Journal of Trauma and Injury

  • 제28권3호
  • /
  • Pages.144-148
  • /
  • 2015
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

중증 외상 환자의 골반골절에서 경피적 혈관 색전술과 Young과 Burgess 분류의 상관관계

Correlation between Young and Burgess Classification and Transcatheter Angiographic Embolization in Severe Trauma Patients

  • Cha, Yong Han (Department of Orthopedic Surgery, Eulji University Hospital) ;
  • Sul, Young Hoon (Department of Surgery, Eulji University Hospital) ;
  • Kim, Ha Yong (Department of Orthopedic Surgery, Eulji University Hospital) ;
  • Choy, Won Sik (Department of Orthopedic Surgery, Eulji University Hospital)
  • 투고 : 2015.08.05
  • 심사 : 2015.10.04
  • 발행 : 2015.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn't an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. Methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. Results: The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. Conclusion: Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies.

키워드

참고문헌

  1. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg 2002; 195: 1-10. https://doi.org/10.1016/S1072-7515(02)01197-3
  2. Huittinen VM, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery 1973; 73: 454-62.
  3. Blackmore CC, Cummings P, Jurkovich GJ, Linnau KF, Hoffer EK, Rivara FP. Predicting major hemorrhage in patients with pelvic fracture. J Trauma 2006; 61: 346-52. https://doi.org/10.1097/01.ta.0000226151.88369.c9
  4. Eastridge BJ, Starr A, Minei JP, O'Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446-50; discussion 50-1. https://doi.org/10.1097/00005373-200209000-00009
  5. Pohlemann T, Bosch U, Gansslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res. 1994: 69-80.
  6. Poole GV, Ward EF. Causes of mortality in patients with pelvic fractures. Orthopedics 1994; 17: 691-6.
  7. Schutz M, Stockle U, Hoffmann R, Sudkamp N, Haas N. Clinical experience with two types of pelvic C-clamps for unstable pelvic ring injuries. Injury 1996; 27 Suppl 1: S-a46-50.
  8. Gilliland MD, Ward RE, Barton RM, Miller PW, Duke JH. Factors affecting mortality in pelvic fractures. J Trauma 1982; 22: 691-3. https://doi.org/10.1097/00005373-198208000-00007
  9. Papakostidis C, Giannoudis PV. Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury 2009; 40 Suppl 4: S53-61. https://doi.org/10.1016/j.injury.2009.10.037
  10. Heetveld MJ, Harris I, Schlaphoff G, Balogh Z, D'Amours SK, Sugrue M. Hemodynamically unstable pelvic fractures: recent care and new guidelines. World J Surg 2004; 28: 904-9. https://doi.org/10.1007/s00268-004-7357-9
  11. White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury 2009; 40: 1023-30. https://doi.org/10.1016/j.injury.2008.11.023
  12. Henry SM, Tornetta P, 3rd, Scalea TM. Damage control for devastating pelvic and extremity injuries. Surg Clin North Am 1997; 77: 879-95. https://doi.org/10.1016/S0039-6109(05)70591-0
  13. Totterman A, Dormagen JB, Madsen JE, Klow NE, Skaga NO, Roise O. A protocol for angiographic embolization in exsanguinating pelvic trauma: a report on 31 patients. Acta orthop 2006; 77: 462-8. https://doi.org/10.1080/17453670610046406
  14. Margolies MN, Ring EJ, Waltman AC, Kerr WS, Jr., Baum S. Arteriography in the management of hemorrhage from pelvic fractures. N Eng J Med 1972; 287: 317-21. https://doi.org/10.1056/NEJM197208172870701
  15. Cook RE, Keating JF, Gillespie I. The role of angiography in the management of haemorrhage from major fractures of the pelvis. J Bone Joint Surg Br 2002; 84: 178-82.
  16. Frevert S, Dahl B, Lonn L. Update on the roles of angiography and embolisation in pelvic fracture. Injury 2008; 39: 1290-4. https://doi.org/10.1016/j.injury.2008.07.004
  17. Ruatti S, Guillot S, Brun J, Thony F, Bouzat P, Payen JF, et al. Which pelvic ring fractures are potentially lethal? Injury 2015; 46: 1059-63. https://doi.org/10.1016/j.injury.2015.01.041
  18. O'Neill PA, Riina J, Sclafani S, Tornetta P, 3rd. Angiographic findings in pelvic fractures. Clin Orthop Relat Res 1996: 60-7.
  19. Brun J, Guillot S, Bouzat P, Broux C, Thony F, Genty C, et al. Detecting active pelvic arterial haemorrhage on admission following serious pelvic fracture in multiple trauma patients. Injury 2014; 45: 101-6. https://doi.org/10.1016/j.injury.2013.06.011
  20. Manson T, O'Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J. Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma 2010; 24: 603-9. https://doi.org/10.1097/BOT.0b013e3181d3cb6b
  21. Osterhoff G, Scheyerer MJ, Fritz Y, Bouaicha S, Wanner GA, Simmen HP, et al. Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess. Injury 2014; 45: 742-7. https://doi.org/10.1016/j.injury.2013.12.003
  22. Young JW, Resnik CS. Fracture of the pelvis: current concepts of classification. AJR Am J Roentgenol 1990; 155: 1169-75. https://doi.org/10.2214/ajr.155.6.2122661
  23. O'Sullivan RE, White TO, Keating JF. Major pelvic fractures: identification of patients at high risk. J Bone Joint Surg Br 2005; 87: 530-3. https://doi.org/10.2106/JBJS.D.01753
  24. Lunsjo K, Tadros A, Hauggaard A, Blomgren R, Kopke J, Abu-Zidan FM. Associated injuries and not fracture instability predict mortality in pelvic fractures: a prospective study of 100 patients. J Trauma 2007; 62: 687-91. https://doi.org/10.1097/01.ta.0000203591.96003.ee
  25. Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN, et al. Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma 2002; 16: 553-61. https://doi.org/10.1097/00005131-200209000-00003
  26. Alla SR, Roberts CS, Ojike NI. Vascular risk reduction during anterior surgical approach sacroiliac joint plating. Injury 2013; 44: 175-7. https://doi.org/10.1016/j.injury.2012.08.009
  27. Rue JP, Inoue N, Mont MA. Current overview of neurovascular structures in hip arthroplasty: anatomy, preoperative evaluation, approaches, and operative techniques to avoid complications. Orthopedics 2004; 27: 73-81. quiz 2-3. https://doi.org/10.3928/0147-7447-20040101-25