Multivariate analysis of the influence of emergency interventional therapy on pelvic fracture prognosis
-
摘要: 目的:探讨与分析影响急诊介入治疗骨盆骨折预后的因素。方法:2014-02—2019-02期间在本院进行急诊介入的骨盆骨折患者160例,调查患者一般资料、骨折情况、临床诊治与预后情况。结果:在160例患者中,经过急诊介入后死亡16例(死亡组),存活144例(存活组),病死率为10.0%。死亡组的性别、年龄、收缩压、体重指数、舒张压、骨折分型、骨折原因、骨折部位与死亡组对比差异无统计学意义(P>0.05),死亡组的伤后到院前时间、合并创伤状况、手术时间、输血情况等与死亡组对比差异有统计学意义(P<0.05)。死亡组入院时的格拉斯哥预后评分(GCS)、简明损伤评分(AIS)、损伤严重程度评分(ISS)、急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分与存活组对比差异均有统计学意义(P<0.05)。死亡组急诊期间的呼吸衰竭、休克、感染等并发症发生率为50.0%,显著高于存活组的6.3%(P<0.05)。Logistic回归分析显示GCS评分、AIS评分、ISS评分、APACHEⅡ评分、伤后到院前时间、合并创伤为患者预后死亡的主要影响因素(P<0.05)。结论:骨盆骨折的预后相对比较差,多伴随有各种并发症,GCS评分、AIS评分、ISS评分、APACHEⅡ评分、伤后到院前时间、合并创伤为患者预后死亡的主要影响因素。
-
关键词:
- 骨盆骨折 /
- 急诊介入治疗 /
- 预后 /
- 急性生理与慢性健康评分 /
- 简明损伤评分
Abstract: Objective:To investigate and analysis the factors affecting the prognosis of emergency interventional treatment of pelvic fractures. Method:From February 2014 to February 2019, 160 patients with pelvic fractures who underwent emergency intervention were enrolled in our hospital. The general data, fractures, clinical diagnosis and prognosis were investigated. Result:There were 16 patients died(death group) after emergency intervention and 144 patients survived(survival group) in the 160 patients with the mortality rate of 10.0%. There were no significant differences in gender, age, systolic blood pressure, body mass index, diastolic blood pressure, fracture classification, fracture cause, fracture site compared between the death group and the survival group before the emergency department(P>0.05). There were statistically significant difference between the combined trauma, surgery time, blood transfusion compared between the two groups(P<0.05). The Glasgow coma scale(GCS), abbreviated injury scale(AIS), injury severity score(ISS), acute physiology, age and chronic health evaluation Ⅱ(APACHE Ⅱ) in he death group compared to the death group were statistically significant difference(P<0.05). The incidence of complications such as respiratory failure, shock, and infection during the emergency in the death group was 50.0%, which was significantly higher than that of the survival group(6.3%)(P<0.05). Logistic regression analysis showed that GCS score, AIS score, ISS score, APACHE Ⅱ score, fracture to emergency time, and combined trauma were the main influencing factors of prognosis(P<0.05).Conclusion:The prognosis of pelvic fractures are relatively poor, with many complications. The GCS score, AIS score, ISS score, APACHE Ⅱ score, fracture to emergency time, and combined trauma were the main influencing factors of prognosis. -
-
[1] 庞富利,毛辰波.严重骨盆骨折的急诊救治方案分析[J].浙江创伤外科,2017,22(6):1162-1163.
[2] 赖全,何钰楠,汪洪莉.创伤大出血患者的短期生存状况研究[J].湖南师范大学学报(医学版),2019,16(3):131-133.
[3] Mann SM,Banaszek D,Lajkosz K,et al.High-energy trauma patients with pelvic fractures:Management trends in Ontario,Canada[J].Injury,2018,49(10):1830-1840.
[4] Noser J,Dietrich M,Tiziani S,et al.Mid-term follow-up after surgical treatment of fragility fractures of the pelvis[J].Injury,2018,49(11):2032-2035.
