Open pelvic fractures – results of a multi-institutional study
Sažetak
Uvod/Cilj. Otvoreni prelomi karličnog prstena su retke razorne povrede, sa velikom smrtnošću. Vodeći razlozi smrtnosti su: krvarenje, infekcija i udružene povrede. Cilj rada bio je da se ukaže na metode zbrinjavanja tih povreda i veliki broj prognostičkih faktora smrtnosti. Metode. U periodu od 2011. do 2015. godine, lečen je 221 pacijent sa prelomom karličnog prstena u tri velika klinička centra Srbije, a 13 (5%) pacijenata imalo je otvoreni tip preloma. Prelomi karličnog prstena su klasifikovani prema Young-Burgess klasifikaciji. Povrede smo podelili prema Gustilo klasifikaciji na povrede I, II i III stepena, a lokalizacija im je određena prema Faringer kalsifikaciji u zone I, II i III. Praćene su urogenitalne i intraabdominalne povrede, a težina povreda određivana je prema Severity score injury (ISS) i Trauma skoru (TS). Rezultati. Istraživanjem je obuhvaćeno 6 (46%) žena i 7 (54%) muškaraca prosečne starosti od 41 godine (13–76). Dominirale su povrede zadobijene u saobraćajnim udesima. Najčešći načini nastajanja preloma karličnog prstena bili su antero-posteriorna kompresija – 6 (46%), lateralna kompresija – 4 (31%) i vertikalana sila kod 3 (23%) bolesnika. Dominirale su povrede tipa I i II po Gustilo klasifikaciji i zona I po Faringer klasifikaciji. Bilo je 6 (46%) pacijenata sa urogenitalnim povredama, a isti broj i sa intra-abdominalnim povredama, od kojih je kod njih 3 (23%) urađena resekcija kolona. Zbog obilne hemoragije i hipovolemijskog šoka umrla su 2 pacijenta, a još jedan posle tri dana, zbog sepse i multisistemskog organskog poremećaja. Zaključak. Otvoreni prelomi karlice imaju veliku stopu smrtnosti, a tome doprinose: krvarenje, infekcija, prateće povrede abdomena i genitourinarnog trakta, ISS > 25, TS < 8 i starost > 65 godina.
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