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Einfluss der externen Beckenstabilisierung bei hämodynamisch instabilen Beckenfrakturen

Influence of external pelvic stabilization on hemodynamically unstable pelvic fractures

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Zusammenfassung

Hintergrund

Bei der Behandlung komplexer Beckenverletzungen steht die Blutungskontrolle im Vordergrund. Untersuchungen bzgl. der Blutungslokalisation sind jedoch sehr widersprüchlich, sodass unterschiedliche Behandlungskonzepte empfohlen werden. Die im Schockraum angelegte externe Beckenkompression soll v. a. das Beckenvolumen verkleinern und durch eine Selbsttamponade dem Blutverlust entgegenwirken. Welchen Einfluss die externe Beckenkompression auf die Letalität und das Outcome bei hämodynamisch instabilen Beckenverletzungen aufweist, soll anhand einer größeren Fallzahl untersucht werden.

Material und Methode

In der vorliegenden Studie wurden anhand des TraumaRegister DGU® (TR-DGU) 104 Datensätze über den Zeitraum von 2002 bis 2011 retrospektiv ausgewertet. Alle Verletzten erlitten eine Verletzungsschwere von mindestens 16 ISS-Punkten (Injury Severity Score). Des Weiteren befanden sich die Patienten in einer hämodynamisch instabilen Kreislaufsituation bei nachgewiesener relevanter Monoverletzung des Beckens. Zur Beurteilung der Effektivität der externen Beckenkompression wurden die Patienten mit und ohne externe Beckenstabilisierung miteinander verglichen.

Ergebnisse

Von den untersuchten Patienten erlagen 26,9 % ihren Verletzungen. Dabei betrug die Letalität in den ersten 6 h nach Aufnahme im Schockraum 78,8 %. Eine externe Beckenstabilisierung wurde bei 45,2 % der Patienten durchgeführt. In der Gruppe der Patienten mit externer Beckenstabilisierung verstarben 19,1 %. Dagegen lag die Sterblichkeit in der Gruppe der Patienten ohne externe Beckenstabilisierung bei 33,3 %. Im stationären Verlauf entwickelten die überlebenden Patienten mit externer Beckenstabilisierung deutlich häufiger eine Sepsis bzw. ein Multiorganversagen und waren länger intensivpflichtig.

Schlussfolgerung

Die externe Beckenstabilisierung scheint ein wesentliches Instrument der Initialbehandlung bei hämodynamisch instabilen Beckenfrakturen zu sein und zeigt eine positive Wirkung auf die Letalität der Verletzten.

Abstract

Background

In the treatment of complex pelvic fractures hemorrhage control is of primary importance; however, studies regarding the localization of bleeding are contradictory so that various treatment approaches are recommended. The primary aim of external pelvic compression applied in the trauma room is to reduce the pelvic volume and counteract blood loss through self-induced tamponade. This study examined the influence of external pelvic compression on mortality and outcome in cases of hemodynamically unstable pelvic fractures in a larger number of cases.

Material and methods

The current study used the TraumaRegister DGU® (TR-DGU) to retrospectively evaluate the records of 104 patients treated between 2002 and 2011. All patients suffered severe injury with an injury severity score (ISS) of at least 16 points. In addition, the patients were hemodynamically unstable with confirmed relevant isolated pelvic injuries. To evaluate the effectiveness of external pelvic compression, patients with and without external pelvic stabilization were compared.

Results

Of the investigated patients 26.9 % died of their injuries and of these the mortality was 78.6 % within the first 6 h of admission to the trauma room. External pelvic stabilization was performed in 45.2 % of patients. The mortality was 19.1 % in patients with external pelvic stabilization and in contrast, the mortality in the group of patients without external pelvic stabilization was 33.3 %. During the course of hospitalization, surviving patients with external pelvic stabilization were significantly more likely to develop sepsis or multiple organ failure and required longer periods of intensive care.

Conclusion

External pelvic stabilization seems to be an important instrument for the initial treatment of hemodynamically unstable pelvic fractures and showed a positive effect on patient mortality.

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Authors and Affiliations

  1. Orthopädie und Unfallchirurgie, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland

    E. Esmer

  2. Orthopädie und Unfallchirurgie, Johanniter-Krankenhaus Geesthacht, Geesthacht, Deutschland

    E. Esmer

  3. Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Halle, Deutschland

    P. Derst, M. Schulz, H. Siekmann & K.S. Delank

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Esmer, E., Esmer, E., Derst, P. et al. Einfluss der externen Beckenstabilisierung bei hämodynamisch instabilen Beckenfrakturen. Unfallchirurg 120, 312–319 (2017). https://doi.org/10.1007/s00113-015-0119-3

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