[5] Shim H,Jang JY,Kim JW,et al.Effectiveness and postoperative wound infection of preperitoneal pelvic packing in patients with hemodynamic instability caused by pelvic fracture[J].PLoS One,2018,13(11):e0206991.
[6] Tan JH,Mohamad Y,Imran Alwi R,et al.Development and validation of a new simplified anatomic trauma mortality score[J].Injury,2019,50(5):1125-1132.
[7] 欧琳娜.总结损伤控制理论在骨盆骨折患者急诊护理中的实施价值[J].中国伤残医学,2019,27(7):89-90.
[8] Campbell A,Dugarte A,Ly TV.Minimally invasive endoscopic-assisted technique for implant removal after pelvic bridge plating[J].J Orthop Trauma,2018,32(11):e457-e461.
[9] Liu HS,Duan SJ,Xin FZ,et al.Robot-assisted minimally-invasive internal fixation of pelvic ring Injuries:A single-center experience[J].Orthop Surg,2019,11(1):42-51.
[10] 包小燕,张雁.急诊护理中运用损伤控制理论对骨盆骨折患者预后的影响[J].安徽医药,2019,23(7):1361-1364.
[11] 林曦,胡平,杨俊,等.损害控制策略在伴胸部创伤老年多发伤患者中的应用及效果评价[J].中华创伤杂志,2018,34(9):833-837.
[12] Cho MR,Lee JH,Kwon JB,et al.The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw[J].Clin Orthop Surg,2018,10(3):292-298.
[13] Diacon AL,Kimmel LA,Hau RC,et al.Outcomes of midfoot and hindfoot fractures in multitrauma patients[J].Injury,2019,50(2):558-563.
[14] Ghosh S,Aggarwal S,Kumar P,et al.Functional outcomes in pelvic fractures and the factors affecting them-A short term,prospective observational study at a tertiary care hospital[J].J Clin Orthop Trauma,2019,10(5):896-899.
[15] 赵菊红,刘威,乐爱平.多发性损伤患者临床预后转归危险因素分析[J].中国输血杂志,2018,31(7):703-707.
[16] Huang GB,Hu P,Gao JM,et al.Analysis of early treatment of multiple injuries combined with severe pelvic fracture[J].Chin J Traumatol,2019,22(3):129-133.
[17] Kim WY,Lee SW,Kim KW,et al.Minimally invasive surgical treatment using 'iliac pillar' screw for isolated iliac wing fractures in geriatric patients:a new challenge[J].Eur J Trauma Emerg Surg,2019,45(2):213-219.
[18] Kruppa CG,Khoriaty JD,Sietsema DL,et al.Does skeletal maturity affect pediatric pelvic injury patterns,associated injuries and treatment intervention?[J].Injury,2018,49(8):1562-1567.
[19] 谭振,王光林.骨盆骨折后环损伤的诊断及治疗研究进展[J].四川大学学报(医学版),2017,48(5):655-660.
[20] Tian W,Chen WH,Jia J.Traumatic Spino-pelvic Dissociation with Bilateral Triangular Fixation[J].Orthop Surg,2018,10(3):205-211.
[21] Younis MH,Mahmoud K,Kawas A,et al.Early versus late hip spica casting for paediatric femoral shaft fractures[J].J Pediatr Orthop B,2019,28(2):122-126.
[22] Zwingmann J,Lefering R,Maier D,et al.Pelvic fractures in severely injured children:Results from the TraumaRegister DGU[J].Medicine(Baltimore),2018,97(35):e11955.
[23] 黄明伟,孔来法,张德意,胡维君,王健,倪晓伟.血管介入栓塞在血流动力学不稳定骨盆骨折急救中的应用[J].中华创伤杂志,2016,32(3):244-248.
[24] Agarwal MG,Gundavda MK,Gupta R,et al.Does Extracorporeal Irradiation and Reimplantation After Acetabular Resections Results in Adequate Hip Function?A Preliminary Report[J].Clin Orthop Relat Res,2018,476(9):1738-1748.
-
计量
- 文章访问数: 456
- PDF下载数: 347
- 施引文献: 0
下载: