献中描述了不同的腹盆腔损伤方案，并比较它们的主要区别在于CT扫描的时间，血管造影和剖腹术时治疗骨盆环病变。如果患者血液动力学不稳定且出现骨盆环病变，我们的方案建议在急诊室进行最简单，最快的稳定（骨盆外固定器），并延迟检查，例如CT扫描作为二级检查。在腹部受伤的情况下，应通过超声检查进行创伤检查的阳性重点评估，第一步应该是骨盆环稳定化，因为剖腹手术可以降低腹部压力并减少对腹膜后的压塞作用。根据提出的协议，血管造影术不是首选治疗方法。从2002年10月至2005年12月，该方案适用于58例腹部不稳定型盆腔病变的腹部-盆腔损伤。平均损伤严重程度评分为27.2（CI 24.1-30.3）。结果5例（8％）死亡，3例因流血性休克而死亡，2例因肺栓塞。四名患者（6.9％）患有部分或完全马尾综合症，四名患者（6.9％）主诉轻度尿失禁，而另一名患者（1.7％）主诉多发性膀胱炎的尿retention留。两名患有3.4留和多发性膀胱炎的患者（3.4％）患有畸形畸形和骨折不愈合。七名患者（12.3％）患有神经功能障碍：坐骨神经麻痹5例（8.6％），C2型骨折1例（1.7％）腰s部根部病变，其中有1例（1.7％）伴有坐骨神经痛的不稳定腰痛。 12名患者报告了不同程度的性功能障碍（20.7％）。结论尽管需要进行更大的队列验证，但我们的初步临床数据与该问题的最新出版物相似或优于最近的出版物，这表明该方案可以降低死亡率和长期并发症。腹部骨盆损伤。

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