骨盆及髋臼骨折(王满宜)(《外科学》年制版配套).ppt

第75章骨盆及髋臼骨折FracturesofPelvisandAcetabulum王满宜FracturesofPelvisPelvicpathology: Undisplaced/minmallydisplaced/displaced: Stablefracture Partiallystablefracture(rotational) Completelyunstable(rotationaland vertically/translationally) Isolatediliacwingfractures Undisplacedpubicramiifractures Transversefracturesofsacrumbelowpelvic ring ygisfracturesAllpelvicligamentsintact!Unstablepelvicfractures: Partiallystable: Rotationallyunstable: External/internalrotation (pression) Flexion/extension Abduction/adduction Completelyunstable: Rotationallyandvertically (translationally)unstablePartiallystablepelvicfractures: Rotationallyunstable: Openbookfractures>external rotation pressionfractures> internalrotationExternalrotation: Mechanismsofinjury: Posteriorcrush DirectpressureASIS Externalrotationthroughfemur(s) >Rupturesymphysis/sacrospinous lig./anteriorsacroiliaclig Alwaysposteriorandinterossessacroiliac ligamentsintact!Externalrotationallyunstablefracture: Partiallystablepelvicfractures: Disruptionofsymphysisonly: >Slightexternalrotation >Wideningofsymphysis  =OpenbookinjuryExternalrotationallyunstablefractures: Partiallystablepelvicfracture: Disruptionofsymphysis,sacrospinous ligamentand anteriorsacroiliacligament: >Openbookinjury Massiveexternalrotation>PSISabuts sacrum: ExternalrotationalinstabilityExternalrotationallyunstablefractures: Partiallystablepelvicfracture: Disruptionofsymphysis,sacrospinous ligament, allsacroiliacligaments: >Openbookinjurywith: Massiveexternalrotation Flexion >Transitionto vertical/translationalinstabilityInternalrotation: Mechanismsofinjury: rest Forceagainstgreatertrochanter> femoralhead>acetabulum Forceparalleltosacralplane (s)