当院での骨盤骨折における経カテーテル的動脈塞栓術（TAE）症例の検討
目的：骨盤骨折に対しTranscatheter Arterial Embolization（以下TAE）を施行した症例について検討した．対象と方法：2010年１月から2013年12月の間で，骨盤骨折に対して緊急TAEを施行した24症例について，診療録から各項目を後方視的に調査し，生存群と死亡群間での有意差を統計学的に比較した．結果：凝固異常，アシドーシス，循環不安定，遷延するショックを伴っており，また骨盤骨折部位以外の後腹膜出血を合併する症例が死亡群には有意に多かった．非選択的塞栓術は50％に施行されていたが，局所合併症は認めなかった．損傷血管は，内腸骨動脈領域が88％を占めており，２枝以上の...
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| Published in | Journal of the Japanese Association for the Surgery of Trauma Vol. 29; no. 3; pp. 348 - 354 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本外傷学会
2015
The Japanese Association for the Surgery of Trauma |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.29.348 |
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| Abstract | 目的：骨盤骨折に対しTranscatheter Arterial Embolization（以下TAE）を施行した症例について検討した．対象と方法：2010年１月から2013年12月の間で，骨盤骨折に対して緊急TAEを施行した24症例について，診療録から各項目を後方視的に調査し，生存群と死亡群間での有意差を統計学的に比較した．結果：凝固異常，アシドーシス，循環不安定，遷延するショックを伴っており，また骨盤骨折部位以外の後腹膜出血を合併する症例が死亡群には有意に多かった．非選択的塞栓術は50％に施行されていたが，局所合併症は認めなかった．損傷血管は，内腸骨動脈領域が88％を占めており，２枝以上の多発動脈損傷は75％と高率に認めた．骨折型と損傷血管とに相関関係はなかった．結語：全身状態とCTなどの画像評価を確実に行い，他部位の出血を過小評価せず，短時間で有効なTAEを施行することが重要である． |
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| AbstractList | 目的：骨盤骨折に対しTranscatheter Arterial Embolization（以下TAE）を施行した症例について検討した．対象と方法：2010年１月から2013年12月の間で，骨盤骨折に対して緊急TAEを施行した24症例について，診療録から各項目を後方視的に調査し，生存群と死亡群間での有意差を統計学的に比較した．結果：凝固異常，アシドーシス，循環不安定，遷延するショックを伴っており，また骨盤骨折部位以外の後腹膜出血を合併する症例が死亡群には有意に多かった．非選択的塞栓術は50％に施行されていたが，局所合併症は認めなかった．損傷血管は，内腸骨動脈領域が88％を占めており，２枝以上の多発動脈損傷は75％と高率に認めた．骨折型と損傷血管とに相関関係はなかった．結語：全身状態とCTなどの画像評価を確実に行い，他部位の出血を過小評価せず，短時間で有効なTAEを施行することが重要である． Objective : We evaluated the cases that underwent transcatheter arterial embolization (TAE) for pelvic fracture at our department. Methods : Using medical records from January 2010 to December 2013, we examined 24 cases that were treated by urgent TAE for pelvic fracture and analyzed the significance of differences between the survival group and the non-survival group statistically. Results : The non-survival group was significantly accompanied by acidosis, coagulopathy, unstable hemodynamics, and prolonged hemorrhagic shock. There were significantly more cases with retroperitoneal bleeding at other sites in the non-survival group. Nonselective embolization was performed in 50%, but there were no local complications. As for the location of extravasation, internal iliac artery constituted 88%, but the rate of multiple extravasation at more than 2 vessels was 75%. There was no correlation between pelvic fracture type and the location of extravasation. Conclusions : It is important that we initially perform evaluation of the general condition and imaging diagnosis, after which we must perform effective TAE in a short time without underestimating the bleeding at other sites. 目的：骨盤骨折に対しTranscatheter Arterial Embolization（以下TAE）を施行した症例について検討した．対象と方法：2010年１月から2013年12月の間で，骨盤骨折に対して緊急TAEを施行した24症例について，診療録から各項目を後方視的に調査し，生存群と死亡群間での有意差を統計学的に比較した．結果：凝固異常，アシドーシス，循環不安定，遷延するショックを伴っており，また骨盤骨折部位以外の後腹膜出血を合併する症例が死亡群には有意に多かった．非選択的塞栓術は50％に施行されていたが，局所合併症は認めなかった．損傷血管は，内腸骨動脈領域が88％を占めており，２枝以上の多発動脈損傷は75％と高率に認めた．骨折型と損傷血管とに相関関係はなかった．結語：全身状態とCTなどの画像評価を確実に行い，他部位の出血を過小評価せず，短時間で有効なTAEを施行することが重要である． |
