Early usage of extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta for treatment of pelvic fractures with hemodynamic instability / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical outcomes of extraperitoneal pelvic packing combined with temporary occlusion of abdominal aorta in treatment of pelvic fractures with hemodynamic instability.Methods A retrospective case series study was made on 14 patients with pelvic fractures with hemodynamic instability managed by extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta between December 2006 and December 2013.There were ten males and four females,with mean age of 38.2 years old (range,18-63 years).The fractures were classified according to the Tile classification,including two patients with type B1,two with type B2.2,one with type C1.1,two with type C1.2,two with type C1.3,three with type C2,and two with type C3.In addition,10 patients were with closed pelvic fractures and four with open pelvic fractures.All patients were diagnosed as hypovolemic shock once they were admitted.Every patient was given anti-shock treatment,temporary occlusion of abdominal aorta,and extraperitoneal pelvic packing instantly,in order to control hemorrhage of pelvic fracture after they were admitted.The operation time,red blood cell transfusion volume,preoperative and postoperative blood pressures,heart rates as well as other relevant parameters concerning death and survival were recorded and compared.Postoperative infection and wound healing status were recorded as well.Results The operation time was 50-70 minutes (mean,61 minutes).After surgery,the length of ICU stay was (10.9 ± 9.8) days and hospital stay was (23.1 ± 14.9) days.Red blood cell transfusion volume before and after surgery was (17.7 ± 2.2)U and (8.4± 1.7)U,respectively (P ＜ 0.05).The parameters of systolic pressures varied from preoperative (63.6 ± 2.1) mmHg to postoperative (90.9 ± 1.1) mmHg,and the parameters of heart rates declined from preoperative (106.2 ± 5.9) beats/min to postoperative (94.0 ± 6.2) beats/min,(P ＜ 0.05).Ten patients were available for follow-up of 8-24 months (mean,11.5 months).There were four deaths (29％) postoperatively,among which three were died from multisystem and organ failure,and one from severe brain injury.There were statistically significant differences between the survivors and the deaths in terms of time from injury to operation,average systolic pressures,and average heart rates (P ＜ 0.05).None had complications and wound was well healed.Conclusion For pelvic fractures with hemodynamic instability,extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta has advantages of short manipulation time and effective outcomes,which can control the hemorrhage of pelvic fracture and ameliorate the hemodynamic status.