골반골절 환자에서 출혈의 정도를 반영하는 분류

황태식,손대곤,김인병,장석준 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The causes of death of pelvic bone fracture are hemorrhage, associated internal organ injuries, sepsis, and multi-organ failure, among which hemorrhage still remains as the leading cause of death. While previous classification for pelvic bone fracture was focused on orthopedic treatment, Pennel & Sutherland suggested a new classification according to the pelvis AP film took in the emergency room. Since this classification supposedly evaluates hemorrhage from pelvic bone fracture, we are reporting on the efficiency of this classification. Out of all the 150 patients admitted to Yong Dong Severance Hospital Emergency Room from 1992, Jan. through 1994, Dec. due to pelvic bone fracture, 18 people with incomplete medical record and X-ray film excluded from the study. The study was done Cohort method and t-test was used. According to the new classification, the unstable fracture had a much more bleeding amount regardless of the type, and type I stable fracture bled more than all the other stable fracture. These were statistically meaningful. Also, there was no differences in the type of fracture when ISS(Injury Severity Scale), GCS(Glasgow Coma Scale), and associated injury were compared. In conclusion, previous classification was done according to orthopedic treatment and this classification could be done only after pelvis X-ray series and pelvic bone CT was performed. Therefore much more time is consumed, more stress is put upon the patient and no comparisons can be made in performing emergency care. On the other hand, modified Pennel &-Sutherl`s classification can be simply classified in the emergency room by taking pelvis AP film only and the bleeding amount can be measured according to the type. Therefore, this classification can be helpful in performing emergency care.

방광 파열을 동반한 골반 골절

이상홍(Sang Hong Lee),송경철(Kung Chul Song),박상하(Sang Ha Park),박치형(Chi Hyoung Park),조승환(Sueng-Hwan Jo),임동훈(Dong Hoon Lim) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.3

목적: 골반 골절과 동반되어 발생하는 방광 파열에 대해 골반 골절의 손상 기전과 방광 손상의 형태 및 치료에 대해 알아보고자 하였다. 대상 및 방법: 2002년 9월부터 2011년 2월까지 골반 골절로 치료 받고 1년 이상 추시가 가능했던 방광 파열이 동반된 골반 골절 환자 56예를 대상으로 골반 골절의 손상 기전의 분류는 Young 등의 분류, 방광 파열의 형태는 복강 내 방광 손상, 복강 외 방광 손상, 복강 내, 외 방광 손상으로 분류한 후 골반 골절의 형태에 따른 방광 손상을 후향적으로 조사하여 그 연관성을 검증하고자 하였다. 결과: 방광 파열이 동반된 골반 골절 환자 56예 중 남자 34예(60.7%), 여자 22예(39.3%)였으며 평균 연령은 58.2 (19-84)세였다. 원인은 교통사고가 41예, 손상 기전은 측방 압박 손상 23예로 가장 많았으며, 해부학적 분류상 38예(67.9%)에서 치골지 골절이 발생하였다. 방광 파열은 복강 내 파열 17예, 복강 외 파열 37예, 복강 내, 외 동반 파열은 2예였으며 복강 내 파열과 복강 내, 외 동반 파열은 전 예에서, 복강 외 파열은 6예(10.7%)에서 수술이 시행되었다. 방광 파열에 대해 수술을 시행 받은 25예 중 13예에서, 방광 파열에 대해 보존적 치료를 시행했던 31예 중 5예에서 각각 골반 골절에 대해 수술을 시행하였다. 결론: 방광 파열이 동반된 골반 골절에 있어서 측방 압박 손상이 가장 많았으며 전위가 심하지 않은 골반 골절 및 저에너지 손상에서도 방광 파열은 발생하였다. Purpose: The purpose of this study was to evaluate the injury mechanism of pelvic bone fracture and injury type and treatment of bladder rupture associated with pelvic bone fracture. Materials and Methods: From September 2002 to February 2011, we treated pelvic bone fracture with bladder rupture in 56 cases with minimal follow up of one year. Each of the 56 cases was classified into groups depending on the mechanism of pelvic fracture (Young classification) and the aspect of bladder rupture (intraperitoneal rupture, extraperitoneal rupture, combined rupture) after which the relationship between the two aspects was analyzed retrospectively. Results: There were a total of 56 cases where bladder ruptures occurred in association with pelvic bone fractures; 34 patients were men and 22 patients were women. The average age was 58.2 years (range: 19-84). Traffic accidents were the main cause of pelvic bone fractures with bladder ruptures in 41 cases. The main injury mechanism was lateral compression, and pubic ramus fractures occurred in 38 cases (67.9%). Regarding the classifications of bladder ruptures, there were 17 cases of intraperitoneal rupture, 37 cases of extraperitoneal rupture, and two cases of combined rupture. Operations were performed on all cases of intraperitoneal and combined rupture and on six cases of extraperitoneal rupture. Conclusion: Lateral compression was the most common injury of bladder rupture in pelvic bone fracture. Bladder ruptures occurred even in cases where the displacement of pelvic bones was not severe and also in cases of low energy injury.

