| Background:Unstable pelvic fractures are mostly caused by high energy damage, such as serious traffic accidents, falling injury and industrial injury accidents.It is often associated with hemorrhagic shock and multiple organs injury, which is called severe pelvis fracture. As with massive hemorrhage, mortality rates can reach as high as25%-65%(according to statistics,80%died of early8hs after injury), The crucial aspect in early treatment is to control the active bleeding in order to treat the hemorrhagic shock. Gauze packing technology was firstly used by Logothetopulos in1926to control the hemorrhage in the open pelvic fracture; in the last century sixty, gauze packing had been used in exploratory laparotomy; In recent years gauze packing has become a common method of hemostasis of hemodynamically in unstable pelvic fractures. Osborn. et al.collectted the pelvic fractures patients treated from1998-2006year period at a level1trauma center, in the treatment of hemodynamically unstable pelvic fracture by pelvis analysis packing and angiographic, the preparation time of retroperitoneal packing required was significantly less than the embolization, Using gauze packing method,the volume of blood transfusion after operation was significantly reduced. Practice has proved, gauze packing technology can effectively control active bleeding, reduce the volume of blood transfusion, obviously reduce the early mortality.Gauze packing as an alternative method of treatment for massive hemorrhage in pelvic fracture has been successfully used in Europe trauma center more than10years, Developed retroperitoneal packing also has been gradually used in North America in recent years. It is accepted that pelvic packing technique is a rapid, effective method in the treatment of massive hemorrhage from pelvic fractures.Objective:1. Discuss the factors influenced on the mortality in patients with massive hemorrhage in pelvic fractures。2. Discuss the application.timing and efficacy of gauze packing for massive hemorrhage in pelvic fracture;3. Prevention of late complications of gauze packing.Methods:From2007December to2012December we collected15cases with gauze packing for treatment method for the massive hemorrhage from pelvic fractures in Shan-dong Provincial Hospital,, including10male,5female, the average ages is44.2years old (range from23-67),. According to AO Fracture Classification:type B12cases, type B22cases, type C15cases, type C21cases, type C35cases, all the patients were complicated by hypovolemic shock, the mean value of systolic blood pressure was70.3±4.0mmHg, heart rate for an average is113.4±6.3/min, the average value of hemoglobin is5.1±0.5g/dL, the mean injury severity scores(ISS) were40.4±7.7scores. After the treatment of anti-shock, temporary fixation with pelvic bound, in emergency descending pelvic volume control (external fixation, fixation of C type clamp or internal fixation with a steel plate) and gauze packing.Record the preoperative and postoperative blood pressures,heart rate and the volume of blood transfusion.Results:After the pelvic volume control and gauze packing, the mean systolic pressure (92.1±8.7mmHg) of15cases of patients was significantly increased compared to the preoperative systolic pressure (70.3±4.0mmHg), postoperative hemoglobin (8.7±0.3g/dL) significantly increased than that before operation (5.1±0.5g/dL), after the operation the heart rate (96±6.7/min) was significantly lower than that before the treatment (113.4±6.3/min). Blood cell transfusion before internal or external fixation and gauze packing compared with the first postoperative24hs was (7.3±1.5U) vs (14.7± 2.9U) units(P<0.05), The differences were statistically significant (P<0.05). In this group,4patients died, the mortality rate was26.7%. The time of removing the packing gauze was2.3(1～5) days. Compared to the survivors, the non-survivors had a statistically significant difference in the time from addmition to operation..Conclusion:1. Make a quick diagnosis of massive hemorrhage in patients with pelvic fractures, and use the appropriate methods to control bleeding is the key to reduce mortality;2. Gauze packing technology is a rapid and effective method in the early control of pelvic fracture bleeding;3. The key to reduce the postoperative mortality, improve the patients’ quality of life is to prevent and control the postoperative infection,... |
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