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Journal of the Korean Society of Traumatology 2008;21(1):22-27.
Factors Affecting Hemodynamic Instability in Patients with Pelvic Bone Fracture
Seung Min Park, Kang Hyun Lee, Han Ju Choi, Kyung Hye Park, Sang Chul Kim, Hyun Kim, Sung Oh Hwang
Depatment of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea. ed119@yonsei.ac.kr
골반골 골절 환자의 혈역학적 불안정화에 미치는 영향요소
박승민·이강현·최한주·박경혜·김상철·김@ 현·황성오
연세대학교 원주의과대학 응급의학과학교실
Abstract
PURPOSE
Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern.
METHODS
Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared.
RESULTS
The mean age of the patients was 48.8+/-18.7, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was 7.5+/-8.7 days in intensive care and 55.1+/-47.9 days in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007).
CONCLUSION
The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.
Key Words: Pelvic bone fracture; Hemodynamic instability


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