골반골절의 분류, 동반손상 및 혈역학적 변화

조준,박찬상,유병대,이동필 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

In general, pelvic fracture carries higher mortality especially from motor veicle accident, we have retrospectively reviewed charts and radiographs of 185 patients in order to identify clinical finding, kinds of fracture, hemodynamic changes and associated injuries in patients with pelvic fractures. We attempted to classify pelvic fractures according Young classification. The following results were obtained; 1. On age and sex distribution, the pelvic fractures showed peak incidence between 2nd decade and 5th decade. Male was affected more frequently than female, the ratio being male to female, 2.6 to 1. 2. The mechamisn of injury was motor veicle accident in 155(83.8%), fall in 25(13.5%), others in 5(2.7%). 3. The associated injuries of pelvic fractures: extremity, thoracic, urinary system, intraperitoneal and head injury. 4. Of the 185 cases of the pelvic fractures, simple pelvic fractures are 101 cases(54.6%), lateral compression in 39(21.1%), anteroposterior compression in 18(9.7%), vertical shearing in 17(9.2%), mixed pattern in 10(5.4%). 5. Retroperitoneal hematoma and urinary tracts injuries were the most common associated in mixed pattern. 6. The incidence of hemodynamically unstable fractures were 19.8% in simple pelvic fracture but, as expected was higher in major pelvic ring disruptions except to acetabular fracture(52.4%) 7. Mortality rates were 5.9% in all pelvic fractures but 10.7% in major pelvic ring disruptions except to acetabular fractures. Prognostic factor in pelvic fractures were the amount of hemorrhage and associated injuries, therefore early diagnosis and management are essential to reduce the mortality in pelvic fracture.

Clinical Analysis of Pelvic Fracture in 54 Dogs

김경희,이종훈,윤헌영,정순욱 한국임상수의학회 2011 한국임상수의학회지 Vol.28 No.5

This study was conducted to describe clinical presentation of pelvic fracture and compare clinical outcomes of each part of pelvic fractures in 54 client-owned dogs. There was an average of 3.61 pelvic fractures per dog and 47 dogs had more than two fractures. The average time until initial weight-bearing on the affected leg, hospitalization after surgery, and lameness score at final check in 31 dogs that underwent surgery were 7.04 days, 16.39 days, and 1.25, respectively, and there were no significant difference in the incidence of sacroiliac luxation, iliac fracture, and acetabular fracture among them. The length of hospitalization and the lameness score upon final check of the dogs with over two surgically repaired sites were significantly longer and higher than those of the dogs with one surgically repaired site (P = .043 and P = .008, respectively). Upon final check of the dogs with bilateral pelvic fracture that was surgically treated, the hospitalization and lameness score were significantly longer and higher than those of dogs with unilateral pelvic fracture that was surgically treated (P = .034 and P = .033), respectively. The number of pelvic fractures treated surgically appears to be a more influential factor influencing recovery from pelvic fractures than the location of the pelvic fractures.

골반 골절 환자에 있어서 골절 위치에 따른 하부 요로 손상의 연관성

신대은,문형윤,박성운,노준 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.3

Background and Objectives: Lower urinary tract injuries in pelvic bone fracture can lead to significant complication. We tried to find out the relationship between the fracture location and the bladder, urethra injury in patients who sustaining pelvic bone fracture. We thought that the fracture locations could serves as markers for injury. Materials and Methods: A clinical study was made on 43 patients who sustaining pelvic bone fracture with bladder or urethra injury in the Chosun University hospital during the period of 5 years from January, 2002 to December 2006. Diagnosis was done by retrograde cystography, retrograde urethragraphy, abdomenpelvic computed tomography. Results: Of the 43 patients reviewed, 27 patients had intraperitoneal type bladder rupture, and 12 patients had extra-peritoneal type bladder rupture. 9 patients had urethral rupture. Intraperitoneal type bladder rupture cases are most commonly associated with infrapubic ramus, suprapubic ramus and acetabulum. but the statistically significance is abscent (p= 0.642). Also extraperitoneal type bladder rupture cases are most commonly associated with infrapubic ramus, suprapubic ramus and acetabulum. but the statistically significance is abscent (p= 0.548). And all type bladder rupture cases are most commonly associated with infrapubic ramus, suprapubic ramus and acetabulum. but the statistically significance is abscent (p= 0.775). And urethral rupture cases are most commonly associated with infrapubic ramus, suprapubic ramus and acetabulum but the statistically significance is abscent (p= 0.528). Lastly, Combineded bladder rupture and urethral rupture cases are most commonly associated with infrapubic ramus, llium, Symphysis pubis. But the statistically significance is abscent (p= 0.462). Conclusions: In our study when there is a pelvic bone fracture, the fractured site of pelvic bone have no statistically association with lower urinary tract injury. But most common pelvic bone fracture site of all lower urinary tract injury cases is infrapubic ramus. Therefore, if infrapubic ramus fracture is found in the condition of pelvic bone fracture, it is highly likely to have lower urinary tract injury. More careful observation and diagnosis is necessary for this case.

