骨盆骨折分类及治疗指南（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].

描述骨折的确切性质有益于骨科医师对损失的处置并提高对相关损伤的警觉性。许多研究试图依据骨折类型预测出血风险[4,20]。然而，不稳定型骨盆骨折更经常性的与出血相关联，因此骨折类型不能绝对地预测出血[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。后环包括骶骨、骶髂关节和髂骨，前环包括耻骨及其联合。骶髂关节可分为前后两部分，通过前后骶髂韧带连接在一起。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提供额外的后方支撑。相反的，前方的耻骨联合薄弱，更容易发生断裂。

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.

目前得到公认的有两种分类系统，Young–Burgess和Tile分类系统[21,22]。Young–Burgess系统根据损伤机制和严重程度分类。Tile系统将骨折主要分为3类，稳定型、部分不稳定型和完全不稳定型。由于本研究的目的，考虑使用Young–Burgess系统。损伤类型主要有3种：

前后挤压型

侧方挤压型

垂直剪切型

10. AP compression

10. 前后挤压型

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.

前后挤压型骨折引起单或双侧半骨盆外旋转，引起髂骨翼向外移位。此型骨折以耻骨分离为特征，在耻骨联合处或矢状位穿耻骨支骨折。相关损失可能包括骶髂关节分离和不常发生的骶骨骨折。前后挤压型由于出血致骨盆腔容积增加，不太可能自发填塞。因此早期处置优先选用骨盆包裹法。