骨盆骨折(九院)匯編課件

骨盆骨折(fh院)Radiographic

Evaluationof

the

acetabulumJudet

Views1.Anteroposterior2.iliac

oblique3.obturatoroblique45°Anteroposterior

view髂會陰線髂坐骨線

髖臼前后唇“teardrop”與髂坐線的關系Obturator

oblique

view前柱恥骨上支髖臼后壁Iliac

oblique

view后柱前壁Tomography

and 3-DReconstructionCT評估常規(guī)X線未能顯示的骨折關節(jié)內(nèi)的骨折碎片,股骨頭骨折骶髂關節(jié)的骨折3-D重建能立體的顯示骨盆Classification

of

AcetabularFractures

(Judet

and

Lelournel)Type

A:

Partial

articular,

involving

onlyone

ofthe

twocolumnsA1 posterior

wall

fractureA2 posterior

columnA3 Anterior

column

orwallType

B:

partial

articular,

involvinga

transverse

componentB1 Pure

transverseB2

T-shapedB3 Anterior

Column

and

posteriorhemitransverseType

C:

Fracture

(complete

articular

:both

columns)C1 High

variety,

extending

to

the

iliacC2 Low

variety,

extending

to

the

anteriorborder

of

theiliumC3 Extension

into

the

SacroiliacjointC1/C2

(both

column=Complete

articular

fracture)Ilioinguinal

approachInvolvement

of

the

posteriorcolumn

or

wallextensile

approachC3 (

Both

column

extendinginto

SIjoint)Extended

Iliofemoral

approachEvaluation

and

diagnosisThe

patient氣道 呼吸 循環(huán)伴隨損傷：長骨干骨折、脊柱、

腦部、腹腔、盆腔、泌尿道Surgical

indicationand

timing病人的全身情況經(jīng)濟情況，需求外科醫(yī)師的經(jīng)驗，器械骨折類型關節(jié)面的完整性

>2mm手術時間：傷后7-10天反指征嚴重骨質疏松無移位骨折后笠骨折碎片小低位前柱骨折Cefazolin

for

48-72

hours

ThromboembolicprophylaxisIndomethacin

75mg

once

daily

sit

up

withthe

first

24-48

hoursActabular

and

limb

fractureInjury

of

sciatic nerve

(12-38%)Hip

dislocation(requires

prompt

reduction)Malreduction

or

subluxation

of

the

hipjoint

will

lead

to

abnormal

loading

ofthe

articular

cartilage

andsubsequentjointarthrosisPrinciple

that

performing

an

accuratereduction

of

the

articular

surface,thereby

obtaining

surface,

therebyobtaining

a

congruent

hip

joint,

willrestore

normal

joint

mechanics.Reduction

techniquesand internal

fixationEssential

reduction

toolsdistractorJudet

fracturetablemanual

reduction“King

Tong”

and

“Queen

Tang”

ClampsThe

majority

of

acetabular

fracturescan

be

managed

through

asinglesurgical

approach,

but

combinedapproaches

are

alsofeasibleThe

four

most

frequently

used

approachesare:Kocher-LangenbeckIlioinguinalExtended

iliofemoralCombination

of

1)

and

2)Interaoperative

traction

Indirectreduction which

have

retainedtheir capsularor

soft-tissueA

dislocated

Sacroiliac

joint

ordisplaced

sacral

fracture

is

usuallyreduced

first

and

fixed.

Prior

to

thereduction

of

the

acetabular

fractureA1(posterior

wall)

Kocher-langenbeckapproach-lateral

decubitusA2

(posterior

column)K-LapproachA3

(anterior

wall

orcolumn)Iiloinguinal

approachB1

(pure

transverse)K-L

approach(prone)B13 extensile

approach

B2

(T-shaped)K-Lor

ilioginguinalB3

(anterior

column

posterior

hemitransverse)Ilioinguinal

or

K-Lor

extended

iliofemoralWeight

bearing

is

not

advanced

for

6-8

weeksDuring

the

third

month,

depending

onradiographic

evidence

of

healing,the

patient

is

allowed

tofull

weightbearingPostoperative

managementrehabilitationThe

third

day,

patient

are

allowed

toe-touch

weight

bearing

using

crutches.Strengthening

exercises

and

gaittrainingComplicationsEarlyNeurovascular

injuryinadequate

reduction,

arti