Gauze packing for massive hemorrhage in pelvic fracture / 中华创伤杂志

Objective To investigate the clinical value of gauze packing for haemodynamically unstable pelvic fracture.Methods Between January 2006 and January 2014,gauze packing was used to treat haemodynamically unstable pelvic fracture in 42 patients consisting of 23 males and the 19 females aged 34.2 years (range,18 to 54 years).AO classification of the fracture was type B1 in 9,B2 in 5,B3 in 3,C1 in 13,C2 in 4,and C3 in 8 patients.All the patients were diagnosed with hypovolemic shock upon admission with the systolic pressure of (75.4 ± 4.3) mmHg and heart rate of (126.5 ± 12.4) beats/ min.Injury severity score (ISS) was (38.7 ± 6.2)points.Anti-shock treatment,internal or external fixation of pelvic ring,and gauze packing were performed immediately to control the hemorrhage following pelvic fracture.Results Systolic pressure was (95.2 ± 4.6) mmHg and mean heart rate was declined to (85.4 ± 13.2)beats/min after pelvis volume control and gauze packing,with significant differences compared to these preoperatively (P ＜ 0.05).Red blood cell transfusion before internal or external fixation and gauze packing was (15.0 ± 2.4) units versus (8.3 ± 1.5) units within the first postoperative 24 hours (P ＜ 0.05).Twenty-four out of the 42 patients underwent temporary abdominal aorta occlusion.Six patients died postoperatively with the death rate of 14％.Mean time of removing the packing gauze was (51.4 ± 10.3) hours (range,24-168 hours).Conclusion Anti-shock treatment with concurrent gauze packing and pelvis volume control is effective to arrest the massive hemorrhage in hemodynamically unstable pelvic fracture.

Arterial angiographic embolization in treatment of severe pelvic fractures / 第二军医大学学报

Pelvic fractures are high energy injuries involving severe trauma and potential intra pelvic bleeding. Immediate control of hemorrhage, fixation of pelvic fractures and inter department cooperation are important for their treatment. Transcatheter angiographic embolization can be used to identify bleeding sites, control hemorrhage and improve mortality and complications, and it has been proved to be a valuable technique in the diagnosis and treatment of pelvic vascular injuries. Still there is a considerable controversy on the fracture patterns, the sequence and the timing of emergency angiography and possible embolization in these patients. In this paper, we reviewed the role of angiographic embolization and we thought more attention should be paid on angiographic embolization in the control of hemorrhage.