Treatment strategy of pelvic fractures associated with trauma induced coagulopathy
WEI Gong-bin
GAO Jin-mou
HU Ping
YANG Jun
WANG Jian-bai
LIU Chao-pu
Abstract：Objective To summarize managing methods for pelvic fractures associated with trauma induced coagulopathy.Methods A retrospective analysis was done on the clinical data of 423 cases of severe pelvic frac-tures treated by damage control surgery(DCS) and damage control resuscitation(DCR) from Jan.2007 to Dec. 2015.Another 198 cases,as the control group,were treated without DCS or DCR from Jan.1995 to Feb.2003.And the former was as the study group.The control group underwent definitive operation initially.The study group un-derwent internal iliac arteries devascularization in the first place, followed by surgical interventions for hemostasis and blocking contamination.Patients were then transferred to ICU for further resuscitation based on DCR protocol. Definitive operations were performed only when patients became stable.Results Traumatic induced coagulopathy developed in 52 patients in the control group,including 23 deaths among them.And the mortality was 44.23%(23/52) .In the study group,there were 382 cases with ongoing hemorrhage,and trauma induced coagulopathy occurred in 86 cases.A total of 382 patients with ongoing hemorrhage underwent emergent internal iliac arteries devascular-ization,206 of whom received pelvic external fixation.In patients associated with visceral injuries,laparotomy was performed in accordance with DCS.Abiding by the principle of damage control resuscitation,hemostatic resuscitation measures were performed,and blood products and coagulation factor were transfused in the first place.The definitive surgery was performed when vital signs got stable after further resuscitation in ICU.The main complications included 17 cases of sepsis of pelvic and abdominal cavity,22 cases of abdominal compartment syndrome,12 cases of fat em-bolisation syndrome,and 30 cases of deep venous embolism.The death rate of the study group was 22.09%(19/86).The main cause of death was hemorrhagic shock.Conclusion Trauma induced coagulapathy would easily develop when pelvic fractures are severe.It would be greatly helpful in treating such patients with DCR protocol, combined with internal iliac arteries devascularization and pelvic external fixation to control hemorrhage,and the sur-vival rate will be improved obviously.
Keywords：pelvic fractureabdominal injurycomplicationresuscitationdamage control
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 648-651 )