The analysis of modern methods of diagnosis in patients with unstable injuries of pelvis and pelvic organs at polytrauma in acute traumatic disease
DOI:
https://doi.org/10.15587/2519-4798.2017.93292Keywords:
unstable pelvis, polytrauma, pelvic organs, diagnostic methods, acute traumatic disease periodAbstract
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
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Copyright (c) 2017 Микола Львович Анкін, Володимир Володимирович Бурлука, Сергій Олександрович Король
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