Targeted interventional embolization therapy for hemorrhagic shock caused by pelvic fracture or/and acetabular fracture by a multidisciplinary team
10.3760/cma.j.cn115530-20240122-00036
- VernacularTitle:多学科协作团队模式下靶向介入栓塞治疗骨盆与髋臼骨折所致失血性休克的效果分析
- Author:
Liang LIU
1
;
Peilu SHI
;
Lang SONG
;
Liang PEI
;
Guangsheng LIU
;
Yonghong ZHANG
;
Haiyu SUN
Author Information
1. 山西医科大学第二医院骨科，太原 030000
- Keywords:
Shock, hemorrhagic;
Radiology, interventional;
Embolization, therapeutic;
Pelvis;
Acetabulum;
Fractures, bone;
Multidisciplinary team
- From:
Chinese Journal of Orthopaedic Trauma
2024;26(9):783-789
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical efficacy of targeted interventional embolization therapy by a multidisciplinary team for the hemorrhagic shock caused by acute pelvic fracture or/and acetabular fracture.Methods:A retrospective study was conducted to analyze the data of 63 patients with hemorrhagic shock caused by pelvic fracture or/and acetabular fracture who had been admitted to Department of Orthopaedics, The Second Hospital of Shanxi Medical University from January 2015 to July 2022. There were 44 males and 19 females with an age of (39.6±15.6) years, and 23 pelvic fractures, 35 acetabular fractures, and 5 pelvic and acetabular fractures. The time from injury to targeted interventional embolization therapy was 2.67 (2.00, 3.33) hours. All the patients were treated with targeted interventional embolization therapy by a multidisciplinary team involving orthopedics, interventional medicine, general surgery, and urology. The shock index and lactate level within 12 hours after therapy, 24-hour urine output, and incidence of complications 3 weeks after therapy were recorded.Results:No bleeding was found again in the 63 patients after embolization. Within 12 hours after therapy, the shock index was ≤1.0, indicating the shock was corrected. Within 12 hours after targeted interventional embolization therapy, the shock index (0.70±0.46) and lactate value [(2.03±1.35) mmol/L] in the 63 patients were significantly lower than those before therapy [(1.76±0.56) and (4.53±1.74) mmol/L] ( P<0.05). The 24-hour urine output [(50.26±20.38) mL/h] was significantly higher than that before therapy [(21.56±1.27) mL/h] ( P<0.05). Two patients experienced poor blood circulation in the distal skin of the great toe, which was relieved after treatment with blood circulation promotion and anticoagulation. Three patients developed necrosis of the hip soft tissue, which was cured after multiple times of debridement and anti-infection treatments. One patient with severe injury died from multiple organ dysfunction. Conclusions:The targeted interventional embolization therapy can not only diagnose the bleeding location in patients with hemorrhagic shock caused by pelvic fracture or/and acetabular fracture, but also timely and accurately carry out hemostatic treatment to correct shock. Moreover, a multidisciplinary team can help patients avoid multiple surgeries and decrease their pain and financial loss.
