1、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Fractures of Pelvisn Pelvic pathology:Undisplaced/minmally displaced/displaced:Stable fracturePartially stable fracture (rotational)Completely unstable (rotational and vertically/translationally)Isolated iliac wing fracturesUndisplaced pubic
2、 ramii fracturesTransverse fractures of sacrum below pelvic ringOs coccygis fracturesAll pelvic ligaments intact!nUnstable pelvic fractures:Partially stable:Rotationally unstable:External/internal rotation (lateral compression)Flexion/extensionAbduction/adductionCompletely unstable:Rotationally and
3、vertically (translationally) unstablenPartially stable pelvic fractures:Rotationally unstable:Open book fractures external rotationLateral compression fractures internal rotationn External rotation:Mechanisms of injury:Posterior crushDirect pressure ASISExternal rotation through femur(s) Rupture sym
4、physis/sacrospinous lig./anterior sacroiliac ligAlways posterior and interosses sacroiliac ligaments intact!nExternal rotationally unstable fracture:Partially stable pelvic fractures:Disruption of symphysis only: Slight external rotation Widening of symphysis max. 2.5 cm= Open book injurynExternal r
5、otationally unstable fractures:Partially stable pelvic fracture:Disruption of symphysis, sacrospinous ligament andanterior sacroiliac ligament: Open book injuryMassive external rotation PSIS abuts sacrum:External rotational instabilityn External rotationally unstable fractures:Partially stable pelvi
6、c fracture:Disruption of symphysis, sacrospinous ligament, all sacroiliac ligaments: Open book injury with:Massive external rotationFlexion Transition to vertical/translational instabilitynInternal rotation:Mechanisms of injury:Direct pressure to iliac crestForce against greater trochanter femoral head acetabulum Force parallel to sacral plane through SI.joint(s)
