Objective: 

To quantify preoperative blood loss in isolated acetabular fractures and identify any fracture or patient characteristics associated with increased blood loss or blood transfusion.

Design: 

Retrospective cohort study.

Setting: 

Two level 1 trauma centers.

Patients/Participants: 

All patients with operative, isolated acetabular fractures from January 2010 to December 2018.

Intervention: 

Operative management of an acetabular fracture.

Main Outcome Measurements: 

Volume of preoperative blood loss and transfusion rates associated with isolated acetabular fracture patterns.

Results: 

A total of 598 patients were included. The mean preoperative blood loss of all fractures was 1172.6 mL. The 3 fracture patterns with the greatest average preoperative blood loss were associated both column (1454.9 mL), T-type (1374.8 mL), and anterior column posterior hemitransverse fractures (1317.7 mL). The acetabular fracture pattern had a significant association with preoperative blood loss and preoperative transfusion. The timing from injury to surgery and body mass index were significantly associated with preoperative blood loss.

Conclusions: 

In conclusion, operatively treated isolated acetabular fractures surprisingly lose an average of greater than 1 liter of blood in the preoperative setting. Surgeons must carefully assess patient's physiology, ensuring they are adequately resuscitated before surgery and remain aware that increasing body mass index is associated with increased preoperative blood loss. However, as patients await surgery, unreduced acetabular fractures continue to contribute to ongoing blood loss beyond the first 24 hours from injury. We believe the best hemostasis after initial resuscitation is provided by surgical reduction and fixation, and we recommend a continued early surgical intervention to prevent continued bleeding from fracture surfaces.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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孤立性髋臼骨折的术前失血

客观的： 

量化孤立性髋臼骨折的术前失血量，并确定与失血量增加或输血相关的任何骨折或患者特征。

设计： 

回顾性队列研究。

环境： 

两个一级创伤中心。

患者/参与者： 

2010 年 1 月至 2018 年 12 月期间所有接受手术的孤立性髋臼骨折患者。

干涉： 

髋臼骨折的手术治疗。

主要结果测量： 

与孤立性髋臼骨折模式相关的术前失血量和输血率。

结果： 

总共包括 598 名患者。所有骨折的术前平均失血量为 1172.6 mL。术前平均失血量最多的 3 种骨折类型与柱 (1454.9 mL)、T 型 (1374.8 mL) 和前柱后半横断骨折 (1317.7 mL) 相关。髋臼骨折类型与术前失血和术前输血显着相关。从受伤到手术的时间和体重指数与术前失血量显着相关。

结论： 

总之，手术治疗的孤立性髋臼骨折令人惊讶地在术前平均损失了超过 1 升的血液。外科医生必须仔细评估患者的生理机能，确保他们在手术前得到充分复苏，并始终意识到体重指数增加与术前失血增加有关。然而，随着患者等待手术，未复位的髋臼骨折继续导致受伤后 24 小时后的持续失血。我们认为，初始复苏后最好的止血方法是手术复位和固定，我们建议继续早期手术干预，以防止骨折面继续出血。

证据等级： 

预后等级 III。有关证据等级的完整描述，请参阅作者须知。