Pelvik Fraktür İle İlişkili Hemoraji Yönetimi

Hüseyin Utku Özdeş; Ekrem Özdemir

doi:10.37609/akya.3473

Yazarlar

Hüseyin Utku Özdeş

https://orcid.org/0000-0003-4437-9860

Ekrem Özdemir

https://orcid.org/0000-0002-3709-558X

DOI: https://doi.org/10.37609/akya.3473.c11104

Özet

Pelvis kırıkları yüksek enerjili travmalar sonrası oluşur ve genellikle çoklu sistem yaralanmaların bir komponentidir. Bu kırıklar mortal seyredebilir. Erken dönem ölümlerin en sık nedeni ise kanamalardır. Pelvis kırıklarını tanıma da fizik muayene ve görüntüleme yöntemleri önemlidir ve kırığa ait sınıflamalar geliştirilmiştir. Ancak kanamayı belirlemede genellikle nicel veriler yoktur ve bu sınıflamalar yetersizdir. Pelvis kırıklarına bağlı kanamalar büyük ölçüde venöz sisteme ait yapılardan kaynaklansa da arteriyel kanamalarda olabilir. Hastanın ilk değerlendirmesiyle hemodinamik stabilite belirlenir ve tedavi protokolü kanamaya göre değişir. Kırık tedavisinde primer rol ortopedistler de olsa da kanama ve hasta yaşamı söz konusu olduğunda bu hastalara multidisipliner yaklaşmak gereklidir. Yakın takip için uygun yoğun bakım şartları, acil ameliyathane odaları pelvis kırıklarına bağlı kanama yönetiminde şarttır. Kanama tedavisinde basit pelvik çarşaf uygulamalarından, anjio-embolizasyona kadar birçok yöntem bulunmaktadır. Kırık tedavisi gibi pelvis kırığına bağlı kanamaların tedavisi de zordur. Bu nedenle deneyimli merkezler ve altyapısı sağlam hastanelerde bu hastalar değerlendirilmelidir.

Pelvic fractures occur after high-energy trauma and are usually a component of multi-system injuries. These fractures may have a mortal progression. The most common cause of early death is haemorrhage. Physical examination and imaging methods are important in the recognition of pelvic fractures and fracture classifications have been developed. However, there is usually no quantitative data in determining bleeding and these classifications are insufficient. Although haemorrhage due to pelvic fractures is mostly caused by venous structures, arterial haemorrhage may also occur. Haemodynamic stability is determined by the initial assessment of the patient and the treatment protocol varies according to the bleeding. Even though orthopaedists have the primary role in the treatment of fractures, a multidisciplinary approach to these patients is necessary when bleeding and patient survival are in doubt. Appropriate intensive care conditions for close follow-up and emergency operating theatre rooms are essential in the management of bleeding due to pelvic fractures. There are many methods for the treatment of bleeding, ranging from simple pelvic sheet applications to angioembolisation. Like fracture treatment, treatment of bleeding due to pelvic fracture is also difficult. Therefore, these patients should be evaluated in experienced centers and hospitals with good infrastructure.

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