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1、骨盆骨折,上海第二医科大学附属 第九人民医院骨科 孙月华,Radiographic Evaluation of the acetabulum,Judet Views 1.Anteroposterior 2.iliac oblique 3.obturator oblique,45,Anteroposterior view,髂会阴线 髂坐骨线 髋臼前后唇 “teardrop”与髂坐线的关系,Obturator oblique view,前柱 耻骨上支 髋臼后壁,Iliac oblique view,后柱 前壁,Tomography and 3-D Reconstruction,CT评估常规X线未能
2、显示的骨折 关节内的骨折碎片,股骨头骨折 骶髂关节的骨折 3-D重建能立体的显示骨盆,Classification of Acetabular Fractures (Judet and Lelournel),Type A: Partial articular, involving only one of the two columns A1 posterior wall fracture A2 posterior column A3 Anterior column or wall,Type B: partial articular, involving a transverse compone
3、nt B1 Pure transverse B2 T-shaped B3 Anterior Column and posterior hemitransverse,Type C: Fracture (complete articular : both columns) C1 High variety, extending to the iliac C2 Low variety, extending to the anterior border of the ilium C3 Extension into the Sacroiliac joint,C1/C2 (both column =Comp
4、lete articular fracture) Ilioinguinal approach Involvement of the posterior column or wall extensile approach,C3 ( Both column extending into SI joint) Extended Iliofemoral approach,Evaluation and diagnosis The patient,气道 呼吸 循环 伴随损伤： 长骨干骨折、脊柱、 脑部、腹腔、盆腔、泌尿道,Surgical indication and timing,1. 病人的全身情况 2
5、. 经济情况，需求 3. 外科医师的经验，器械 4. 骨折类型 5. 关节面的完整性 2mm,手术时间：伤后7-10天 反指征 严重骨质疏松 无移位骨折 后笠骨折碎片小 低位前柱骨折,Cefazolin for 48-72 hours Thromboembolic prophylaxis Indomethacin 75mg once daily sit up with the first 24-48 hours,Actabular and limb fracture Injury of sciatic nerve (12-38%) Hip dislocation (requires promp
6、t reduction),Malreduction or subluxation of the hip joint will lead to abnormal loading of the articular cartilage and subsequent joint arthrosis,Principle that performing an accurate reduction of the articular surface, thereby obtaining surface, thereby obtaining a congruent hip joint, will restore
7、 normal joint mechanics.,Reduction techniques and internal fixation,Essential reduction tools,distractor Judet fracture table manual reduction “King Tong” and “Queen Tang” Clamps,The majority of acetabular fractures can be managed through a single surgical approach, but combined approaches are also
8、feasible,The four most frequently used approaches are: 1. Kocher-Langenbeck 2. Ilioinguinal 3. Extended iliofemoral 4. Combination of 1) and 2),Interaoperative traction Indirect reduction which have retained their capsular or soft-tissue,A dislocated Sacroiliac joint or displaced sacral fracture is
9、usually reduced first and fixed. Prior to the reduction of the acetabular fracture,A1 (posterior wall) Kocher-langenbeck approach-lateral decubitus A2 (posterior column) K-L approach A3 (anterior wall or column) Iiloinguinal approach,B1 (pure transverse) K-L approach (prone) B13 extensile approach B
10、2 (T-shaped) K-L or ilioginguinal B3 (anterior column posterior hemitransverse) Ilioinguinal or K-L or extended iliofemoral,Weight bearing is not advanced for 6-8 weeks During the third month, depending on radiographic evidence of healing, the patient is allowed to full weight bearing,Postoperative
11、management rehabilitation,The third day, patient are allowed toe-touch weight bearing using crutches. Strengthening exercises and gait training,Complications,Early,Neurovascular injury inadequate reduction, articular penetration of hardware, pulmonary embolism,Late,Heterotopic ossification Chondrolysis avascular necrosis posttraumatic arthrosis,Thank You,
