骨盆骨折.ppt

西南医院骨科许建中,西南医院骨科许建中,骨盆骨折FractureofthePelvis,骨盆骨折FractureofthePelvis,一、解剖概要Anatomicaloutline,二、骨盆骨折分类Classificationofthepelvicfracture,TypeA:Stablepelvicringinjury稳定的骨盆环损伤,A1:Avulsionoftheinnominatebone骨折块撕脱A2:Stableiliacwingfractureorstableminimallydisplacedringfractures稳定的髂骨翼骨折或稳定的无移位的环状骨折A3:Transversefracturesofthesacrumandcoccyx骶尾骨横型骨折,TypeB:Partiallystable部分稳定骨折,B1:Openbookinjury开书样损伤B2:Thelateralcompressioninjury侧方挤压伤B2.1:IpsilateraltypeB2.2:ContralateralType(bucket-handle桶柄样)B3:BilateralBinjuries双侧B型损伤,Openbookinjury,Openbookinjury,Openbookinjury,Lateralcompressionfracture,Lockedsymphysis,Avariantofthetypeinjuryoftenseeninyoungwomen,LateralcompressioninjuryTypeB2.2,AnteroposteriorradiographTypeB2.2,TypeC:Unstable（verticalshear）不稳定骨折（纵向减切力）,C1:UnilateralC1.1:IliumC1.2:Sacroiliacdislocationorfracturedislocation骶髂关节脱位或骨折脱位C2:Bilateral,onesideB,onesideCC3:BilateralClesions,Telltalesignofinstability,Sacroiliacfracturedislocation,三、Clinicalsituation临床表现,Trauma外伤Shock休克Pain疼痛Localswelling,Patches&tenderness局部肿胀、皮下淤斑和压痛Lowerposteriorsuperioriliacspine髂后上棘双侧不等高Pelviscrushedorseparatetest骨盆挤压、分离实验阳性Affectedextremityshort患肢短缩XrayX线片,四、Complications并发症,Hemorrhagicshock失血性休克Injuryofanteriororposteriorurethra前、后尿道损伤Ruptureofbladder膀胱破裂Injuryofurether输尿管损伤Injuryoffemalegenitalorgan女性生殖道损伤Rectalinjury直肠损伤Nerveinjury神经损伤,1、Lifesaving抢救生命：A.AirwaymaintenancewithcervicalspineprotectionB.Breathing&ventilationC.Circulation&HemorrhagecontrolD.Disability:NeurologicstatusE.Exposure/Environmentalcontrol,五、Firstaidofpelvisfracture骨盆骨折的急救,2、Woundcare创口包扎、止血3、Initialfixation妥善固定：稳定骨折、减轻疼痛、便于运送4、Quicktransportation迅速转运,五、Firstaidofpelvisfracture骨盆骨折的急救,救：Savethelife抢救生命(ATLS)治：Decreasedisability减少残疾,骨盆骨折救治的目的,六、Careofpelvisfracture骨盆骨折的治疗,(一)骨盆外固定支架Externalfixationorpelvicclamp,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Pelvichammock,（三）骨盆骨折手术治疗Operationtreatment,Stableinjuries70Unstabledisruptions30Externalfixation+SkeletaltractonOpenreduction+Internalfixation,Operationornot?,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