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1、骨盆及髋臼骨折骨盆及髋臼骨折Fractures of Pelvis and Acetabulum王王 满满 宜宜北京积水潭医院北京积水潭医院Fractures of PelvisnPelvicpathology:Undisplaced/minmallydisplaced/displaced:StablefracturePartiallystablefracture(rotational)Completelyunstable(rotationalandvertically/translationally)IsolatediliacwingfracturesUndisplacedpubicrami
2、ifracturesTransversefracturesofsacrumbelowpelvicringOscoccygisfracturesAllpelvicligamentsintact!nPartiallystablepelvicfractures:Rotationallyunstable:OpenbookfracturesexternalrotationLateralcompressionfracturesinternalrotationnExternalrotation:Mechanismsofinjury:PosteriorcrushDirectpressureASISExtern
3、alrotationthroughfemur(s)Rupturesymphysis/sacrospinouslig./anteriorsacroiliacligAlwaysposteriorandinterossessacroiliacligamentsintact!nExternalrotationallyunstablefracture:Partiallystablepelvicfractures:Disruptionofsymphysisonly:SlightexternalrotationWideningofsymphysismax.2.5cm=OpenbookinjurynExter
4、nalrotationallyunstablefractures:Partiallystablepelvicfracture:Disruptionofsymphysis,sacrospinousligamentandanteriorsacroiliacligament:OpenbookinjuryMassiveexternalrotationPSISabutssacrum:ExternalrotationalinstabilitynExternalrotationallyunstablefractures:Partiallystablepelvicfracture:Disruptionofsy
5、mphysis,sacrospinousligament,allsacroiliacligaments:Openbookinjurywith:MassiveexternalrotationFlexionTransitiontovertical/translationalinstabilitynInternalrotation:Mechanismsofinjury:DirectpressuretoiliaccrestForceagainstgreatertrochanterfemoralheadacetabulumForceparalleltosacralplanethroughSI.joint
6、(s)nInternalrotationallyunstablefractures:Partiallystablepelvicfracture:CrushoflateralsacrumDisruptionofposteriorsacroiliacligamentAlwaysanteriorlesion:TranssymphysealTranspubicLateralcompressioninjuryAlwayspelvicfloorintact!nVerticalshear:Mechanismsofinjury:Forceperpendicularto:SacralplaneSI-jointp
7、lane(s)nRotationallyandvertically(translationally)unstablefractures:Completelyunstablepelvicfractures:Alwayscompletedisruptionof:PosteriorcomplexPelvicfloorAnteriorcomplexCompletelyunstablefracturenRotationallyandvertically(translationally)unstablefractures:Completelyunstablepelvicfracture:Alwayscom
8、pletedisruptionof:Posteriorcomplex:LigamentousSI-jointfracture-dislocationTransiliacfractureTransalar/transforaminalsacralfractureS1/S2transversefractureAnteriorcomplex!nApplicableclassifications:TILE1984/1991CCFAO/ASIF1996OTAmodificationofCCFAO/ASIF1996nAdditionalterms/definitions:Simple=uncomplica