| Author | 大場, 次郎 一柳, 裕司 甲斐, 達朗 澤野, 宏隆 林, 靖之 |
| Author_FL | KAI Tatsuro SAWANO Hirotaka ICHIYANAGI Hiroshi HAYASHI Yasuyuki OBA Jiro |
| Author_FL_xml | – sequence: 1 fullname: OBA Jiro – sequence: 2 fullname: SAWANO Hirotaka – sequence: 3 fullname: ICHIYANAGI Hiroshi – sequence: 4 fullname: HAYASHI Yasuyuki – sequence: 5 fullname: KAI Tatsuro |
| Author_xml | – sequence: 1 fullname: 澤野, 宏隆 organization: 大阪府済生会千里病院千里救命救急センター – sequence: 1 fullname: 一柳, 裕司 organization: 大阪府済生会千里病院千里救命救急センター – sequence: 1 fullname: 林, 靖之 organization: 大阪府済生会千里病院千里救命救急センター – sequence: 1 fullname: 甲斐, 達朗 organization: 大阪府済生会千里病院千里救命救急センター – sequence: 1 fullname: 大場, 次郎 organization: 大阪府済生会千里病院千里救命救急センター |
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| Copyright | 2015 一般社団法人 日本外傷学会 |
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| DocumentTitleAlternate | PELVIC FRACTURES IN PATIENTS TREATED BY TRANSCATHETER ARTERIAL EMBOLIZATION (TAE) AT A SINGLE HOSPITAL |
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| References | 8) 戸張佳子, 佐々木了, 川野健一, ほか : 骨盤骨折と動脈損傷の関連性. 整・災外 2009 ; 52 : 1677-1684. 9) Durkin A, Sagi HC, Durham R, et al : Contemporary management of pelivic fractures. Am J Surg 2006 ; 192 : 211-223. 11) Dondelinger RF, Trotteur G, Ghaye B, et al : Traumatic injuries : radiological hemostatic intervention at admission. Eur Radiol 2002 ; 12 : 979-993. 1) Biffl WL, Smith WR, Moore EE, et al : Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg 2001 ; 233 : 843-850. 3) Cothren CC, Osborn PM, Moore EE, et al : Preperitonal pelvic packing for hemodynamically unstable pelvic fractures : a paradigm shift. J Trauma 2007 ; 62 : 834-842. 19) Perez JV, Hughes TM, Bowers K : Angiographic embolization in pelvic fracture. Injury 1998 ; 29 : 187-191. 21) Loeffler BJ, Scannell BP, Bosse MJ, et al : Indications and complications of angiography and embolization in the management of high-energy pelvic ring injuries. 24th annual meeting of Orthopaedic Trauma Association 2008 : 161-162. 6) Velmahos GC, Toutouzas KG, Vassiliu P, et al : A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 2002 ; 52 : 303-308. 10) Hagiwara A, Minakawa K, Fukushima H, et al : Predictors of death in patients with life-threatening pelvic hemorrhage after successful transcatheter arterial embolization. J Trauma 2003 ; 55 : 696-703. 14) Suzuki T, Shindo M, Kataoka Y, et al : Clinical characteristics of pelvic fracture with gluteal necrosis resulting from transcather arterial embolization. Arch Orthop Tratuna Surg 2005 ; 125 : 448-452. 5) Margolies MN, Ring EJ, Waltman AC, et al : Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med 1972 ; 287 : 178-182. 18) Yasumura K, lkegami K, Kamohara T, et al : High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture. J Trauma 2005 ; 58 : 985-990. 12) Stephen DJ, Kreder HJ, Day AC, et al : Early detection of arterial bleeding in acute pelvic trauma. J Trauma 1999 ; 47 : 638-642. 16) Kato H, Otamo Y, Homma M, et al : Gluteal soft tissue necrosis after transcatheter angiographic embolization for pelvic fracture : a report of two cases. Eur J Trauma Ernerg Surg 2007 ; 33 : 301-305. 