腹主动脉球囊阻断应用于植入型凶险型前置胎盘剖宫产中的效果

目的 探讨腹主动脉球囊阻断在植入型凶险型前置胎盘产妇剖宫产术中的临床应用效果。方法 回顾性分析18例接受腹主动脉球囊阻断联合剖宫产手术的植入型凶险型前置胎盘产妇的临床资料。记录术中出血量、输血量、球囊阻断有效率、总阻断时间、子宫切除情况及并发症等。结果 18例产妇均成功行腹主动脉球囊阻断辅助剖宫产术,技术成功率为100%（18/18）。剖宫产术中平均出血量为（1 276.11±761.59）ml,平均输入悬浮少白红细胞（2.86±1.51）U,无一例因出血而死亡。球囊阻断有效率100%（18/18）,球囊有效阻断时间（24.06±26.19）min。4例（4/18,22.22%）产妇在胎儿娩出后行子宫切除术,均由于胎盘植入严重,甚至广泛侵犯宫颈、膀胱、肠道。剖宫产前后产妇均未出现与球囊阻断、介入栓塞相关的严重并发症。结论 对于凶险型前置胎盘产妇,腹主动脉球囊可以有效阻断血流,减少剖宫产术中出血量、输血量,降低子宫切除率及手术风险。     

Histoacryl®组织胶超选择性栓塞肾动脉分支治疗医源性肾动脉出血

目的 观察以Histoacryl^®组织胶作为栓塞剂超选择性栓塞肾动脉分支治疗医源性肾动脉出血的效果。方法 回顾性分析52例医源性肾动脉出血患者,其中30例为经皮肾镜术后、15例为经皮肾穿刺活检术后、7例为部分肾切除术后;均接受数字减影血管造影（DSA）引导下超选择性栓塞患肾责任分支动脉,栓塞剂为Histoacryl^®组织胶。评价技术成功率、临床成功率、并发症及操作时间,比较栓塞前、后血红蛋白（Hb）、肌酐（Cr）和尿素氮（BUN）。结果 对52例均顺利完成治疗,平均操作时间（38.23±11.51） min,技术成功率、临床成功率均为100%。术前2 h与术后12 h内Hb、Cr及BUN差异均无统计学意义（P均>0.05）。术后4例（4/52,7.69%）出现轻微并发症（发热伴局部腰痛）,经对症及支持治疗后恢复;无肾脓肿、败血症、肾破裂等严重并发症发生。结论 以Histoacryl^®组织胶作为栓塞剂超选择性栓塞肾动脉分支治疗医源性肾动脉出血安全、有效。     

医源性血管损伤的原因与防治探讨

目的　探讨医源性血管损伤的原因及其防治方法。方法　回顾性分析 11例医源性血管损伤的临床资料。结果　 7例行血管修补术获得成功 ;3例分别采用纱布填塞、结扎止血、或脏器切除等处理 ,无并发症发生 ;1例死于术中大出血。结论　医源性血管损伤有人为因素 ,也有客观原因。提高医生的警觉性及手术技巧 ,规范手术操作 ,术中解剖清晰 ,不盲目钳夹 ,是预防医源性血管损伤的关键     

低位腹主动脉球囊阻断下切除复发性骨盆肿瘤

目的介绍低位腹主动脉球囊阻断技术在控制复发性骨盆肿瘤术中出血的临床应用。方法2000年3月至2007年3月，作者应用低位腹主动脉球囊阻断技术对13例复发性骨盆肿瘤进行肿瘤切除骨盆环重建手术，采用1999年前有完整临床资料的26例以常规手术治疗的复发性骨盆肿瘤患者为对照，分析两组病例的手术时间、术中失血量、输血量及术后并发症。结果两组病人手术时间无明显差异，球囊阻断组术中失血量及输血量明显少于常规手术组（P〈0．05）。术后随访4个月至7年，常规手术组，4例患者发生肺转移死亡。9例局部复发，3例直肠损伤，1例膀胱损伤；球囊阻断组，1例发生肺转移死亡，所有病人均无邻近脏器损伤、肢体远端缺血坏死、肾功能损伤等并发症。结论在复发性盆腔肿瘤手术中应用低位腹主动脉球囊阻断技术能更有效地控制术中出血，使手术视野更加清晰，手术操作更方便，同时可以减少手术并发症，是一项有价值的临床技术。     

