骨盆骨折分型 骨盆骨折分类及医治攻略（一）

a Department of Radiology, Leeds Teaching Hospitals, Leeds, UK

b Radiology Academy, Leeds General In?rmary, Jubilee Wing, Great George St., Leeds LS1 3EX, UK

c Musculoskeletal Radiology Dept, Leeds General In?rmary, Jubilee Wing, Great George St, Leeds LS1 3EX, UK

abstract

摘要

Pelvic fractures are common in polytrauma and continue to pose a dif?cult management dilemma for even the most experienced clinicians. Due to the high energy mechanisms involved, there are often multiple other injuries and many specialists may be involved. Deriving an effective management strategy relies on early diagnosis and prioritisation of the most immediately life-threatening injuries. Contrary to ATLS advice, CT can be used to facilitate this even in the haemodynamically unstable patient. This article de?nes the role of CT in pelvic fractures and provides an overview of fracture classi?cation.

骨盆骨折在多发伤口中较为常见，依然给即便是经历最丰厚的医生形成一个困难的医治窘境。因为触及高能损害机制，一般兼并其他部位多发伤，需求各科专家联合诊治。取得一个有用的医治方案有赖于前期确诊并优先医治最直接危及生命的损害。与高档伤口生命支撑(ATLS)相对，CT可以用来促进这些方案的施行，即便关于血流动力学不稳的患者亦适用。本文论述了CT在骨盆骨折中的效果并供给骨折分类之概述。

1. Introduction

1. 介绍

Pelvic fractures are common in polytrauma and continue to pose dif?cult management dilemmas for even the most experienced clinician. Patients often sustain multiple other injuries due to the high energy mechanisms involved and management requires a multidisciplinary team. Many patients require immediate resuscitation and the standard ATLS pathway, with an ‘ABC’ approach, should be adopted. Most articles on pelvic fractures place great emphasis on fracture classi?cation and only mention the complications in passing. In reality, the order of priority should be:

1. Recognition of life-threatening injuries;

2. Recognition of acute injuries;

3. Fracture classi?cation which aids in directing surgical management whilst also arousing suspicion for undetected associated injuries.

骨盆骨折在多发伤口中较为常见，依然给即便是经历最丰厚的医生形成一个困难的医治窘境。因为触及高能损害机制，患者一般兼并其他部位多发伤，需求多学科归纳小组一起医治。许多患者需求选用ABC办法当即进行复苏和规范ATLS途径。大都关于骨盆骨折的文章首要着重骨折分类，仅顺便提及并发症。实际上，优先次第应该是：

1. 辨认危及生命的损害；

2. 辨认急性损害；

3. 骨折分类可帮忙辅导外科医治，一起也可引起对未被发现的相关损害的置疑。

This review offers guidance on effective use of early imaging to identify the most pertinent injuries and provide a sound platform for which to plan management. In particular, the acute complications of pelvic fractures will be discussed with subsequent reference to speci?c fracture patterns. An algorithm for management is proposed incorporating the use of early CT and thereby challenging current advice from the ATLS.

该总述对区分最密切相关的损害前期印象学查看有用使用供给辅导，并为医治方案的施行供给一个杰出的渠道。尤其是骨盆骨折的急性并发症将于随后说到的骨折详细类型同时评论。一条医治规律主张尽早结合使用CT并因而对ATLS的通用定见提出应战。

2. Mechanism and resuscitation

2. 损害机制和复苏

Pelvic fractures usually result from high energy trauma,although occasionally there may be a trivial mechanism of injury. In such cases, clinicians should be alert to possible underlying bone pathology. However, for the majority, the high energy mechanism results in a high rate of associated injuries. ATLS advice is thus to concentrate on the ABC (airway, breathing, circulation) method of resuscitation [1]. It is vital to look for other potentially life-threatening injuries rather than simply concentrating on the pelvic injury.

骨盆骨折一般由高能伤口引起，虽然偶然或许由细微损害机制引起。在这些病例中，临床医生应该对或许潜在的骨病理改动有所警惕。但是，关于大大都患者，高能机制导致高比率的多发伤。因而ATLS主张集中于ABC(气道，呼吸，循环)复苏办法[1]。发现其它潜在危及生命的损害而不是单纯集中于骨盆损害是至关重要的。

3. ATLS guidance

3. ATLS辅导

Airway;

Breathing;

Circulation;

Disability;

Exposure;

Trauma radiographs (CXR, pelvis XR).

气道；

呼吸；

循环；

失能；

露出；

伤口放射学查看(胸部X线查看，骨盆X线查看)。