20) Cook RE, Keating JF, Gillespie I : The role of angiography in the management of hemorrhage from major fractures of the pelvic. J Bone Joint Surg 2002 ; 84-B : 178-182. 2) Starr AJ, Griffin DR, Reinert CM, et al : Pelvic ring disruptions : prediction of associated injuries, transfusion requirement, pelvic arteriography, complications and mortality. J Orthop Trauma 2002 ; 16 : 553-561. 4) Suzuki T, Smith W, Moore E, et al : Pelvic packing or angiography : competitive or complementary. Injury 2009 ; 40 : 343-353. 13) Suzuki T, Kataoka Y, Minehara H, et al : Transcatheter arterial embolization for pelvic fractures may potentially cause a triad of sequela : Gluteal necrosis, rectal necrosis, and lower limb paresis. J Trauma 2008 ; 65 : 1547-1550. 15) Takahira N, Shindo M, Tanaka K, et al : Gluteal musele necrosis following transcatheter angiographic embolization for retroperitoneal hemorrhage associated with pelvic fracture. Injury 2001 ; 32 : 27-32. 7) Eastridge BJ, Starr A, Minei JP, et al : The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic disruptions. J Trauma 2002 ; 53 : 446-451. 17) Matsuhashi N, Mizoguchi T, Kanematsu M, et al : A case of delayed rectal stenosis from severe pelvic fracture with massive bleeding successfully treated by bilateral internal iliac TAE : report on a patient survival. Lnt J Colorectal Dis 2007 ; 22 : 853-854. 22) Manson TT, Perdue PW, Pollak AN, et al : Embolization of pelvic arterial injury is a risk factor for deep infection after acetabular fracture surgery. 24th annual meeting of Orthopaedic Trauma Association 2008 : 164. |
| References_xml | – reference: 17) Matsuhashi N, Mizoguchi T, Kanematsu M, et al : A case of delayed rectal stenosis from severe pelvic fracture with massive bleeding successfully treated by bilateral internal iliac TAE : report on a patient survival. Lnt J Colorectal Dis 2007 ; 22 : 853-854. – reference: 9) Durkin A, Sagi HC, Durham R, et al : Contemporary management of pelivic fractures. Am J Surg 2006 ; 192 : 211-223. – reference: 8) 戸張佳子, 佐々木了, 川野健一, ほか : 骨盤骨折と動脈損傷の関連性. 整・災外 2009 ; 52 : 1677-1684. – reference: 11) Dondelinger RF, Trotteur G, Ghaye B, et al : Traumatic injuries : radiological hemostatic intervention at admission. Eur Radiol 2002 ; 12 : 979-993. – reference: 18) Yasumura K, lkegami K, Kamohara T, et al : High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture. J Trauma 2005 ; 58 : 985-990. – reference: 1) Biffl WL, Smith WR, Moore EE, et al : Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg 2001 ; 233 : 843-850. – reference: 15) Takahira N, Shindo M, Tanaka K, et al : Gluteal musele necrosis following transcatheter angiographic embolization for retroperitoneal hemorrhage associated with pelvic fracture. Injury 2001 ; 32 : 27-32. – reference: 16) Kato H, Otamo Y, Homma M, et al : Gluteal soft tissue necrosis after transcatheter angiographic embolization for pelvic fracture : a report of two cases. Eur J Trauma Ernerg Surg 2007 ; 33 : 301-305. – reference: 10) Hagiwara A, Minakawa K, Fukushima H, et al : Predictors of death in patients with life-threatening pelvic hemorrhage after successful transcatheter arterial