Verletzungen des Beckenrings und der Beckenorgane

Galanski, Michael

doi:10.1007/s00104-006-1226-z

Cited by 8 publications

(10 citation statements)

References 27 publications

(17 reference statements)

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“…In den Akutphasen kann auf die konventionellen Aufnahmen verzichtet werden und die Computertomographie zum Einsatz kommen (Galanski 2006). Die konventionelle Bildgebung als Beckenübersichtsaufnahme hat im Schockraum bei denjenigen Patienten einen Stellenwert, die nicht stabil genug für das CT sind.…”

Section: Diagnostikunclassified

“…Besonders ist im kleinen Becken die A. pudenda, ein Ast der A. iliaca interna sowie die Corona mortis, eine Anastomose zwischen der A. epigastrica inferior und der A. obturatoria, bei Frakturen des Schambeines betroffen (Galanski 2006;Siewert und Pichlmayr 2013).…”

Section: Blutungenunclassified

“…Die konfluierenden Hämatome können durch Ausbreitung ein Kompartementsyndrom im Bereich der Beckenmuskulatur, besonders aber im Bereich des Gesäßes, durch Frakturen des Kreuzbeines, oder seltener im M. Psoas herbeiführen (Burkhardt et al 2005;Galanski 2006). Insbesondere spielt der Retroperitonealraum für die Ausbreitung von Blutungen eine große Rolle, so dass durch sein großes Fassungsvermögen von sechs Litern, Blutungen von außen nicht erkannt werden und zum Verblutungstod führen (Siegmeth et al 2000).…”

Section: Blutungenunclassified

“…Rupturen der Harnblase sind in 10 % der Beckenfrakturen eine Begleitverletzung (Galanski 2006). Nachgewiesen wird diese mit einer retrograden Zystographie und Austritt von Kontrastmittel, einfacher im Rahmen des Polytraumas ist jedoch ein CT-Scan mittels Kontrastmittelgabe.…”

Section: Verletzungen Des Urogenitalsystemsunclassified

“…Nachgewiesen wird diese mit einer retrograden Zystographie und Austritt von Kontrastmittel, einfacher im Rahmen des Polytraumas ist jedoch ein CT-Scan mittels Kontrastmittelgabe. Man unterscheidet extraperitoneale von intraperitonealen Blasenrupturen, wobei erstere mit 80 % häufiger sind und vor allem durch vordere Beckenfrakturen verursacht werden (Galanski 2006). Intraperitoneale Rupturen findet man vor allem bei Kindern oder Erwachsenen mit stumpfem Bauchtrauma (Galanski 2006).…”

Section: Verletzungen Des Urogenitalsystemsunclassified

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Gefahren von Gefäßverletzungen bei schwerem Beckentrauma

Möller¹

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Section: Diagnostikunclassified

Section: Blutungenunclassified

Section: Verletzungen Des Urogenitalsystemsunclassified

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Gefahren von Gefäßverletzungen bei schwerem Beckentrauma

Möller¹

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The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures

Spering,

Lehmann,

Möller

et al. 2023

Eur J Trauma Emerg Surg

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Purpose The purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management. Methods To identify potential predictive factors, data were taken (1) of a Level I Trauma Centre with 467 patients (ISS ≥ 16 and AISPelvis ≥ 3). Analysis including patient’s charts and digital recordings, radiographical diagnostics, mechanism and pattern of injury as well as the vascular bleeding source was performed. Statistical analysis was performed descriptively and through inference statistical calculation. To further analyse the predictive factors and finally develop the score, a 10-year time period (2012–2021) of (2) the TraumaRegister DGU® (TR-DGU) was used in a second step. Relevant peri-pelvic bleeding in patients with AISPelvis ≥ 3 (N = 9227) was defined as a combination of the following entities (target group PVITR-DGUN = 2090; 22.7%): pelvic fracture with significant bleeding (> 20% of blood volume), Injury of the iliac or femoral artery or blood transfusion of ≥ 6 units (pRBC) prior to ICU admission. The multivariate analysis revealed nine items that constitute the pelvic vascular injury score (P-VIS). Results In study (1), 467 blunt pelvic trauma patients were included of which 24 (PVI) were presented with significant vascular injury (PVI, N = 24; control (C, N = 443). Patients with pelvic fractures and vascular injury showed a higher ISS, lower haemoglobin at admission and lower blood pressure. Their mortality rate was higher (PVI: 17.4%, C: 10.3%). In the defining and validating process of the score within the TR-DGU, 9227 patients met the inclusion criteria. 2090 patients showed significant peripelvic vascular injury (PVITR-DGU), the remaining 7137 formed the control group (CTR-DGU). Nine predictive parameters for peripelvic vascular injury constituted the peripelvic vascular injury score (P-VIS): age ≥ 70 years, high-energy-trauma, penetrating trauma/open pelvic injury, shock index ≥ 1, cardio-pulmonary-resuscitation (CPR), substitution of > 1 l fluid, intubation, necessity of catecholamine substitution, remaining shock (≤ 90 mmHg) under therapy. The multi-dimensional scoring system leads to an ordinal scaled rating according to the probability of the presence of a vascular injury. A score of ≥ 3 points described the peripelvic vascular injury as probable, a result of ≥ 6 points identified a most likely vascular injury and a score of 9 points identified an apparent peripelvic vascular injury. Reapplying this score to the study population a median score of 5 points (range 3–8) (PVI) and a median score of 2 points (range 0–3) (C) (p < 0.001). The OR for peripelvic vascular injury was 24.3 for the patients who scored > 3 points vs. ≤ 2 points. The TR-DGU data set verified these findings (median of 2 points in CTR-DGU vs. median of 3 points with in PVITR-DGU). Conclusion The pelvic vascular injury score (P-VIS) allows an initial risk assessment for the presence of a vascular injury in patients with unstable pelvic injury. Thus, the management of these patients can be positively influenced at a very early stage, prehospital resuscitation performed safely targeted and further resources can be activated in the final treating Trauma Centre.

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Aktuelle Behandlung der Beckenringfraktur

Culemann

Oestern

Pohlemann

2013

Chirurg

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Pelvic injuries are often associated with multiple injuries of other body regions, neurovascular and visceral lesions, as well as hemodynamic instability. The use of a standardized classification characterizing the severity and stability of pelvic fractures and the early stabilization of pelvic ring injuries in appreciation of damage control principles has helped to improve the number of survivors. This is particularly necessary due to the higher number of older patients.Complex pelvic trauma still represents a life-threatening situation for the patient, particularly in multiple traumatized patients. Standardized clinical investigations and modern concepts even in the preclinical therapy of complex pelvic fractures make a contribution to enhancement of treatment options. Because of the still problematic long-term results after surgery of instable pelvic fractures, the need for modern treatment concepts has to be adapted to the requirements.

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Verletzungen des Beckenrings und der Beckenorgane

Cited by 8 publications

References 27 publications

Gefahren von Gefäßverletzungen bei schwerem Beckentrauma

Gefahren von Gefäßverletzungen bei schwerem Beckentrauma

The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures

Aktuelle Behandlung der Beckenringfraktur

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