2022年医学专题—第75章-骨盆及髋臼骨折(王满宜)(1).ppt

第75章 骨盆(gpn)及髋臼骨折Fractures of Pelvis and Acetabulum,王 满 宜北京积水潭医院,第一页，共一百五十九页。,Fractures of Pelvis,第二页，共一百五十九页。,Pelvic pathology:Undisplaced/minmally displaced/displaced:Stable fracturePartially stable fracture(rotational)Completely unstable(rotational and vertically/translationally)Isolated iliac wing fracturesUndisplaced pubic ramii fracturesTransverse fractures of sacrum below pelvic ringOs coccygis fracturesAll pelvic ligaments intact!,第三页，共一百五十九页。,Unstable pelvic fractures:Partially stable:Rotationally unstable:External/internal rotation(lateral compression)Flexion/extensionAbduction/adductionCompletely unstable:Rotationally and vertically(translationally)unstable,第四页，共一百五十九页。,Partially stable pelvic fractures:Rotationally unstable:Open book fractures external rotationLateral compression fractures internal rotation,第五页，共一百五十九页。,External rotation:Mechanisms of injury:Posterior crushDirect pressure ASISExternal rotation through femur(s)Rupture symphysis/sacrospinous lig./anterior sacroiliac ligAlways posterior and interosses sacroiliac ligaments intact!,第六页，共一百五十九页。,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,第七页，共一百五十九页。,External rotationally unstable fractures:Partially stable pelvic fracture:Disruption of symphysis,sacrospinous ligament andanterior sacroiliac ligament:Open book injuryMassive external rotation PSIS abuts sacrum:External rotational instability,第八页，共一百五十九页。,External rotationally unstable fractures:Partially stable pelvic fracture:Disruption of symphysis,sacrospinous ligament,all sacroiliac ligaments:Open book injury with:Massive external rotationFlexion Transition to vertical/translational instability,第九页，共一百五十九页。,Internal rotation:Mechanisms of injury:Direct pressure to iliac crestForce against greater trochanter femoral head acetabulum Force parallel to sacral plane through SI.joint(s),第十页，共一百五十九页。,Internal rotationally unstable fractures:Partially stable pelvic fracture:Crush of lateral sacrumDisruption of posterior sacroiliac ligamentAlways anterior lesion:TranssymphysealTranspubic Lateral compression injuryAlways pelvic floor intact!,第十一页，共一百五十九页。,Vertical shear:Mechanisms of injury:Force perpendicular to:Sacral planeSI-joint plane(s),第十二页，共一百五十九页。,Rotationally and vertically(translationally)unstable fractures:Completely unstable pelvic fractures:Always complete disruption of:Posterior complexPelvic floorAnterior complex Completely unstable fracture,第十三页，共一百五十九页。,Rotationally and vertically(translationally)unstable fractures:Completely unstable pelvic fracture:Always complete disruption of:Posterior complex:LigamentousSI-joint fracture-dislocationTransiliac fractureTransalar/transforaminal sacral fractureS1/S2 transverse fractureAnterior complex!,第十四页，共一百五十九页。,Applicable classifications:TILE 1984/1991CCF AO/ASIF 1996OTA modification of CCF AO/ASIF 1996,第十五页，共一百五十九页。,Additional terms/definitions:Simple=uncomplicated pelvic fracture:Soft tissues around pelvis closedNo laceration:GUI/VisceraComplex pelvic fracture:Soft tissues around pelvis openInvolvement of:GUI and/or viscera Traumatic hemipelvectomy,第十六页，共一百五十九页。,Type A fractures:stableType B fractures:partially stableType C fractures:completely unstableTILE 1984/1991,第十七页，共一百五十九页。,Type A stable pelvic ring fractures:Type A1:Avulsion of the innominate boneType A2:Stable iliac wing fracture or stable minimally displaced ring fracturesType A3:Transverse fractures of the sacrum and coccyxTILE 1984/1991,第十八页，共一百五十九页。,第十九页，共一百五十九页。,Type B partially stable pelvic ring fractures:Type B1:Open book injuryType B2:The lateral compression injuryType B3:Bilateral B injuriesTILE 1984/1991,第二十页，共一百五十九页。,Type B1:Anterior-posterior compression injury fractures are“open-book”pelvic fractures External Rotational Instability,They are divided into three stages,第二十一页，共一百五十九页。,Type B2:Lateral compression injury divided into:B2-1:Ipsilateral;B2-2:Contralateral(Bucket-Handle);B2-3:Four Rami type,第二十二页，共一百五十九页。,Type C completely unstable(vertical shear)pelvic ring fractures:Type C1:UnilateralType C2:Bilateral,one side B,one side CType C3:Bilateral C lesionsTILE 1984/1991,第二十三页，共一百五十九页。,第二十四页，共一百五十九页。,Type C2:Bilateral one side B,one side C,第二十五页，共一百五十九页。,Type C3:Bilateral C lesions,第二十六页，共一百五十九页。,骨盆(gpn)的x-线评定Radiologic Evaluation of the Pelvis,第二十七页，共一百五十九页。,骨盆的标准(biozhn)x-线评定,前后位像入口(r ku)位像出口位像Judet位像轴相断层像,第二十八页，共一百五十九页。,用于判定(pndng)骨盆创伤的放射学方式,平片常规(chnggu)断层扫描,第二十九页，共一百五十九页。,其它(qt)用于判断伴随的软组织和盆腔脏器损伤的辅助技术,血管造影术磷酸锝骨扫描(somio)核磁共振影象,第三十页，共一百五十九页。,1.投照方法(fngf),患者仰卧于x线床上，射线(shxin)垂直于骨盆中部和放射线板。,前后(qinhu)位相,第三十一页，共一百五十九页。,2.可见的骨盆(gpn)解剖标识,耻骨联合耻骨上、下支髂嵴骶髂关节(gunji)骶孔第五腰椎横突,前后(qinhu)位相,第三十二页，共一百五十九页。,3.可见(kjin)的髋臼解剖标识,髂耻线髂坐线泪点髋臼顶髋臼前、后缘(hu yun),前后(qinhu)位相,第三十三页，共一百五十九页。,4.用于创伤(chungshng)诊断,前后(qinhu)位相,第三十四页，共一百五十九页。,（1）前环损伤(snshng)：,耻骨支骨折(gzh)耻骨联合撕裂耻骨支骨折合并耻骨联合撕裂。,前后(qinhu)位相,第三十五页，共一百五十九页。,（2）后环损伤(snshng)：,骶骨骨折(gzh)髂骨骨折骶髂关节脱位骶髂关节骨折脱位,前后(qi