9、tedpelvicfracture:SofttissuesaroundpelvisclosedNolaceration:GUI/VisceraComplexpelvicfracture:SofttissuesaroundpelvisopenInvolvementof:GUIand/orvisceraTraumatichemipelvectomynTypeAfractures:stableTypeBfractures:partiallystableTypeCfractures:completelyunstableTILE1984/1991nTypeAstablepelvicringfractur
10、es:TypeA1:AvulsionoftheinnominateboneTypeA2:StableiliacwingfractureorstableminimallydisplacedringfracturesTypeA3:TransversefracturesofthesacrumandcoccyxTILE1984/1991nTypeBpartiallystablepelvicringfractures:TypeB1:OpenbookinjuryTypeB2:ThelateralcompressioninjuryTypeB3:BilateralBinjuriesTILE1984/1991T
11、ype B1: Anterior-posterior compression injury fractures are “open-book” pelvic fractures External Rotational InstabilityThey are divided into three stagesl lType B2: Lateral compression injury divided into: B2-1: Ipsilateral; B2-2: Contralateral(Bucket-Handle); B2-3: Four Rami typenTypeCcompletelyun
12、stable(verticalshear)pelvicringfractures:TypeC1:UnilateralTypeC2:Bilateral,onesideB,onesideCTypeC3:BilateralClesionsTILE1984/1991Type C2:Bilateral one side B, one side CType C3: Bilateral C lesions 骨盆的骨盆的x-x-线评定线评定Radiologic Evaluation of the Pelvis 骨盆的标准x-线评定前后位像前后位像入口位像入口位像出口位像出口位像Judet位像位像轴相断层像轴相
13、断层像用于判定骨盆创伤的放射学方式平片平片常规断层扫描常规断层扫描其它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血管造影术磷酸锝骨扫描磷酸锝骨扫描核磁共振影象核磁共振影象1.投照方法患者仰卧于患者仰卧于x线床上，射线垂直于骨线床上，射线垂直于骨盆中部和放射线板。盆中部和放射线板。前后位相前后位相2.可见的骨盆解剖标识耻骨联合耻骨联合耻骨上、下支耻骨上、下支髂嵴髂嵴骶髂关节骶髂关节骶孔骶孔第五腰椎横突第五腰椎横突前后位相前后位相3.可见的髋臼解剖标识髂耻线髂耻线髂坐线髂坐线泪点泪点髋臼顶髋臼顶髋臼前、后缘髋臼前、后缘前后位相前后位相4.用于创伤诊断前后位相前后位相（1）前环损伤：耻骨
14、支骨折耻骨支骨折耻骨联合撕裂耻骨联合撕裂耻骨支骨折合并耻骨联合撕裂。耻骨支骨折合并耻骨联合撕裂。前后位相前后位相（2）后环损伤：骶骨骨折骶骨骨折髂骨骨折髂骨骨折骶髂关节脱位骶髂关节脱位骶髂关节骨折脱位骶髂关节骨折脱位前后位相前后位相（3）骨盆不稳定的细微表现：移位的第五腰椎横突尖撕脱骨折移位的第五腰椎横突尖撕脱骨折-纵向骨盆不稳定纵向骨盆不稳定 移位的骶棘韧带在坐骨棘或骶骨外缘的撕脱骨折移位的骶棘韧带在坐骨棘或骶骨外缘的撕脱骨折-旋转旋转骨盆不稳定骨盆不稳定前后位相前后位相5.判断下肢长度差异前后位相前后位相通过测量双侧股骨头到通过测量双侧股骨头到骶骨轴线的垂线之距离骶骨轴线的垂线之距离.投照
15、方法：患者仰卧于患者仰卧于X线台上，射线从足线台上，射线从足侧侧 指向耻骨联合与垂线约指向耻骨联合与垂线约成成40角。角。出口位出口位（2）用途有助于发现在骨盆平面上的向上移位有助于发现在骨盆平面上的向上移位观察骨盆矢状面的旋转观察骨盆矢状面的旋转是骶骨的标准前后位相是骶骨的标准前后位相出口位出口位前、后骶骨孔在此投照位显得很圆，接近或累及骶孔前、后骶骨孔在此投照位显得很圆，接近或累及骶孔的骨折也可看到。的骨折也可看到。最佳地显示骶骨体部的骨折特别是横行的骨折。最佳地显示骶骨体部的骨折特别是横行的骨折。易于显示易于显示L5横突的撕脱骨折和骶骨外缘的骨折。横突的撕脱骨折和骶骨外缘的骨折。（2）用
16、）用 途途出口位出口位（1）投照方法： 患者仰卧于患者仰卧于X线台上，射线从头线台上，射线从头侧指向骨盆中央与垂线约成侧指向骨盆中央与垂线约成40角。角。入口位入口位（2）特点：此种与骨盆入口相垂直的投射角度真正地显示了骨盆入此种与骨盆入口相垂直的投射角度真正地显示了骨盆入口。口。X线与线与S2和和S3椎体前缘位于同一平面，故在此投照位置，椎体前缘位于同一平面，故在此投照位置，S2和和S3椎体的前方皮质椎体的前方皮质 相重叠，在骶骨体前呈一条线。相重叠，在骶骨体前呈一条线。此线位于骶骨岬之后几毫米，是置放骶髂关节螺钉的此线位于骶骨岬之后几毫米，是置放骶髂关节螺钉的最前限。最前限。入口位入口位（3）用途：比其它投射方式更能清楚地显示在骨盆平面上骨折向前比其它投射方式更能清楚地显示在骨盆平面上骨折向前及向后的移位。及向后的移位。常显示后骨盆环的最大移位。常显示后骨盆环的最大移位。显示髂骨翼因外侧挤压伤而内旋或因前后挤压伤和剪式显示髂骨翼因外侧挤压伤而内旋或因前后挤压伤和剪式损伤所致的外旋损伤所致的外旋入口位入口位（3）用途：显示骶骨嵌压骨折或骶骨翼骨折显示骶骨嵌压骨折或骶骨翼骨折 （ala
