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西南医院骨科 许建中,西南医院骨科 许建中,骨 盆 骨 折 Fracture of the Pelvis,骨 盆 骨 折 Fracture of the Pelvis,一、解剖概要 Anatomical outline,二、骨盆骨折分类Classification of the pelvic fracture,Type A : Stable pelvic ring injury 稳定的骨盆环损伤,A1: Avulsion of the innominate bone 骨折块撕脱 A2: Stable iliac wing fracture or stable minimally displaced ring fractures 稳定的髂骨翼骨折或 稳定的无移位的环状骨折 A3: Transverse fractures of the sacrum and coccyx 骶尾骨横型骨折,Type B: Partially stable 部分稳定骨折,B1: Open book injury 开书样损伤 B2: The lateral compression injury 侧方挤压伤 B2.1: Ipsilateral type B2.2: Contralateral Type (bucket-handle 桶柄样) B3: Bilateral B injuries 双侧B型损伤,Open book injury,Open book injury,Open book injury,Lateral compression fracture,Locked symphysis,A variant of the type injury often seen in young women,Lateral compression injury Type B2.2,Anteroposterior radiograph Type B2.2,Type C: Unstable （vertical shear） 不稳定骨折（纵向减切力）,C1: Unilateral C1.1: Ilium C1.2: Sacroiliac dislocation or fracture dislocation 骶髂关节脱位或骨折脱位 C2: Bilateral , one side B ,one side C C3: Bilateral C lesions,Telltale sign of instability,Sacroiliac fracture dislocation,三、Clinical situation 临床表现,Trauma 外伤 Shock 休克 Pain 疼痛 Local swelling, Patches & tenderness 局部肿胀、皮下淤斑和压痛 Lower posterior superior iliac spine 髂后上棘双侧不等高 Pelvis crushed or separate test 骨盆挤压、分离实验阳性 Affected extremity short 患肢短缩 X ray X线片,四、Complications 并发症,Hemorrhagic shock 失血性休克 Injury of anterior or posterior urethra 前、后尿道损伤 Rupture of bladder 膀胱破裂 Injury of urether 输尿管损伤 Injury of female genital organ 女性生殖道损伤 Rectal injury 直肠损伤 Nerve injury 神经损伤,1、Life saving 抢救生命： A. Airway maintenance with cervical spine protection B. Breathing & ventilation C. Circulation & Hemorrhage control D. Disability: Neurologic status E. Exposure/Environmental control,五、 First aid of pelvis fracture 骨盆骨折的急救,2、Wound care 创口包扎、止血 3、Initial fixation 妥善固定： 稳定骨折、减轻疼痛、便于运送 4、Quick transportation 迅速转运,五、 First aid of pelvis fracture 骨盆骨折的急救,救：Save the life 抢救生命(ATLS) 治：Decrease disability 减少残疾,骨盆骨折救治的目的,六、 Care of pelvis fracture 骨盆骨折的治疗,(一) 骨盆外固定支架 External fixation or pelvic clamp,减少骨盆容积(B1、B3.1、C) 暂时固定减少出血及再损伤(B1、B3.1、C) 确定性治疗(B1型骨折、B2骨折？),骨盆外固定支架的适应症：,自制骨盆外固定架,穿针点的选择依据 穿针方向的确定,骨盆吊带的适应症：,对B1型骨折的治疗复位不确切 对B2型骨折应视为禁忌 更不适用于C型骨折,（二）骨盆吊带 Pelvic hammock,（三）骨盆骨折手术治疗 Operation treatment,Stable injuries 70 Unstable disruptions 30 External fixation + Skeletal tracton Open reduction + Internal fixation,Operation or not ?,骨盆骨折的手术适应证,A 型 骨 折,髂嵴撕脱骨折(A1)移位明显(运动员) 拉力螺钉 髂骨冀骨折明显移位青年女性 骶椎骨折伴骶丛神经损伤,骨盆骨折的手术适应证,B1骨折分离2.5cm B2骨折耻骨联合交锁 C型骨折稳定前环 膀胱及股血管、神经损伤,前 路 固 定,骨盆骨折的手术适应证,骶髂骨折脱位1cm 骶髂复合结构 + 髋臼损伤 骨盆开放骨折,后 路 固 定,for your attention!,
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