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External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament and anterior sacroiliac ligament: > Open book injury Massive external rotation > PSIS abuts sacrum: External rotational instability
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5
External rotation: Mechanisms of injury: Posterior crush Direct pressure ASIS External rotation through femur(s) > Rupture symphysis/sacrospinous lig./anterior sacroiliac lig Always posterior and interosses sacroiliac ligaments intact!
Isolated iliac wing fractures Undisplaced pubic ramii fractures Transverse fractures of sacrum below pelvic ring Os coccygis fractures All pelvic ligaments intact!
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4
Partially stable pelvic fractures: Rotationally unstable: Open book fractures > external rotation Lateral compression fractures > internal rotation
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11
Vertical shear: Mechanisms of injury: Force perpendicular to: Sacral plane SI-joint plane (s)
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12
Rotationally and vertically (translationally) unstable fractures: Completely unstable pelvic fractures: Always complete disruption of: Posterior complex Pelvic floor Anterior complex > Completely unstable fracture
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Internal rotationally unstable fractures: Partially stable pelvic fracture: Crush of lateral sacrum Disruption of posterior sacroiliac ligament Always anterior lesion: Transsymphyseal Transpubic > Lateral compression injury Always pelvic floor intact!
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8
External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament, all sacroiliac ligaments: > Open book injury with: Massive external rotation Flexion > Transition to vertical/translational instability
第75章
骨盆及髋臼骨折
Fractures of Pelvis and Acetabulum
王满宜
北京积水. 潭医院
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Fractures of Pelvis
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2
Pelvic pathology: Undisplaced/minmally displaced/displaced: Stable fracture Partially stable fracture (rotational) Completely unstable (rotational and vertically/translationalln: Mechanisms of injury: Direct pressure to iliac crest Force against greater trochanter > femoral head > acetabulum Force parallel to sacral plane through SI.joint(s)
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3
Unstable pelvic fractures: Partially stable: Rotationally unstable: External/internal rotation (lateral compression) Flexion/extension Abduction/adduction Completely unstable: Rotationally and vertically (translationally) unstable
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External rotationally unstable fracture: Partially stable pelvic fractures: Disruption of symphysis only: > Slight external rotation > Widening of symphysis max. 2.5 cm = Open book injury