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1、骨盆骨折骨盆骨折上海第二医科大学附属上海第二医科大学附属上海第二医科大学附属上海第二医科大学附属第九人民医院骨科第九人民医院骨科第九人民医院骨科第九人民医院骨科孙月华孙月华孙月华孙月华Radiographic Evaluationof the acetabulumJudet Views1.Anteroposterior2.iliac oblique3.obturator oblique45Anteroposterior view髂会阴线髂会阴线髂坐骨线髂坐骨线髋臼前后唇髋臼前后唇“teardrop”与髂坐线的关系与髂坐线的关系Obturator oblique view前柱前柱耻骨上支耻骨上支
2、髋臼后壁髋臼后壁Iliac oblique view后柱后柱前壁前壁Tomography and 3-D ReconstructionCT评估常规评估常规X线未能显示的骨折线未能显示的骨折关节内的骨折碎片关节内的骨折碎片,股骨头骨折股骨头骨折骶髂关节的骨折骶髂关节的骨折3-D重建能立体的显示骨盆重建能立体的显示骨盆Classification of AcetabularFractures (Judet and Lelournel)Type A: Partial articular, involving only one of the two columnsA1 posterior wall f
3、ractureA2 posterior columnA3 Anterior column or wallType B: partial articular, involving a transverse componentB1Pure transverseB2T-shapedB3Anterior Column and posterior hemitransverseType C: Fracture (complete articular : both columns)C1High variety, extending to the iliac C2Low variety, extending
4、to the anterior border of the iliumC3Extension into the Sacroiliac jointC1/C2 (both column =Complete articular fracture)Ilioinguinal approachInvolvement of the posteriorcolumn or wallextensile approachC3 ( Both column extending into SI joint) Extended Iliofemoral approachEvaluation and diagnosisThe
5、patient气道气道 呼吸呼吸 循环循环伴随损伤：伴随损伤： 长骨干骨折、脊柱、长骨干骨折、脊柱、 脑部、腹腔、脑部、腹腔、盆腔、泌尿道盆腔、泌尿道Surgical indicationand timing1. 病人的全身情况病人的全身情况2. 经济情况，需求经济情况，需求3. 外科医师的经验，器械外科医师的经验，器械4. 骨折类型骨折类型5. 关节面的完整性关节面的完整性 2mm手术时间：伤后手术时间：伤后7-10天天反指征反指征严重骨质疏松严重骨质疏松无移位骨折无移位骨折后笠骨折碎片小后笠骨折碎片小低位前柱骨折低位前柱骨折Cefazolin for 48-72 hours Thrombo
6、embolic prophylaxis Indomethacin 75mg once daily sit up with the first 24-48 hoursActabular and limb fractureInjury of sciatic nerve (12-38%)Hip dislocation(requires prompt reduction)Malreduction or subluxation of the hip joint will lead to abnormal loading of the articular cartilage and subsequent
7、joint arthrosisPrinciple that performing an accurate reduction of the articular surface, thereby obtaining surface, thereby obtaining a congruent hip joint, will restore normal joint mechanics.Reduction techniquesand internal fixationEssential reduction tools distractorJudet fracture tablemanual red
8、uction“King Tong” and “Queen Tang” ClampsThe majority of acetabular fractures can be managed through a single surgical approach, but combined approaches are also feasibleThe four most frequently used approaches are:1. Kocher-Langenbeck2. Ilioinguinal3. Extended iliofemoral4. Combination of 1) and 2)
9、Interaoperative traction Indirect reduction which have retained their capsular or soft-tissueA dislocated Sacroiliac joint or displaced sacral fracture is usually reduced first and fixed. Prior to the reduction of the acetabular fractureA1 (posterior wall) Kocher-langenbeckapproach-lateral decubitus
10、A2 (posterior column) K-L approachA3 (anterior wall or column) Iiloinguinal approachB1 (pure transverse)K-L approach (prone)B13 extensile approachB2 (T-shaped)K-L or ilioginguinalB3 (anterior column posterior hemitransverse)Ilioinguinal or K-L or extended iliofemoralWeight bearing is not advanced fo
11、r 6-8 weeksDuring the third month, depending on radiographic evidence of healing, the patient is allowed to full weight bearingPostoperative managementrehabilitationThe third day, patient are allowed toe-touch weight bearing using crutches.Strengthening exercises and gait trainingComplicationsEarlyNeurovascular injuryinadequate reduction, articularpenetration of hardware,pulmonary embolismLateHeterotopic ossificationChondrolysisavascular necrosisposttraumatic arthrosisThank You