高低位腰椎椎间盘突出症患者脊柱-骨盆矢状面形态变化

目的 比较高位与低位腰椎椎间盘突出症（LDH）患者脊柱-骨盆矢状面形态学差异，探讨脊柱-骨盆矢状面形态学参数异常与高位LDH发生的关系。方法 纳入2006年1月—2022年1月收治的高位LDH患者53例（高位组），同时期性别、年龄和体质量指数（MBI）匹配的低位LDH患者53例（低位组）及单纯下腰部疼痛的非LDH患者53例（对照组）。在站立位全脊柱侧位X线片上测量3组矢状面平衡（SVA）、胸椎后凸角（TK）、腰椎前凸角（LL）、腰骶前凸角（LSL）、骶骨倾斜角（ST）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）等脊柱-骨盆矢状面参数。结果 高位组SVA、TK明显高于对照组，LL、ST、PI、PT及SS明显低于对照组；高位组TK明显高于低位组，LL、ST及PI明显低于低位组；差异均有统计学意义（P<0.05）。高位组L₁/L₂节段患者的LL、ST较L₂/L₃节段患者有下降趋势，但差异无统计学意义（P>0.05）。结论 骨盆水平化导致的胸腰段过度代偿可能是高位LDH发生、发展的机制之一。     

手术联合介入栓塞治疗动静脉瘘

目的 探索动静脉瘘的治疗方法及影响效果的因素。方法 复习1999～2003年收治5例动静脉瘘病人的临床资料。男3例，女2例。5例病人均行栓塞和，或手术治疗。结果 3例先天性动静脉瘘。1例股部刀刺伤致股动静脉瘘。1例因椎间盘手术致腹主动脉下腔静脉瘘。5例病人均有症状。腹主动脉下腔静脉瘘病人进行性加重的心衰、血尿、蛋白尿。股动静脉瘘病人持续性高血压，左心扩大。5例病人术前全部确诊。2例病人术中主要瘘口缝扎切断，加周围血管栓塞，1例术前周围血管栓塞，术中结扎主要瘘口，1例单纯行栓塞治疗，1例瘘口修补加入造血管包被。术后2例患肢肿胀，治疗后痊愈。结论 手术联合介入栓塞疗法对先天性及后天性动静脉瘘效果满意。     

Ankura主动脉覆膜支架行原位开窗重建弓上分支的应用

背景与目的 胸主动脉腔内修复术（TEVAR）已经成为治疗主动脉弓部病变的首选术式。然而,此术式要求支架近端安全锚定区至少为15 mm,对于锚定区不足者,则通常需重建弓部分支血管以确保手术安全。在目前各种重建技术中,原位开窗技术因其较大程度的保留分支血管以及较低的内漏风险而应用最多。因此,本研究探讨Ankura主动脉覆膜支架进行原位开窗重建弓上分支的可行性及效果。方法 回顾性分析2017年3月—2020年12月中国科学院大学宁波华美医院收治的47例近端锚定区不足的主动脉病变患者的临床资料。其中胸主动脉夹层38例,胸主动脉瘤6例,胸主动脉溃疡3例。根据术前CTA影像资料决定患者的开窗数目、开窗支架规格,术中利用穿刺针对Ankura主动脉覆膜支架进行原位开窗重建弓部分支,术后定期行主动脉CTA复查随访。结果 所有患者均获手术成功,共植入Ankura胸主动脉覆膜支架47枚,Gore Viabahn覆膜支架51枚,Cordis Smart裸支架20枚。4例术中转烟囱支架植入,原位开窗成功率91.5%（43/47）,包括左锁骨下动脉（LSA）开窗29例,左颈总动脉（LCCA）开窗+LSA栓塞1例,LSA开窗+左椎动脉烟囱1例,LSA开窗+左LCCA烟囱9例,LCCA+LSA开窗+无名动脉（IA）烟囱1例,LCCA开窗+IA烟囱+LSA栓塞2例。全组患者手术时间160~300 min,平均（200±20）min,术中开窗时间18~45 min,平均（30±8）min;术后内漏（1型）3例,逆撕2例（1例行升主动脉置换后好转,1例死亡）,脑梗死2例,截瘫0例。平均随访时间（28.4±14.7）个月,期间2例内漏在随访中消失,1例内漏未进一步增大予以观察随访中,未见开窗分支血管闭塞。结论 利用穿刺破膜技术对Ankura主动脉覆膜支架进行原位开窗重建分支血管是一种切实可行且有效的治疗方式,近期效果良好。     

