Imageologic study and clinical treatment of pelvic fractures combined with artery injuries / 中华创伤杂志

ABSTRACT

Objective To explore the imageologic characteristics of pelvic fractures with artery injuries and the treatment methods for embolization of arteries.Methods From January 1999 to June 2005,60 cases(42 males and 18 females)aged 21-52 years(average 34.5 years)with pelvic fractures and unsteady blood dynamics were admitted into our hospital.There were 32 cases with traffic injury,13 with crushing injury,nine with fall injury and six with other injuries.The mean injury severity score was 39?16(16-66).All cases were hypetensive with systolic blood pressure less than 90 mm Hg on the arrival.Routine X-ray examination of dorsaventral,debouch and porch of pelvis was performed.The aver- age amount of blood transfusion was 2 886 ml.All cases underwent iliac artery angiography and pelvic ar- teriography.Results X-ray examination of pelvic fractures showed posterior pelvic fracture in 25 ca- ses,with 64 branches of blood vessels injured;anterior pelvic fracture in 13,with 17 branches of blood vessels injured;acetabular fracture in six,with 12 branches of blood vessels injured;and combined pel- vic fracture in 16,with 36 branches of blood vessels injured.Three cases died,with mortality rate of 5%.One case with common arterial thrombosis was treated with artificial blood vessel transplantation, four cases with external iliac artery injuries including one with artery rupture were treated with prosthesis, and among the three cases with external iliac artery thrombosis,one was treated with dislodgment of thrombosis,one treated with recanalization of thrombolysis and one did not give any treatment.Fifty cases with injury and bleeding of internal iliac artery and its branches were treated with arterial embolization. Five cases showed no obvious injury.Conclusions The types of artery injuries can be predicted through X-ray of pelvic fracture.Posterior pelvic fracture may easily cause injury to superior gluteal arter- ies,iliac lumber arteries,and lateral sacral arteries.While anterior pelvic fracture will cause injury to obturator arteries.Superior gluteal artery is susceptible to injury.Embolization of injured arteries and an- astomosis are preferred treatment for pelvic arterial disruptions.