Nested Case Control Study on the Risk of Suicide Death in Elderly Patients with Pelvic Fractures Using a Nationwide Cohort

Suk-Yong Jang,차용한,김갑중,김하용,Won-Sik Choy,Kyung-Hoi Koo 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.3

Background: The aim of this study was to investigate the incidence rate of suicide deaths in elderly patients with pelvic fractures using a nationwide database and to analyze change in the risk of suicide death overtime after pelvic fractures compared to controls. Methods: We used the National Health Insurance Service-Senior cohort (NHIS-Senior) of South Korea. Cases and controls were matched for sex, age, history of hospital admission within 1 year, and presence of depression on the date of suicide death. Controls were collected by random selection at a 1 : 5 ratio from patients at risk of becoming cases when suicide cases were collected. Incident pelvic fractures were identified from the NHIS-Senior as follows: first admission during the observational period (2002–2015) to an acute care hospital with a diagnostic code of International Statistical Classification of Diseases and Related Health Problems, 10th revision S321, S322, S323, S324, S325, or S328 and age 65–99 years. Conditional logistic regression analysis was performed to evaluate the association between pelvic fractures and the risk of suicide death. Results: A total of 2,863 suicide cases and 14,315 controls were identified. Suicide case patients had been more frequently exposed to steroids (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.21–1.45), benzodiazepines (OR, 1.76; 95% CI, 1.61–1.93), and non-steroidal anti-inflammatory drugs (OR, 1.18; 95% CI, 1.07–1.29). Pelvic fractures within 1 year from the date of suicide death were statistically significantly associated with increased risk of suicide (adjusted OR [AOR], 2.65; 95% CI, 1.29–5.45; p = 0.008) compared to controls. The risk of suicide death declined as the incidence date of pelvic fracture was more remote from the date of suicide death: AORs of 2.59 (95% CI, 1.33–5.04; p = 0.005) within 2 years and 2.13 (95% CI, 1.15–3.95; p = 0.017) within 3 years. However, there was no statistical significance in the increased risk of suicide death for pelvic fractures that had occurred ≥ 4 years ago (p > 0.05). Conclusions: Pelvic fractures in the elderly population increased the risk of suicide death within 3 years, suggesting the need for psychiatric support among elderly patients with pelvic fractures.

골반골 골절 환자의 혈역학적 불안정화에 미치는 영향요소

박승민 ( Seung Min Park ),이강현 ( Kang Hyun Lee ),최한주 ( Han Ju Choi ),박경혜 ( Kyung Hye Park ),김상철 ( Sang Chul Kim ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.1

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.

응급실로 내원한 고령의 골반골절 환자의 임상 양상

황현철 ( Hyun Chul Hwang ),홍훈표 ( Hoon Pyo Hong ),김동필 ( Dong Pil Kim ),김명천 ( Myung Chun Kim ),고영관 ( Young Gwan Ko ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Purpose: This study was performed to review our experience with geriatric pelvic fracture patients in our emergency center. Methods: Pelvic bone fracture patients who visited the emergency center of Kyung Hee University Hospital and Dongsuwon General Hospital from March 2001 to July 2003 were analyzed using a retrospective medical records review. Variables included in the data analysis were demographics, injury pattern, transfusion needs, and outcome of pelvic fractures in older versus younger patients. Results: We cared for 93 patients with pelvic fractures during the study period. The mean age was 38 years, 56% were men, and the mean Injury Severity Score (ISS) was 19. Overall mortality was 13%. Seventy-five percent were younger than 55 years, and 25% were older than 55 years. Severe pelvic fractures were more common in older patients. The initial systolic blood pressure was lower and the heart rate higher in older patients, although the ISS was not different between the two age groups. Older patients were 2.2 times as likely to undergo transfusion and those undergoing transfusion, required more blood. Lateral compression (LC) fractures occurred 2.7 times more frequently in older patients than anteroposterior (AP) compression fractures. Conclusion: In older patients, pelvic fractures are more likely to produce severe complications and sequelae. Fracture patterns differ in older patients, with LC fractures occurring more frequently and commonly causing significant blood loss. The outcome for older patients with pelvic fractures is significantly worse than it is for younger patients, particularly for higher injury severity. Recognition of these differences should help clinicians to identify patients at high risk for bleeding and death early and to refine diagnostic and resuscitation strategies.

