The analysis of modern methods of diagnosis in patients with unstable injuries of pelvis and pelvic organs at polytrauma in acute traumatic disease

Authors

DOI:

https://doi.org/10.15587/2519-4798.2017.93292

Keywords:

unstable pelvis, polytrauma, pelvic organs, diagnostic methods, acute traumatic disease period

Abstract

The aim of research was improvement of the diagnostic program in patients with unstable injuries of pelvis and pelvic organs at polytrauma based on the trauma severity estimation for the choice of the optimal surgical therapeutic approach in acute traumatic disease period.

Materials and methods. The analysis of the diagnostic programs in acute traumatic disease period in 406 patients with unstable injuries of pelvis at polytrauma, who were taken to the Kyiv city clinical emergency hospital, was carried out. 249 (61.3 %) of them died, and 157 (38.7 %) of them survived. Pelvic organs were injured in 98 (24.1 %) cases (in 47 (29.9 %) cases – in survivors, and in 51 (20.5 %) cases – in dead patients). According to the Pape HC., Krettek C. (2003) scale, all patients were divided into three groups: boundary condition (minor injury, ISS 17–25 points), unstable condition (severe injury, ISS 26–40 points), critical condition (very severe trauma, ISS more, than 40 points). We used general clinical, laboratory, ray (X-ray research, retrograde contrast uretra cystography, spiral CT, ultrasonography in the abridged version), and instrumental methods.

Results. In the acute trauma period in patients with unstable injuries of pelvis at polytrauma depending on the severity of trauma, ray diagnostic methods were carried out in the following order: plain radiography of pelvis, multi projection oblique, spiral CT (at stable hemodynamic). In unstable and critical patients (ISS 26–40, more, than 40 points), plain radiography of pelvis is complemented by ultrasonography in the abridged version, which together with the data of clinical examination confirms pelvic ring instability in 67.9 % of cases. The scheme of diagnostic studies in patients with unstable injuries of pelvis at polytrauma considering the severity of trauma allowed reducing the time for patients in unstable condition examination to 13.7±3.5 minutes, for patients in critical condition – to 16.7±4.1 minutes. Informational content of the measures with a minimum amount was 52.3 %, with shorten amount – 75.4 %, with full amount – 92.1 %.

The obtained results made it possible to develop the scheme of ray diagnostic of pelvic ring, as well as to reduce the time for detection of injuries of pelvic organs in patients in unstable and critical conditions, which determined the surgical therapeutic approach in acute traumatic disease period

Author Biographies

Nikolai Ankin, Shupyk National medical academies of Postgraduate Education Dorogozhytska str., 9, Kyiv, Ukraine, 04112

MD, Professor, Head of Department

Department of traumatology and orthopaedy No 2

Vladimir Burluka, Ukrainian military medical academy Melnikova str., 24, Kyiv, Ukraine, 04655

PhD, associate professor

Department of military surgery 

Sergey Korol, Ukrainian military medical academy Melnikova str., 24, Kyiv, Ukraine, 04655