MRI所见透明质酸相关眼动脉栓塞患者视神经表现与经导管眼动脉溶栓疗效的关系

目的 观察MRI所见透明质酸（HA）面部美容填充相关眼动脉栓塞患者视神经表现与经导管眼动脉溶栓疗效的关系。方法 回顾性分析60例HA相关眼动脉栓塞患者，根据视神经于弥散加权成像中可见高信号灶与否将其分为阳性组（n=39）和阴性组（n=21）；于经导管眼动脉溶栓治疗后随访3个月，评价治疗效果及其影响因素。结果 对60例均成功完成经导管眼动脉溶栓，19例治疗有效（含阳性组4例、阴性组15例）、41例无效（含阳性组35例、阴性组6例），阴性组疗效优于阳性组（P＜0.01）。以25.5 h为中位时间间隔节点，介入治疗效果在间隔≤25.5 h（8例有效、22例无效）与＞25.5 h患者（11例有效、19例无效）之间差异无统计学意义（P=0.58）。结论 经导管眼动脉溶栓用于治疗MRI显示存在视神经缺血性损伤表现的HA面部美容填充相关眼动脉栓塞患者往往效果有限。     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例（52条）四肢血管损伤患者,男35例,女9例,年龄14⁵8岁,平均27·3岁,分别采用自体血管（42条）和人造血管（10条）移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

比较纱布填塞术与造影栓塞术治疗骨盆骨折大出血的效能

 目的 比较纱布填塞术与造影栓塞术在骨盆骨折大出血治疗中的效能。方法 回顾性分析2004年4月至2012年4月治疗43例骨盆骨折大出血的患者资料。按照骨盆骨折的救治流程进行救治,其中26例应用纱布填塞术（填塞组）,17例应用造影栓塞术（栓塞组）。填塞组26例,男15例,女11例;平均年龄41.6岁;车祸伤12例,坠落伤8例,砸伤6例;骨盆骨折Tile分型：B型16例,C型10例,其中4例为开放性骨盆骨折,5例伴有腹部脏器损伤。栓塞组17例,男10例,女7例;平均年龄39.2岁;车祸伤9例,坠落伤5例,砸伤3例;骨盆骨折Tile分型：A型2例,B型11例,C型4例。比较两组患者的创伤严重程度评分（ISS）、手术时间、输血量、并发症等。结果 填塞组平均ISS评分为（52.4±15.3）分,栓塞组为（40.6±12.4）分;填塞组平均手术时间为（42.0±2.1） min,栓塞组为（86.0±3.6） min;填塞组术后24 h内输血量平均为（6.0±1.6） U,栓塞组为（10.0±2.1） U;填塞组ICU住院时间平均为（8.0±3.6） d,栓塞组为（11.0±1.8） d;以上指标两者比较差异均有统计学意义。填塞组术前输血量平均为（15.0±4.7） U,栓塞组为（13.0±5.4） U,两者比较差异无统计学意义。填塞组2例行二次纱布填塞止血,栓塞组6例行二次纱布填塞治疗。填塞组术后5例死亡,无因大出血而死亡的患者;栓塞组术后4例死亡,1例因大出血而于术后32 h死亡。填塞组3例患者术后7～9 d发生深部感染,其中1例于术后第16天死亡,另2例与栓塞组1例（术后第9天发生浅表感染）经换药处理后好转。结论 纱布填塞术较造影栓塞术手术时间短,止血效果确切,可明显减少术后输血量、ICU住院时间及术后的死亡率,更适用于我国国情及基层医院的骨盆骨折出血的抢救。     

