骨盆骨折分型 骨盆骨折分类及医治攻略（三）

8. Fracture classi?cation

8. 骨折分类

Delineating the exact nature of the fracture is useful both for the orthopaedic surgeon and also in raising suspicion for associated injuries. Many studies have attempted to predict the risk of haemorrhage according to fracture pattern [4,20]. However, whilst unstable pelvic fractures are more frequently associated with haemorrhage, fracture pattern cannot be used to absolutely predict haemorrhage [10].

描绘骨折确实切性质有益于骨科医生对丢失的处置并进步对相关损害的警觉性。许多研讨企图依据骨折类型猜测出血危险[4,20]。但是，不稳定型骨盆骨折更经常性的与出血相关联，因而骨折类型不能绝对地猜测出血[10]。

9. Pelvic ring fractures

9. 骨盆环骨折

The pelvis is considered to be a ring structure comprised of three bones, the sacrum and two innominate bones. The posterior ring includes the sacrum, SI joints and iliac bones, whilst the anterior ring is comprised of the pubic bones and symphysis. The SI joints can be divided into anterior and posterior and are held together by the anterior and posterior sacroiliac ligaments. The posterior sacroiliac ligaments are the strongest in the body and are most important in maintaining pelvic stability. The sacrotuberous and sacrospinous ligaments provide additional support posteriorly.Conversely, the pubic symphysis anteriorly is weaker and more easily ruptured.

骨盆被认为是包含三块骨的环形结构，一块骶骨和两块髋骨。后环包含骶骨、骶髂关节和髂骨，前环包含耻骨及其联合。骶髂关节可分为前后两部分，经过前后骶髂韧带衔接在一起。后骶髂韧带是人体最强韧的韧带，对维系骨盆稳定性最为重要。骶结节韧带和骶棘韧带供给额定的后方支撑。相反的，前方的耻骨联合单薄，更容易发作开裂。

Two accepted classi?cation systems exist, the Young–Burgess and Tile systems [21,22]. The Young–Burgess system classi?es injuries according to the mechanism and severity. The Tile system arranges fractures into three main groups, stable, partially unstable and completely unstable. For the purposes of this review, the Young–Burgess system will be considered. There are three main patterns of injury:

AP compression;

Lateral compression;

Vertical shear.

现在得到公认的有两种分类体系，Young–Burgess和Tile分类体系[21,22]。Young–Burgess体系依据损害机制和严峻程度分类。Tile体系将骨折首要分为3类，稳定型、部分不稳定型和彻底不稳定型。因为本研讨的意图，考虑运用Young–Burgess体系。损害类型首要有3种：

前后揉捏型

侧方揉捏型

笔直剪切型

10. AP compression

10. 前后揉捏型

AP compression fractures cause external rotation of one or both hemipelves, causing the iliac wings to move outwards. These injuries are characterised by pubic diastasis, either at the symphysis or through sagittal ramal fractures. Associated injuries may include sacroiliac joint diastasis and, less commonly, sacral fractures. AP compression injuries cause an increased pelvic volume with any resulting haemorrhage unlikely to tamponade spontaneously. Pelvic wrapping should therefore be a priority in early management.

前后揉捏型骨折引起单或双侧半骨盆外旋转，引起髂骨翼向外移位。此型骨折以耻骨别离为特征，在耻骨联合处或矢状位穿耻骨支骨折。相关丢失或许包含骶髂关节别离和不常发作的骶骨骨折。前后揉捏型因为出血致骨盆腔容积添加，不太或许自发填塞。因而前期处置优先选用骨盆包裹法。