骨盆骨折分类及治疗指南（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.

骨盆骨折在多发创伤中较为常见，仍然给即使是经验最丰富的医师造成一个艰难的治疗困境。由于涉及高能损伤机制，通常合并其他部位多发伤，需要各科专家联合诊治。获得一个有效的治疗方案有赖于早期诊断并优先治疗最直接危及生命的损伤。与高级创伤生命支持(ATLS)相对，CT能够用来促进这些方案的实施，即使对于血流动力学不稳的患者亦适用。本文阐述了CT在骨盆骨折中的作用并提供骨折分类之概述。

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.

骨盆骨折在多发创伤中较为常见，仍然给即使是经验最丰富的医师造成一个艰难的治疗困境。由于涉及高能损伤机制，患者通常合并其他部位多发伤，需要多学科综合小组共同诊疗。许多患者需要采用ABC方式立即进行复苏和标准ATLS路径。多数关于骨盆骨折的文章主要强调骨折分类，仅附带提及并发症。实际上，优先次序应该是：

1. 识别危及生命的损伤；

2. 识别急性损伤；

3. 骨折分类可协助指导外科治疗，同时也可引起对未被发现的相关损伤的怀疑。

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.

该综述对辨别最密切相关的损伤早期影像学检查有效应用提供指导，并为诊疗计划的实施提供一个良好的平台。尤其是骨盆骨折的急性并发症将于随后提到的骨折具体类型一并讨论。一条诊疗法则建议尽早结合应用CT并因此对ATLS的通用意见提出挑战。

2. Mechanism and resuscitation

2. 损伤机制和复苏

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.

骨盆骨折通常由高能创伤引起，尽管偶尔可能由轻微损伤机制引起。在这些病例中，临床医师应该对可能潜在的骨病理改变有所警觉。然而，对于大多数患者，高能机制导致高比率的多发伤。因此ATLS建议集中于ABC(气道，呼吸，循环)复苏方法[1]。发现其它潜在危及生命的损伤而不是单纯集中于骨盆损伤是至关重要的。

3. ATLS guidance

3. ATLS指导

Airway;

Breathing;

Circulation;

Disability;

Exposure;

Trauma radiographs (CXR, pelvis XR).

气道；

呼吸；

循环；

失能；

暴露；

创伤放射学检查(胸部X线检查，骨盆X线检查)。