Research Article
Volume 11 Issue 4 - 2020
Surgical Hemostasis for Severe Combined Pelvic Injuries
IV Kazhanov1,2, AE Demko1, VA Manukovsky1, SI Mikityuk1,2, VA Reva1,2, EA Kolchanov1 and DV Pavlov1
11Director – MD, State budgetary institution St. Petersburg Research Institute of Emergency Medicine. I.I. Dzhanelidze, St. Petersburg, Russia
22Head - Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor A.Ya. Fisun Federal State Budgetary Military Educational Institution of Higher Professional Education “Military Medical Academy. CM. Kirova ”of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
*Corresponding Author: IV Kazhanov, Director – MD, State budgetary institution St. Petersburg Research Institute of Emergency Medicine. I.I. Dzhanelidze, St. Petersburg, Russia.
Received: February 16, 2020; Published: March 23, 2020




Abstract

Introduction: For the treatment of patients with severe concomitant pelvic trauma, accompanied by intra-pelvic bleeding, many algorithms have been proposed that have different procedures for using various methods of surgical haemostasis, but not one of them can guarantee the final stop of pelvic bleeding.

The aim of the study was to assess the clinical effectiveness of the developed algorithm aimed at timely diagnosis of intra-pelvic bleeding and its final stop using various methods of surgical hemostasis in patients with severe combined pelvic trauma.

Materials and methods: The article analyses the results of treatment of 168 patients with unstable pelvic ring injuries and signs of intra-pelvic bleeding, who were treated in two trauma centers of the first level in St. Petersburg: St. Petersburg Scientific Research Institute of St. Petersburg. I.I. Dzhanelidze and the clinic of military field surgery CM. Kirova from 2010 to 2018 The victims were divided into two statistically homogeneous groups. In the comparison group (75 people), to stop intra-pelvic bleeding, the pelvic ring was mechanically stabilized in isolation by the Ganz frame or at the same time the front part of the pelvis was fixed with an external fixation device (AVF) and the continuation of the ongoing pelvic bleeding was expected due to the effect of biological tamponade. In the main group (93 people) after mechanical stabilization of the pelvic ring, various methods of surgical haemostasis were used: balloon aortic occlusion, pelvic tamponade, angiography with embolization. The choice of the method of surgical haemostasis in case of pelvic trauma depended on the severity of the victim’s condition, hemodynamic parameters, the presence of life-threatening consequences of damage to other areas of the body, the effectiveness of the previously applied method for stopping intra-pelvic bleeding.

Conclusion: The introduction of a modern diagnostic and treatment algorithm aimed at achieving the final surgical haemostasis in patients with ongoing intra-pelvic bleeding has reduced the overall mortality rate by 1.7 times, the daily mortality rate by 2.3 times and also 1.8 times reduce the duration and volume of replacement blood transfusion therapy.

Keywords: Polytrauma; Unstable Pelvic Ring Injuries; Retroperitoneal Pelvic Hematoma; Surgical Haemostasis; Ganz Frame; External Fixation; Pelvic Tamponade; Angiography and Embolization; Ileosacral Osteosynthesis

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Citation: IV Kazhanov.et al. “Surgical Hemostasis for Severe Combined Pelvic Injuries”. EC Orthopaedics 11.4 (2020): 62-77.

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