The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery

PurposeCorona mortis is a highly variable vascular connection between the obturator and external iliac or inferior epigastric arteries or veins located behind the superior pubic ramus in the retropubic space (space of Retzius). Due to the significant variation in this collateral circulation, detailed anatomical knowledge of the corona mortis is vital to enhance the prevention of possible iatrogenic errors in hernia repair and other pubic surgical procedures. The aim of our meta-analysis was to provide comprehensive data on the prevalence, anatomical characteristics, and ethnic variations of the corona mortis vessel.MethodsAn extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included investigative method, prevalence of the corona mortis vessels among hemi-pelvises (overall, arterial only, venous only, and combined), distance from the corona mortis to pubic symphysis, and assessment of gender, side, laterality, and ethnicity subgroups.ResultsA total of 21 studies (n = 2184 hemi-pelvises) were included in the meta-analysis. The overall prevalence of the corona mortis in hemi-pelvises is high (49.3%). A venous corona mortis is more prevalent than an arterial corona mortis (41.7% vs. 17.0%). The corona mortis is more common in Asia (59.3%) than in Europe (42.8%) and North America (44.3%).ConclusionsAs a corona mortis is present in an about half of all hemi-pelvises, it is important to consider the possibilities of its presence when undertaking surgical procedures and plan accordingly to avoid injuries. All surgeons operating in the retropubic region should have a thorough understanding of the anatomical characteristics and surgical implications of a corona mortis.     

选择性动脉造影与栓塞在血流动力学不稳定骨盆骨折诊治中的应用

目的 探讨选择性动脉造影与栓塞在诊治骨盆骨折伴血流动力学不稳定患者中的应用.方法 回顾性分析2002年1月至2008年12月收治的62例骨盆骨折伴动脉损伤患者资料,骨折采用AO分型:A2型2例;B1型6例,B2型9例,B3型8例;C1型16例,C2型13例,C3型8例.其中开放性损伤6例(Gustilo分型:Ⅱ型1例,Ⅲ型5例).多发伤患者46例,12例发生休克.62例患者在积极补液及应用血管活性药物的同时进行动脉造影检查,其中59例患者行栓塞治疗. 结果 62例患者行动脉造影79次,其中行2次以上动脉造影患者12例.损伤动脉由多至少依次为臀上动脉、髂腰动脉、骶外侧动脉、闭孔动脉、臀下动脉、阴部内动脉以及髂内动脉和髂外动脉的主干.32例患者伴有两条以上动脉(分支)损伤.59例行骨盆内动脉损伤栓塞治疗的患者中,56例有效.7例患者因腹腔脏器严重损伤抢救无效而死亡,10例失访,45例患者术后获6～52个月(平均14个月)随访.11例患者患侧臀部肌肉力量较健侧弱,未见其他明显并发症.12例多次行选择性动脉造影与(或)栓塞治疗的患者均获随访,其中2例发生患侧臀部肌肉力量减弱. 结论 选择性动脉造影与栓塞是诊治骨盆骨折患者动脉损伤的有效措施.对于多发动脉损伤或延迟动脉损伤的患者,重复性动脉造影和栓塞治疗是必要且安全有效的.     

Pelvic fractures

Pelvic fractures are relatively uncommon injuries, but their incidence is rising within the trauma population. Their severity ranges from low-energy, stable injuries to high-energy and unstable patterns; and they continue to cause significant morbidity and mortality. The diagnostic and therapeutic modalities utilized depend on numerous factors including patients' characteristics and haemodynamic status, mechanism of injury and fracture pattern with associated pelvic instability, as well as the timing of presentation and treatment. Knowledge of the complex anatomy and biomechanics of the pelvic ring is essential and dictates the appropriate management. Pelvic surgery following a traumatic disruption of the pelvic ring can be divided into the acute stabilization phase and the delayed reconstruction phase. For unstable pelvic fractures with associated haemodynamic instability, acute management with provisional stabilization of the pelvis and haemorrhage control, with arterial embolization or pelvic packing, helps to reduce early mortality. The second phase of definite pelvic reconstruction and restoration of pelvic anatomy is performed when the patient is physiologically stable, usually within 3–7 days post-injury, aiming to reduce associated late complications and improve function. Besides the complexity of such treatment, pelvic fractures are also associated with a number of acute and chronic complications, including infection, iatrogenic nerve lesions, thromboembolic episodes and pelvic malunion/non-unions, leading to significant morbidity and long-term disabilities with significant impact on patients' quality of life and substantial socioeconomic implications. The management of pelvic fractures still remains a challenge even to the most experienced trauma surgeons and well-developed trauma care systems.     

Management of Hemodynamic Unstable Patients "in extremis" with Pelvic Ring Fractures

The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure .70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission. The sources of pelvic bleeding is in approximately 80-90% of venous origin and relevant arterial bleeding accounts for 10-20%. Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources. In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels.     