Comparison of mortality between open and closed pelvic bone fractures in Korea using 1:2 propensity score matching: a single-center retrospective study

Jaeri Yoo,Donghwan Choi,Byung Hee Kang The Korean Society of Traumatology 2024 大韓外傷學會誌 Vol.37 No.1

Purpose: Open pelvic bone fractures are relatively rare and are considered more severe than closed fractures. This study aimed to compare the clinical outcomes of open and closed severe pelvic bone fractures. Methods: Patients with severe pelvic bone fractures (pelvic Abbreviated Injury Scale score, ≥4) admitted at a single level I trauma center between 2016 and 2020 were retrospectively analyzed. Patients aged <16 years and those with incomplete medical records were excluded from the study. The patients were divided into open and closed fracture groups, and their demographics, treatment, and clinical outcomes were compared before and after 1:2 propensity score matching. Results: Of the 321 patients, 24 were in the open fracture group and 297 were in the closed fracture group. The open fracture group had more infections (37.5% vs. 5.7%, P<0.001) and longer stays in the intensive care unit (median 11 days, interquartile range [IQR] 6-30 days vs. median 5 days, IQR 2-13 days; P=0.005), but mortality did not show a statistically significant difference (20.8% vs. 15.5%, P=0.559) before matching. After 1:2 propensity score matching, the infection rate was significantly higher in the open fracture group (37.5% vs. 6.3%, P=0.002), whereas the length of intensive care unit stay (median 11 days, IQR 6-30 days vs. median 8 days, IQR 4-19 days; P=0.312) and mortality (20.8% vs. 27.1%, P=0.564) were not significantly different. Conclusions: The open pelvic fracture group had more infections than the closed pelvic fracture group, but mortality was not significantly different. Aggressive treatment of pelvic bone fractures is important regardless of the fracture type, and efforts to reduce infection are important in open pelvic bone fractures.

골반골 골절 환자의 혈역학적 불안정화에 미치는 영향요소

박승민 ( Seung Min Park ),이강현 ( Kang Hyun Lee ),최한주 ( Han Ju Choi ),박경혜 ( Kyung Hye Park ),김상철 ( Sang Chul Kim ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.1

Purpose: Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern. Methods: Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young`s classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared. Results: The mean age of the patients was 48.8±18.7, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young`s classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was 7.5±8.7 days in intensive care and 55.1±47.9 days in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007). Conclusion: The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.

응급실로 내원한 고령의 골반골절 환자의 임상 양상

황현철 ( Hyun Chul Hwang ),홍훈표 ( Hoon Pyo Hong ),김동필 ( Dong Pil Kim ),김명천 ( Myung Chun Kim ),고영관 ( Young Gwan Ko ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Purpose: This study was performed to review our experience with geriatric pelvic fracture patients in our emergency center. Methods: Pelvic bone fracture patients who visited the emergency center of Kyung Hee University Hospital and Dongsuwon General Hospital from March 2001 to July 2003 were analyzed using a retrospective medical records review. Variables included in the data analysis were demographics, injury pattern, transfusion needs, and outcome of pelvic fractures in older versus younger patients. Results: We cared for 93 patients with pelvic fractures during the study period. The mean age was 38 years, 56% were men, and the mean Injury Severity Score (ISS) was 19. Overall mortality was 13%. Seventy-five percent were younger than 55 years, and 25% were older than 55 years. Severe pelvic fractures were more common in older patients. The initial systolic blood pressure was lower and the heart rate higher in older patients, although the ISS was not different between the two age groups. Older patients were 2.2 times as likely to undergo transfusion and those undergoing transfusion, required more blood. Lateral compression (LC) fractures occurred 2.7 times more frequently in older patients than anteroposterior (AP) compression fractures. Conclusion: In older patients, pelvic fractures are more likely to produce severe complications and sequelae. Fracture patterns differ in older patients, with LC fractures occurring more frequently and commonly causing significant blood loss. The outcome for older patients with pelvic fractures is significantly worse than it is for younger patients, particularly for higher injury severity. Recognition of these differences should help clinicians to identify patients at high risk for bleeding and death early and to refine diagnostic and resuscitation strategies.