embolization. J Trauma 2003 ; 55 : 696-703. – reference: 4) Suzuki T, Smith W, Moore E, et al : Pelvic packing or angiography : competitive or complementary. Injury 2009 ; 40 : 343-353. – reference: 5) Margolies MN, Ring EJ, Waltman AC, et al : Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med 1972 ; 287 : 178-182. – reference: 19) Perez JV, Hughes TM, Bowers K : Angiographic embolization in pelvic fracture. Injury 1998 ; 29 : 187-191. – reference: 21) Loeffler BJ, Scannell BP, Bosse MJ, et al : Indications and complications of angiography and embolization in the management of high-energy pelvic ring injuries. 24th annual meeting of Orthopaedic Trauma Association 2008 : 161-162. – reference: 20) Cook RE, Keating JF, Gillespie I : The role of angiography in the management of hemorrhage from major fractures of the pelvic. J Bone Joint Surg 2002 ; 84-B : 178-182. – reference: 3) Cothren CC, Osborn PM, Moore EE, et al : Preperitonal pelvic packing for hemodynamically unstable pelvic fractures : a paradigm shift. J Trauma 2007 ; 62 : 834-842. – reference: 6) Velmahos GC, Toutouzas KG, Vassiliu P, et al : A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 2002 ; 52 : 303-308. – reference: 12) Stephen DJ, Kreder HJ, Day AC, et al : Early detection of arterial bleeding in acute pelvic trauma. J Trauma 1999 ; 47 : 638-642. – reference: 22) Manson TT, Perdue PW, Pollak AN, et al : Embolization of pelvic arterial injury is a risk factor for deep infection after acetabular fracture surgery. 24th annual meeting of Orthopaedic Trauma Association 2008 : 164. – reference: 2) Starr AJ, Griffin DR, Reinert CM, et al : Pelvic ring disruptions : prediction of associated injuries, transfusion requirement, pelvic arteriography, complications and mortality. J Orthop Trauma 2002 ; 16 : 553-561. – reference: 14) Suzuki T, Shindo M, Kataoka Y, et al : Clinical characteristics of pelvic fracture with gluteal necrosis resulting from transcather arterial embolization. Arch Orthop Tratuna Surg 2005 ; 125 : 448-452. – reference: 7) Eastridge BJ, Starr A, Minei JP, et al : The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic disruptions. J Trauma 2002 ; 53 : 446-451. – reference: 13) Suzuki T, Kataoka Y, Minehara H, et al : Transcatheter arterial embolization for pelvic fractures may potentially cause a triad of sequela : Gluteal necrosis, rectal necrosis, and lower limb paresis. J Trauma 2008 ; 65 : 1547-1550. |
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| Snippet | 目的：骨盤骨折に対しTranscatheter Arterial Embolization（以下TAE）を施行した症例について検討した．対象と方法：2010年１月から2013年12月の間で，骨盤骨折に対して... Objective : We evaluated the cases that underwent transcatheter arterial embolization (TAE) for pelvic fracture at our department. Methods : Using medical... |
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| StartPage | 348 |
| SubjectTerms | complication pelvic fracture transcatheter arterial embolization 動脈塞栓術 合併症 骨盤骨折 |
| Title | 当院での骨盤骨折における経カテーテル的動脈塞栓術（TAE）症例の検討 |
| URI | https://www.jstage.jst.go.jp/article/jjast/29/3/29_348/_article/-char/ja https://cir.nii.ac.jp/crid/1390001205515503616 |
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