骨盆骨折合并腹部实质性脏器损伤的危险因素

Risk factors of pelvic bone fractures concurrent abdominal solid organ injuries

目的 分析骨盆骨折患者的疾病进展过程,评价骨盆骨折合并腹部实质性脏器损伤的危险因素.方法 将436例骨盆骨折患者分为非实质性脏器损伤组和实质性脏器损伤组,比较两组临床特征、创伤严重程度评分（ISS）、治疗方法和结果.结果 实质性脏器损伤患者在所有骨盆骨折患者中占18.3％ （80/436）;高处坠落致实质性脏器损伤患者有较高的坠落高度（P＜0.05）;实质性脏器损伤组的初次血压显著降低（P＜0.01）、ISS评分显著升高（P ＜0.05）;ISS评分增高[比值比（OR） =2.137,P＜0.05）和在急诊科即发生休克（OR=3.024,P＜0.05）是合并实质性脏器损伤的危险因素.结论 对于骨盆骨折患者,了解其外伤类型、坠空高度、评价ISS、是否合并休克有助于在第一时间判断这类患者是否合并腹部实质性脏器损伤.

Objective To evaluate the risk factors of pelvic bone fractures concurrent abdominal solid organ injuries by analyzing the clinical progression of the patients with pelvic bone fractures.Methods The clinical data of 436 patients with pelvic bone fractures were retrieved.Subjects were categorized based on injury types：solid organ versus non-solid organ.The types of injuries,clinical manifestations,treatments,injury severity scores （ISS） and clinical outcomes in the two groups were compared.Results There were 80 patients （18.3％） subjected to solid organ injury.Fall from height occurred at greater distances （P ＜ 0.05） in patients that sustained solid organ injuries.The initial blood pressure was lower （P ＜ 0.05） and the ISS were significantly higher （P ＜ 0.01） in solid organ injury group.Shock diagnosed immediately upon emergency department arrival （OR ratio =3.024,P ＜ 0.05） and the increased ISS [odds ratio（OR） =2.137,P ＜ 0.05] were the risk factors for intra-abdominal solid organ injuries in trauma patients with pelvic bone fractures.Conclusion For the patients with traumatic pelvic fracture,it will be helpful to judge whether the patient has concurrent abdominal solid organ injuries by investigating the types of injuries,falling height,ISS and initial blood pressure as soon as possible.