골반골절의 유형과 혈관조영술상 출혈 위치의 관계

이효민,김정호,변성수,김형식 대한영상의학회 2012 대한영상의학회지 Vol.67 No.4

Purpose: The purpose of this study is to evaluate the relationship between the patterns of pelvic bone fracture and location of hemorrhage on angiography. Materials and Methods: We retrospectively reviewed 56 patients with pelvic bone fracture and active bleeding. Fractures were classified according to Tile classification. Locations of bleedings were divided into four groups; main trunk/anterior/posterior divisions of internal iliac artery, and other locations. The relationship between the fracture pattern and bleedings were analyzed statistically. Results: Forty-one bleedings were in 22 patients with type A fracture. Twenty (49%) were at the anterior division, 12 (29%) were at the posterior division, and 9 (22%) were found in other location. Thirty-three bleedings were in 23 patients with type B fracture. Fifteen (45%) were at the posterior division, 10 (30%) were at the anterior division, 3 (9%) were at the main trunk of the internal iliac artery, and 5 (16%) were at other location. Eighteen bleedings were in 11 patients with type C fracture. Thirteen (72%) were at the posterior division, 4 (22%) were at the anterior division, and 1 (6%) was at main trunk of internal iliac artery. Anterior divisional bleedings were more common in type A, posterior divisional bleedings were more common in type B and C fractures (p = 0.014). Conclusion: The distribution of bleeding is significantly related to the fracture patterns. Fracture pattern may help in predicting the location of bleeding foci on embolization. 목적: 외상성 골반골절의 유형과 혈관조영술에서 나타난 출혈의 위치 간의 관계를 알아보고자 하였다. 대상과 방법: 골반골절을 동반한 외상 환자에서 출혈이 의심되어 혈관조영술을 시행 받은 56명의 환자를 대상으로 후향적으로 분석하였다. 골반골절은 Tile 분류법을 이용하여 분류하였다. 출혈 위치는 주내장골동맥, 내장골동맥의 앞가지 및 뒷가지 그리고 기타 위치 등 네 가지로 분류하였다. 골반골절 유형과 출혈 위치와의 관계를 통계적으로 분석하였다. 결과: A형 골반골절 환자(n = 22)에서 41개의 출혈이 있었다. 20개(49%)는 내장골동맥의 앞가지에, 12개(29%)는 뒷가지에, 9개(22%)는 기타 위치에 있었다. B형 골반골절 환자(n = 23)에서 33개의 출혈이 있었다. 15개(45%)는 내장골동맥의 뒷가지에, 10개(30%)는 앞가지에, 3개(9%)는 주내장골동맥에, 5개(16%)는 기타 위치에 있었다. C형 골반골절 환자(n = 11)에서 18개의 출혈이 있었다. 13개(72%)는 내장골동맥 뒷가지에, 4개(22%)는 앞가지에, 1개(6%)는 주내장골동맥에 있었다. A형 골반골절은 내장골동맥의 앞가지에, B형과 C형 골반골절은 내장골동맥의 뒷가지에 호발하였다(p = 0.014). 결론: 외상성 골반골절에서 발생하는 출혈의 위치는 골반골절의 유형과 연관성이 있는 것으로 생각되며 이러한 연관성은 혈관색전술 시행시 출혈 위치를 예측하는 데 유용할 것으로 생각된다.

