Journal of orthopaedic trauma · 2015
Combat-Related Hemipelvectomy: 14 Cases, a Review of the Literature and Lessons Learned.
Клинический случайСтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
DʼAlleyrand Jean-Claude G, Lewandowski Louis R, Forsberg Jonathan A, Gordon Wade T, Fleming Mark E, Mullis Brian H, Andersen Romney C, Potter Benjamin K
Аннотация
OBJECTIVES: Trauma-related hemipelvectomy is a rare and often fatal injury that poses a number of challenges to the treating surgeon. Our objective was to identify patient and injury characteristics that have proven difficult to treat, and to describe management techniques.
DESIGN: Retrospective review.
SETTING: Level II trauma center.
PATIENTS: Thirteen consecutive patients who underwent 14 combat-related hemipelvectomies between 2001 and 2013.
INTERVENTION: We reviewed our prospective trauma registry, along with the patients' medical records, radiographs, and clinical photographs.
MAIN OUTCOME MEASUREMENTS: Injury severity scores, required surgical procedures, ambulatory status, and bowel and bladder function.
RESULTS: Hemipelvectomy was indicated for insufficient soft tissue coverage, complicated by life-threatening local infection and/or a dysvascular hemipelvis. Five patients underwent resection for angioinvasive fungal infections. All patients sustained a genitourinary injury, with 7 requiring suprapubic catheters and all undergoing diverting colostomy. After a median of 2 years of follow-up, 2 patients had normal urinary continence and 3 regained fecal continence. The surviving patients required a mean of 44 operations. One patient returned to community ambulation.
CONCLUSIONS: This is the largest published series of trauma-related hemipelvectomies. Our lessons learned may benefit civilian surgeons who are confronted with high-energy open injuries to the pelvic girdle. Although the decision to perform hemipelvectomy should not be taken lightly, this procedure can be lifesaving and should be performed in a timely fashion when indicated.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective review.
SETTING: Level II trauma center.
PATIENTS: Thirteen consecutive patients who underwent 14 combat-related hemipelvectomies between 2001 and 2013.
INTERVENTION: We reviewed our prospective trauma registry, along with the patients' medical records, radiographs, and clinical photographs.
MAIN OUTCOME MEASUREMENTS: Injury severity scores, required surgical procedures, ambulatory status, and bowel and bladder function.
RESULTS: Hemipelvectomy was indicated for insufficient soft tissue coverage, complicated by life-threatening local infection and/or a dysvascular hemipelvis. Five patients underwent resection for angioinvasive fungal infections. All patients sustained a genitourinary injury, with 7 requiring suprapubic catheters and all undergoing diverting colostomy. After a median of 2 years of follow-up, 2 patients had normal urinary continence and 3 regained fecal continence. The surviving patients required a mean of 44 operations. One patient returned to community ambulation.
CONCLUSIONS: This is the largest published series of trauma-related hemipelvectomies. Our lessons learned may benefit civilian surgeons who are confronted with high-energy open injuries to the pelvic girdle. Although the decision to perform hemipelvectomy should not be taken lightly, this procedure can be lifesaving and should be performed in a timely fashion when indicated.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.