Laceration of a branch of the profunda femoris artery caused by a spike of the displaced lesser trochanter in an inter-trochanteric femoral fracture. A case report

IntroductionInjury of femoral vessels is an extremely rare complication in intertrochanteric femoral fractures. In most cases reported, the vascular lesion involves the superficial femoral artery, whereas in very few cases does it involve the profunda femoris artery.Presentation of case: We report a case of acute bleeding due to laceration of a perforating branch of the profunda femoris artery caused by a sharp fragment of the displaced lesser trochanter in an intertrochanteric femoral fracture; the lesion was treated by transcatheter embolization.DiscussionThe arterial injury may be iatrogenic, occurring during intramedullary internal fixation, or less frequently, the injury may be due to the fracture itself, caused by a sharp bone fragment that damages the profunda femoris artery or one of its perforating branches.ConclusionWe believe that intertrochanteric femoral fractures with avulsed lesser trochanter are at risk for femoral vessel injuries caused by the displaced bone spike, and we advise meticulous clinical and laboratory monitoring pre- and post-operatively to prevent serious complications.     

Pelvic ring injuries: Emergency assessment and management

Pelvic ring injuries are associated with significant morbidity and mortality. Understanding the anatomy of the pelvic ring is essential for accurate diagnosis and treatment. A systematic approach taking into account the mechanism of injury, physical examination, and radiographic assessment is important to quickly identify unstable pelvic disruptions and associated injuries. Because the pelvis is a ring structure, isolated pubic rami fractures on plain radiographs are unusual and should warrant careful evaluation for posterior pelvic disruption with computed tomography. Hemorrhagic shock can occur in about 10% of pelvic ring injuries. Immediate recognition and treatment of this life-threatening condition is critical in emergency management. In addition to fluid resuscitation and blood transfusion, circumferential wrapping, angiographic embolization, laparotomy with pelvic packing, and external fixation can be important life-saving adjuncts in the setting of hemodynamic instability.     

Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes

BACKGROUND: Pelvic fractures are often associated with major intraabdominal injuries or severe bleeding from the fracture site. OBJECTIVE: To study the epidemiology of pelvic fractures and identify important risk factors for associated abdominal injuries, bleeding, need for angiographic embolization, and death. METHODS: Trauma registry study on pelvic fractures from blunt trauma. Stepwise logistic regression was used to identify risk factors of severe pelvic fractures, associated abdominal injuries, need for major blood transfusion, therapeutic embolization, and death from pelvic fracture. Adjusted relative risks and 95% confidence intervals were derived. RESULTS: There were 16,630 trauma registry patients with blunt trauma, of whom 1,545 (9.3%) had a pelvic fracture. The incidence of abdominal injuries was 16.5%, and the most common injured organs were the liver (6.1%) and the bladder and urethra (5.8%). In severe pelvic fractures (Abbreviated Injury Scale [AIS] > or =4), the incidence of associated intraabdominal injuries was 30.7%, and the most commonly injured organs were the bladder and urethra (14.6%). Among the risk factors studied, motor vehicle crash is the only notable risk factor negatively associated with severe pelvic fracture. Major risk factors for associated liver injury were motor vehicle crash and pelvis AIS > or = 4. Risk factors of major blood loss were age > 16 years, pelvic AIS > or =4, angiographic embolization, and Injury Severity Score (ISS) > 25. Age> 55 years was the only predictor for associated aortic injury. Factors associated with therapeutic angiographic embolization were pelvic AIS > or =4 and ISS > 25. The overall mortality was 13.5%, but only 0.8% died as a direct result of pelvic fracture. The only pronounced risk factor associated with mortality was ISS>25. CONCLUSIONS: Some epidemiological variables are important risk factors of severity of pelvic fractures, presence of associated abdominal injuries, blood loss, and need of angiography. These risk factors can help in selecting the most appropriate diagnostic and therapeutic interventions.     

Combined endovascular and neurosurgical approach to the removal of an intraaortic pedicle screw

Iatrogenic aortic injuries are a potentially devastating complication of spine surgery. In instrumented cases, injuries may occur in the perioperative period due to iatrogenic vessel injury, or they may occur years later as prominent implants erode or penetrate major vessels. The authors present a case of a 71-year-old man in whom a thoracic pedicle screw was found perforating the thoracic aorta during routine follow-up 6 months after surgery. Due to the risk of future complications, the screw was removed while simultaneously delivering an endovascular aortic stent to gain vascular control. Surgical considerations and potential technical limitations are discussed.     