골반 골절에 한방재활치료를 적용한 증례 보고 및 보존적 치료에 대한 국내 문헌 분석

하현주 ( Hyun Ju Ha ),구지향 ( Ji Hyang Gu ),최봉석 ( Bong Seok Choi ),오태영 ( Tae Young Oh ),오은미 ( Eun Mi Oh ),이옥진 ( Yu-chen Li ),오민석 ( Min-seok Oh ) 대한한의학회 한방재활의학과학회 2018 한방재활의학과학회지 Vol.28 No.2

The objective of this study is to investigate conservative treatment of pelvic fracture, and report that Korean rehabilitation treatment is effective for pelvic fracture. We reported a case about pelvic fracture treated with Korean rehabilitation treatment. We searched 10 domestic electronic databases to find reports on conservative treatment of pelvic fracture. We selected and analyzed 12 studies. In this case, pain, range of motion, and Oswestry Disability Index of patient were improved by Korean rehabilitation treatment. In analysis, traction, pelvic sling, hip spica cast, pelvic belt, medication are used in western medical treatment. Acupuncture, herbal medicine, cupping, moxibustion, physical therapy, manual therapy are used in Korean medical treatment. Most of conservative treatments are effective for pain, bone union, osteoporosis, dysfunction. In this study, we expect further study of Korean rehabilitation treatment program for pelvic fracture to compensate existing conservative treatment. (J Korean Med Rehabil 2018;28(2):135-148)

방광 파열을 동반한 골반 골절

이상홍(Sang Hong Lee),송경철(Kung Chul Song),박상하(Sang Ha Park),박치형(Chi Hyoung Park),조승환(Sueng-Hwan Jo),임동훈(Dong Hoon Lim) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.3

목적: 골반 골절과 동반되어 발생하는 방광 파열에 대해 골반 골절의 손상 기전과 방광 손상의 형태 및 치료에 대해 알아보고자 하였다. 대상 및 방법: 2002년 9월부터 2011년 2월까지 골반 골절로 치료 받고 1년 이상 추시가 가능했던 방광 파열이 동반된 골반 골절 환자 56예를 대상으로 골반 골절의 손상 기전의 분류는 Young 등의 분류, 방광 파열의 형태는 복강 내 방광 손상, 복강 외 방광 손상, 복강 내, 외 방광 손상으로 분류한 후 골반 골절의 형태에 따른 방광 손상을 후향적으로 조사하여 그 연관성을 검증하고자 하였다. 결과: 방광 파열이 동반된 골반 골절 환자 56예 중 남자 34예(60.7%), 여자 22예(39.3%)였으며 평균 연령은 58.2 (19-84)세였다. 원인은 교통사고가 41예, 손상 기전은 측방 압박 손상 23예로 가장 많았으며, 해부학적 분류상 38예(67.9%)에서 치골지 골절이 발생하였다. 방광 파열은 복강 내 파열 17예, 복강 외 파열 37예, 복강 내, 외 동반 파열은 2예였으며 복강 내 파열과 복강 내, 외 동반 파열은 전 예에서, 복강 외 파열은 6예(10.7%)에서 수술이 시행되었다. 방광 파열에 대해 수술을 시행 받은 25예 중 13예에서, 방광 파열에 대해 보존적 치료를 시행했던 31예 중 5예에서 각각 골반 골절에 대해 수술을 시행하였다. 결론: 방광 파열이 동반된 골반 골절에 있어서 측방 압박 손상이 가장 많았으며 전위가 심하지 않은 골반 골절 및 저에너지 손상에서도 방광 파열은 발생하였다. Purpose: The purpose of this study was to evaluate the injury mechanism of pelvic bone fracture and injury type and treatment of bladder rupture associated with pelvic bone fracture. Materials and Methods: From September 2002 to February 2011, we treated pelvic bone fracture with bladder rupture in 56 cases with minimal follow up of one year. Each of the 56 cases was classified into groups depending on the mechanism of pelvic fracture (Young classification) and the aspect of bladder rupture (intraperitoneal rupture, extraperitoneal rupture, combined rupture) after which the relationship between the two aspects was analyzed retrospectively. Results: There were a total of 56 cases where bladder ruptures occurred in association with pelvic bone fractures; 34 patients were men and 22 patients were women. The average age was 58.2 years (range: 19-84). Traffic accidents were the main cause of pelvic bone fractures with bladder ruptures in 41 cases. The main injury mechanism was lateral compression, and pubic ramus fractures occurred in 38 cases (67.9%). Regarding the classifications of bladder ruptures, there were 17 cases of intraperitoneal rupture, 37 cases of extraperitoneal rupture, and two cases of combined rupture. Operations were performed on all cases of intraperitoneal and combined rupture and on six cases of extraperitoneal rupture. Conclusion: Lateral compression was the most common injury of bladder rupture in pelvic bone fracture. Bladder ruptures occurred even in cases where the displacement of pelvic bones was not severe and also in cases of low energy injury.