PhD, associate professor

Department of military surgery 

References

  1. Аnkin, L. N., Аnkin, N. L. (2008). Povrezhdeniya taza i perelomy vertluzhnoj vpadiny. Kyiv: Kniga plyus, 216.
  2. Ankin, L. N., Baramiya, N. N., Kukuruz, Ya. S. (2006). Standartizaciya xirurgicheskogo lecheniya povrezhdenij tazovoj oblasti u postradavshix s politravmoj. Problemi vіjskovoi oxoroni zdorov’ya, 392–398.
  3. Borozda, I. V., Voronin, N. S., Bushmanov, A. V. (2009). Lechenie sochetannyx povrezhdenij taza. Vladivostok: Dalnauka DVO RAN, 200.
  4. Culemann, U., Scola, A., Tosounidis, G., Pohlemann, T., Gebhard, F. (2010). Versorgungskonzept der Beckenringverletzung des alten Patienten. Der Unfallchirurg, 113 (4), 258–271. doi: 10.1007/s00113-010-1762-3
  5. Hauschild, O., Strohm, P. C., Culemann, U., Pohlemann, T., Suedkamp, N. P., Koestler, W., Schmal, H. (2008). Mortality in Patients With Pelvic Fractures: Results From the German Pelvic Injury Register. The Journal of Trauma: Injury, Infection, and Critical Care, 64 (2), 449–455. doi: 10.1097/ta.0b013e31815982b1
  6. Letournel, E., Judet, R.; Elson, R. A. (Ed.) (1993). Fractures of the Acetabulum. Berlin: Springer Verlag, 733. doi: 10.1007/978-3-642-75435-7
  7. Tile, M., Helfet, D. L., Kellam, J. F. (2003). Fractures of the pelvis and acetabulum. Philadelphia: Lippincott Williams & Wilkins, 822.
  8. Borozda, I. V. (2009). Kompleksnaya diagnostika sochetannyx povrezhdenij taza, proektirovanie i upravlenie konstrukciyami vneshnej fiksacii. Yakutsk, 37.
  9. Heetveld, M. J., Harris, I., Schlaphoff, G., Sugrue, M. (2004). Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ Journal of Surgery, 74 (7), 520–529. doi: 10.1111/j.1445-2197.2004.03074.x
  10. Rzaev, R. S. (2010). Lechenie povrezhdenij taza s narusheniem celostnosti ego kolca u postradavshix s shokogennoj travmoj. Saint Petersburg, 29.
  11. Yerasimides, J., Roberts, C. S. (2005). Pelvic fractures and genitourinary injuries. Current Orthopaedics, 19 (5), 354–361. doi: 10.1016/j.cuor.2005.09.004
  12. Rindenko, S. V. (2007). Dіagnostika ta lіkuvannya perelomіv kіstok taza v postrazhdalix іz polіtravmoyu. Medicina neotlozhnyx sostoyanij, 5 (12), 20–25.
  13. Sokolov, V. A., Byalik, E. I., Smolyar, A. N., Garaev, D. A., Evstygneev, D. V., Fajn, A. M. (2011). Taktika lecheniya nestabilnyx povrezhdenij tazovogo kolca u postradavshix s politravmoj na reanimacionnom etape. Skoraya medicinskaya pomoshh, 1, 62–66.
  14. Glumcher, F. S., Fomin, P. D., Pedachenko, E. K. (Eds.) (2012). Politravma: xirurgiya, travmatologiya, anesteziologiya, intensivnaya terapiya. Kyiv: VSI «Medicina», 736.
  15. Sokolov, V. A. (2006). Mnozhestvennye i sochetannye travmy. Moscow: GEOTAR Media, 512.
  16. Culemann, U., Burkhardt, M., Knopp, W. (2012). Emergency Treatment of Pelvic Fractures. German medical journal, 14, 15–31.
  17. Dyatlov, M. M. (2003). Neotlozhnaya i srochnaya pomoshh pri tyazhelyx travmax taza. Gomel: IMMS NAN Belarusi, 296.
  18. Klimovickij, V. G., Lobanov, G. V., Xudobin, V. Yu. (2011). Diagnostika i lechenie slozhnoj travmy taza: stereotipy, problemy i perspektivy. Zdorov’ya Ukraini, 3 (6), 49–51.
  19. Runkov, A. V., Shlykov, I. L. (2009). Poliproekcionnaya rentgenografiya pri povrezhdeniyax taza. Ekaterinburg: Medicinskaya texnologiya, 39.
  20. Treshhev, V. S. (1967). Lokalizaciya i rasprostranenie gematom pri razryvax krestcovo-podvzdoshnyx sochlenenij i perelomax krestca. Klinicheskaya xirurgiya, 10, 61–65.
  21. Pape, H.-C., Krettek, C. (2003). Frakturversorgung des Schwerverletzten – Einfluss des Prinzips der “verletzungsadaptierten Behandlungsstrategie” (“damage control orthopaedic surgery”). Der Unfallchirurg, 106 (2), 87–96. doi: 10.1007/s00113-003-0580-2
  22. Kazhanov, I. V., Manukovskij, V. A., Tyurin, M. V. (2012). Mnogoetapnaya xirurgicheskaya taktika pri lechenii postradavshix s povrezhdeniem krestca. Medyko-byologycheskye y socyal'no-psyhologycheskye problemi bezopasnosty v chrezvichajnih sytuacyjah, 2, 38–47.

Published

2017-02-28

How to Cite

Ankin, N., Burluka, V., & Korol, S. (2017). The analysis of modern methods of diagnosis in patients with unstable injuries of pelvis and pelvic organs at polytrauma in acute traumatic disease. ScienceRise: Medical Science, (2 (10), 7–14. https://doi.org/10.15587/2519-4798.2017.93292

Issue

Section

Medical Science