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1、西南醫(yī)院骨科 許建中,西南醫(yī)院骨科 許建中,骨 盆 骨 折 Fracture of the Pelvis,骨 盆 骨 折 Fracture of the Pelvis,一、解剖概要 Anatomical outline,,,二、骨盆骨折分類Classification of the pelvic fracture,Type A : Stable pelvic ring injury 穩(wěn)定的骨盆環(huán)損傷,A1: Avulsion of the innominate bone 骨折塊撕脫 A2: Stable iliac wing fracture or stable minimall
2、y displaced ring fractures 穩(wěn)定的髂骨翼骨折或 穩(wěn)定的無移位的環(huán)狀骨折 A3: Transverse fractures of the sacrum and coccyx 骶尾骨橫型骨折,Type B: Partially stable 部分穩(wěn)定骨折,B1: Open book injury 開書樣損傷 B2: The lateral compression injury 側(cè)方擠壓傷 B2.1: Ipsilateral type B2.2: Contralateral Type (bucket-handle 桶柄樣) B3:
3、 Bilateral B injuries 雙側(cè)B型損傷,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） 不穩(wěn)定
4、骨折（縱向減切力）,C1: Unilateral C1.1: Ilium C1.2: Sacroiliac dislocation or fracture dislocation 骶髂關(guān)節(jié)脫位或骨折脫位 C2: Bilateral , one side B ,one side C C3: Bilateral C lesions,Telltale sign of instability,Sacroiliac fracture dislocation,三、Clinical situation 臨床表現(xiàn),Trauma 外傷 Shock 休克 Pain 疼痛 Local swelli
5、ng, Patches & tenderness 局部腫脹、皮下淤斑和壓痛 Lower posterior superior iliac spine 髂后上棘雙側(cè)不等高 Pelvis crushed or separate test 骨盆擠壓、分離實(shí)驗(yàn)陽性 Affected extremity short 患肢短縮 X ray X線片,四、Complications 并發(fā)癥,Hemorrhagic shock 失血性休克 Injury of anterior or posterior urethra 前、后尿道損傷 Rupture of bladder 膀胱破裂 Injury of u
6、rether 輸尿管損傷 Injury of female genital organ 女性生殖道損傷 Rectal injury 直腸損傷 Nerve injury 神經(jīng)損傷,1、Life saving 搶救生命： A. Airway maintenance with cervical spine protection B. Breathing & ventilation C. Circulation & Hemorrhage control D. Disability: Neurologic status E. Exposure/Environmental control,五、 Fi
7、rst aid of pelvis fracture 骨盆骨折的急救,2、Wound care 創(chuàng)口包扎、止血 3、Initial fixation 妥善固定： 穩(wěn)定骨折、減輕疼痛、便于運(yùn)送 4、Quick transportation 迅速轉(zhuǎn)運(yùn),五、 First aid of pelvis fracture 骨盆骨折的急救,救：Save the life 搶救生命(ATLS) 治：Decrease disability 減少殘疾,骨盆骨折救治的目的,六、 Care of pelvis fracture 骨盆骨折的治療,(一) 骨盆外固定支架 External f
8、ixation or pelvic clamp,減少骨盆容積(B1、B3.1、C) 暫時(shí)固定減少出血及再損傷(B1、B3.1、C) 確定性治療(B1型骨折、B2骨折？),骨盆外固定支架的適應(yīng)癥：,自制骨盆外固定架,穿針點(diǎn)的選擇依據(jù) 穿針方向的確定,,,骨盆吊帶的適應(yīng)癥：,對B1型骨折的治療復(fù)位不確切 對B2型骨折應(yīng)視為禁忌 更不適用于C型骨折,（二）骨盆吊帶 Pelvic hammock,（三）骨盆骨折手術(shù)治療 Operation treatment,Stable injuries 70 Unstable disruptions 30 External fixation + Skeletal tracton Open reduction + Internal fixation,Operation or not ?,骨盆骨折的手術(shù)適應(yīng)證,A 型 骨 折,髂嵴撕脫骨折(A1)移位明顯(運(yùn)動(dòng)員) 拉力螺釘 髂骨冀骨折明顯移位青年女性 骶椎骨折伴骶叢神經(jīng)損傷,骨盆骨折的手術(shù)適應(yīng)證,B1骨折分離2.5cm B2骨折恥骨聯(lián)合交鎖 C型骨折穩(wěn)定前環(huán) 膀胱及股血管、神經(jīng)損傷,前 路 固 定,骨盆骨折的手術(shù)適應(yīng)證,骶髂骨折脫位1cm 骶髂復(fù)合結(jié)構(gòu) + 髖臼損傷 骨盆開放骨折,后 路 固 定,for your attention!,
FractureofthePlevis(骨盆骨折