Pelvic packing and angio-embolization after blunt pelvic trauma: a retrospective 18-year analysis

IntroductionTreatment of pelvic trauma related hemorrhage is challenging and remains controversial. In hemodynamically unstable patients suspected for massive bleeding, pre-peritoneal packing (PPP) with temporary external fixation (EF) and subsequent trans-arterial embolization (TAE) can be performed in order to control bleeding. In hemodynamically stable patients suspected for minor to moderate bleeding, primary TAE with EF may be performed. The goal of this study was to determine effectiveness and safety of both strategies.MethodsRetrospectively, patients that received treatment for pelvic trauma-related hemorrhage at two level 1 trauma centers located in the United States between January 2001 and January 2019 were evaluated. Both centers advocate subsequent TAE in addition to PPP and EF in hemodynamically unstable patients, and primary TAE in stable patients. Demographic and clinical data was collected and mortality, ischemic and infectious complications were determined.ResultsIn total, 135 patients met the inclusion criteria. Of these, 61 hemodynamically unstable patients suspected for massive pelvic bleeding underwent primary PPP (45%) and 74 stable patients suspected for minor/moderate bleeding underwent primary TAE (55%). In total, 37/61 primary PPP patients underwent EF (61%) and 48 underwent adjunct TAE (79%), performed bilaterally in 77% and unselective by use of gelfoam in 72% of cases. Primary TAE patients received embolization bilaterally in 49% and unselective in 35% of cases. Exsanguination-related deaths were found in 7/61 primary PPP patients (11%). There were none among the primary TAE patients. Potentially ischemic in-hospital complications, of which one could be considered severe (gluteal necrosis), occurred more in patients that received bilateral unselective TAE compared to all other TAE patients (p=0.02).ConclusionPrimary TAE appears to be an effective and safe adjunct for (minor) pelvic hemorrhage in hemodynamically stable patients. Primary PPP followed by EF and adjunct bilateral unselective TAE with gelfoam appears effective for those suspected of massive pelvic bleeding. This unselective embolization approach using gelfoam might be related to (ischemic) complications. When considering the amount and severity of complications and the severity of pelvic trauma, these might not outweigh the benefit of fast hemorrhage control.     

Effect of angioembolization for isolated complex pelvic injury: A post-hoc analysis of a nationwide multicenter trauma database in Japan

Background and importanceComplex pelvic injuries are among the types of trauma with the highest mortality. Treatment strategies should be based on the hemodynamic status, the anatomical type of fracture, and the associated injuries. Combination therapies, including preperitoneal pelvic packing, temporary mechanical stabilization, resuscitative endovascular balloon occlusion of the aorta, and angioembolization, are recommended for pelvic injuries.ObjectiveTo investigate the effect of urgent angioembolization alone on severe pelvic injury-associated mortality.Design, settings, and participantsWe used the Japan Trauma Data Bank database, a multicenter observational study, to retrospectively identify adult patients with isolated blunt pelvic injuries (Abbreviated Injury Scale [AIS] score: 3–5) from 2004 to 2018.Outcome measures and analysisThe primary outcome measure was in-hospital mortality. We subdivided patients into two groups, those who underwent urgent angioembolization and non-urgent angioembolization, and compared their mortality rates. We performed multiple imputation and multivariable analyzes to compare the mortality rates between groups after adjusting for known potential confounding factors (age, sex, Glasgow Coma Scale score, systolic blood pressure on hospital arrival, Injury Severity Score, pelvic AIS score, laparotomy, resuscitative endovascular balloon occlusion of the aorta, and external fixation) and for within-hospital clustering using the generalized estimating equation.Main resultsWe analyzed 4207 of 345,932 trauma patients, of whom 799 underwent urgent angioembolization. The in-hospital mortality rate was significantly higher in the urgent embolization group than in the non-urgent embolization group (7.4 vs. 4.0%; p < 0.01). However, logistic regression analysis revealed that the mortality rates of patients with urgent angioembolization significantly decreased after adjusting for factors independently associated with mortality (odds ratio: 0.60; 95% confidence interval: 0.37–0.96; p = 0.03).ConclusionUrgent angioembolization may be an effective treatment for severe pelvic injury regardless of the pelvic AIS score and the systolic blood pressure on hospital arrival.