골반골 골절의 치료

박명식 ( Myung Sik Park ),김철진 ( Chul Jin Kim ),최하영 ( Ha Young Choi ),김정렬 ( Jung Ryul Kim ),송상헌 ( Sang Heon Song ) 전북대학교 의과학연구소 2001 全北醫大論文集 Vol.25 No.2

The pelvis is a ring structure with strong ligamentous support. This support includes the symphysis pubis, the anterior and posterior sacroiliac ligaments, the strong sacrospinous and sacrotuberous ligaments. Since the pelvis is a ring, disruption of any portion of the ring is always associated with disruption of other portion of the ring. Massive pelvic disruption is an important and often life threatening injury. The authors reviewed 35 cases of unstable pelvic bone fracture treated at the Orthopedic Department of Chonbuk National University Hospital from January 1999 to April 2001. We analyzed methods of treatment and reviewed the initial management of unstable pelvic bone fractures by external fixator and radiological view of assessment of external fixation The satisfactory results of conservative treatment were 40%, and operative treatment were 75%. In unstable pelvic bone fracture, we found that anteriorly the external fixation and posterior ORIF may be the definitive treatment of unstable pelvic bone fracture.

Feasibility of Early Definitive Internal Fixation of Pelvic Bone Fractures in Therapeutic Open Abdomen

( Kyunghak Choi ),( Kwang-hwan Jung ),( Min Ae Keum ),( Sungjeep Kim ),( Jihoon T Kim ),( Kyu-hyouck Kyoung ) 대한외상학회 2020 大韓外傷學會誌 Vol.33 No.1

Purpose: Damage control laparotomy has contributed to improved survival rates for severe abdominal injuries. A large part of severe abdominal injury occurs with a concomitant pelvic bone fracture. The safety and effectiveness of internal fixation of pelvic bone fracture(s) has not been established. The aim of the present study was to evaluate infection risk in the pelvic surgical site in patients who underwent emergent abdominal surgery. Methods: This single-center retrospective observational study was based on data collected from a prospectively maintained registry between January 2015 and June 2019. Patients who underwent laparotomy and pelvic internal fixation were included. Individuals <18 and ≥80 years of age, those with no microbiological investigations, and those who underwent one-stage abdominal surgery were excluded. Comprehensive statistical comparative analysis was not performed due to the small number of enrolled patients. Results: A total of six patients met the inclusion criteria, and the most common injury mechanism was anterior-posterior compression (67%). The average duration of open abdomen was 98 hours (range, 44-198), and the time interval between abdominal closure and pelvic surgery was 98 hours. One patient (16.7%) died due to multi-organ dysfunction syndrome. Micro-organisms were identified in the abdominal surgical site in five patients (83%), with no micro-organisms in pelvic surgical sites. There was no unplanned implant removal. Conclusions: Internal fixation of pelvic bone fracture(s) could be performed in the state of open abdomen, and the advantages of early fixation may countervail the risks for cross contamination.

골반 골절 위치와 방광, 요도, 하부 위장관계 손상의 관련성

김창호 ( Chang Ho Kim ),박정배 ( Jung Bae Park ),류현욱 ( Hyun Wook Ryoo ),서강석 ( Kang Suk Seo ),서준석 ( Jun Seok Seo ),정제명 ( Jae Myung Chung ),제동욱 ( Dong Wook Je ),성애진 ( Ae Jin Sung ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purpose: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. Methods: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher`s-exact test and multiple logistic regression. Results: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). Conclusion: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts. (J Korean Soc Traumatol 2007;20:90-95)

Hip&Pelvis : CASE REPORT : Atypical Pelvic Crescent Fracture Caused by Vertical Shear Force

( Sang Eun Park ),( Se Won Lee ),( Weon Yoo Kim ),( Yong Park ) 대한고관절학회 2014 Hip and Pelvis Vol.26 No.3

The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the sacroiliac joint. This fracture represents a subset of lateral compression injury. The strong posterior ligaments of sacroiliac joint remain intact and a fracture fragment (crescent shape) involving the posterior superior iliac spines remains firmly attached to the sacrum. We report a patient with atypical pelvic crescent fracture that is mainly influenced by vertical shear injury and is characterized by posterior fracturedislocations of the sacroiliac joint. In this case report, we review the literature on classification and treatment of atypical type of crescent fracture.