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骨盆创伤：初步评估与处理

Author
James Fiechtl, MD
Section Editors
Maria E Moreira, MD
Richard G Bachur, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
王冰, 副主任医师

引言

骨盆损伤的范围包括从良性损伤到威胁生命的损伤以及中间的所有损伤。包括骨盆环骨折、髋臼骨折和撕脱性损伤。大多数骨盆损伤可归因于高能量钝挫伤，尽管虚弱患者和老年患者所遭受的骨盆损伤也可能归因于低能量创伤机制(即跌倒)。高能量创伤增加了合并伤的可能性，极有可能累及腹部和盆腔脏器。

成人骨性骨盆损伤将总结在此。腹部损伤及创伤的其他方面(包括其初步处理)将单独讨论。(参见“成人腹部钝挫伤的初始评估和处理”和“成人创伤的早期处理”)

流行病学

发病率和死亡率 — 骨盆骨折约占骨骼损伤的3%[1]。骨盆骨折的总体死亡率为5%-16%不等，其中不稳定骨盆骨折的死亡率约为8%[2]。髋臼骨折相关的死亡率为3%[3]，而占全部骨盆骨折2%-4%的开放性骨盆骨折相关的死亡率却高达45%[1,2,4-6]。大多数死亡是由于伴随的内部损伤引起的；单纯由骨盆骨折所造成的死亡占创伤性死亡的0.4%-0.8%[5,7]。年龄大于65岁的骨盆骨折患者的死亡率约为20%[8]。总的说来，骨盆骨折与创伤患者的死亡风险增加相关[9,10]。

一项澳大利亚的骨盆环骨折研究表明其发病率为23/100,000人年，而一项英国的研究发现髋臼骨折的发病率为3/100,000人年[11,12]。一项纳入了2项大型创伤患者登记资料研究的综述发现，在住院的创伤患者中骨盆环骨折的发病率分别为8%和9.3%[7,13]。

骨盆骨折的危险因素包括骨量低、吸烟、既往行子宫切除、年龄较长以及有跌倒倾向[14]。年龄大于60岁对于显著骨盆骨折的患者预示发生需要血管造影术的出血的可能性更高[15,16]。

                                        

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-19.
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