골반골절 환자에서 출혈의 정도를 반영하는 분류

황태식,손대곤,김인병,장석준 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The causes of death of pelvic bone fracture are hemorrhage, associated internal organ injuries, sepsis, and multi-organ failure, among which hemorrhage still remains as the leading cause of death. While previous classification for pelvic bone fracture was focused on orthopedic treatment, Pennel & Sutherland suggested a new classification according to the pelvis AP film took in the emergency room. Since this classification supposedly evaluates hemorrhage from pelvic bone fracture, we are reporting on the efficiency of this classification. Out of all the 150 patients admitted to Yong Dong Severance Hospital Emergency Room from 1992, Jan. through 1994, Dec. due to pelvic bone fracture, 18 people with incomplete medical record and X-ray film excluded from the study. The study was done Cohort method and t-test was used. According to the new classification, the unstable fracture had a much more bleeding amount regardless of the type, and type I stable fracture bled more than all the other stable fracture. These were statistically meaningful. Also, there was no differences in the type of fracture when ISS(Injury Severity Scale), GCS(Glasgow Coma Scale), and associated injury were compared. In conclusion, previous classification was done according to orthopedic treatment and this classification could be done only after pelvis X-ray series and pelvic bone CT was performed. Therefore much more time is consumed, more stress is put upon the patient and no comparisons can be made in performing emergency care. On the other hand, modified Pennel &-Sutherl`s classification can be simply classified in the emergency room by taking pelvis AP film only and the bleeding amount can be measured according to the type. Therefore, this classification can be helpful in performing emergency care.

Comparison of mortality between open and closed pelvic bone fractures in Korea using 1:2 propensity score matching: a single-center retrospective study

Jaeri Yoo,Donghwan Choi,Byung Hee Kang The Korean Society of Traumatology 2024 大韓外傷學會誌 Vol.37 No.1

Purpose: Open pelvic bone fractures are relatively rare and are considered more severe than closed fractures. This study aimed to compare the clinical outcomes of open and closed severe pelvic bone fractures. Methods: Patients with severe pelvic bone fractures (pelvic Abbreviated Injury Scale score, ≥4) admitted at a single level I trauma center between 2016 and 2020 were retrospectively analyzed. Patients aged <16 years and those with incomplete medical records were excluded from the study. The patients were divided into open and closed fracture groups, and their demographics, treatment, and clinical outcomes were compared before and after 1:2 propensity score matching. Results: Of the 321 patients, 24 were in the open fracture group and 297 were in the closed fracture group. The open fracture group had more infections (37.5% vs. 5.7%, P<0.001) and longer stays in the intensive care unit (median 11 days, interquartile range [IQR] 6-30 days vs. median 5 days, IQR 2-13 days; P=0.005), but mortality did not show a statistically significant difference (20.8% vs. 15.5%, P=0.559) before matching. After 1:2 propensity score matching, the infection rate was significantly higher in the open fracture group (37.5% vs. 6.3%, P=0.002), whereas the length of intensive care unit stay (median 11 days, IQR 6-30 days vs. median 8 days, IQR 4-19 days; P=0.312) and mortality (20.8% vs. 27.1%, P=0.564) were not significantly different. Conclusions: The open pelvic fracture group had more infections than the closed pelvic fracture group, but mortality was not significantly different. Aggressive treatment of pelvic bone fractures is important regardless of the fracture type, and efforts to reduce infection are important in open pelvic bone fractures.