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Re: Операция на переднем полукольце таза при налич
dan schlatterer 12 Июнь 2007, 04:51
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hello sam
it is good to hear from you. this lady is an independent ambulator, lives alone, drives a pick-up truck (which ran her over), and she is healthy. GYN pelvic exam was completed pre-operatively and CT scan with contrast did not show any bladder/urethral leaks. no blood has ever been noted from foley catheter or from the vagina. pretty amazing given the diastasis.
in terms of stressing the pelvis intra-operatively to assess overall stability, the trauma AP pelvis and CT scan provided plenty of info. I suppose one could stress the vertical stability, but again to what end? this pt had nearly 8cm of diastasis. rotational instability was a given. in terms of a lateral pelvic xray, I cannot say that besides a false profile lateral for hip dysplasia, I am not aware of lateral pelvic xrays for pelvic ring disruptions. if this is something that you do I would be interested in seeing an xray or two.
your final question is a good one. why not place the SI screws at the time of the I/D and pelvic ex-fix. the time involved is not that great. I place a lot of SI screws (at least I think I do although I am sure others place more) and they can take very little time. no one factor made the decision. it was a combo of poor fluoro (views and tech), time from injury, meaning these pts can turn suddenly for the worse. so I started to feel that we were pushing too much (pts' pressure was up/down, she was getting blood, etc), and so on. if I stayed in the OR longer and the pt crashed (which I have seen) questions would arise. If I left the OR and the pt had no further problems and retrospective it looked like I could have stayed in the OR longer then questions would arise. in the middle of the night I am happy (relatively) to work but the goals of this case (emergent I/D and pelvic stabilization) were met so I decided not to proceed any further. for a lot of folks this will not be acceptable but to me less was more.
thank you for your input.
dan schlatterer
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