骨盆骨折分型.pptVIP

骨盆骨折的分型Classification of pelvic disruption 创伤骨科 孙煜杰 骨折分类的目的 指导临床治疗 评价伤情特征 了解损伤机制 判断病程转归 推测预后等 常用分型 Tile 分型：根据骨折的稳定程度及其移位方向所提出的分类标准。得到了学术界（AO/ASIF、OTA、SICOT）较广泛的认可，具有明显的优点。 Young-Burgess 分型：在Pennal 和Tile分型基础上，以损伤机制为重点，可作为判断骨盆损伤严重程度的预警性标准。 Tile分型（1988） A 型骨折 没有累及及骨盆环的撕脱骨折，属稳定型骨折。 该类骨折中骨盆后部和顶部的骨和韧带仍保持完整。 A1:骨盆边缘骨折,不累及骨盆环,撕脱伤; A2:骨盆环有骨折或有轻度移位。 A3:不累及骨盆环,骶骨或尾骨骨折无移位。 B 型骨折 旋转不稳、垂直稳定的骨盆环损伤,损伤的骨盆后侧张力带和骨盆底仍保持完整无损伤,髋骨可发生旋转不稳定。 B1:外旋损伤,翻书样损伤。 B2:骨盆单侧的侧方挤压损伤或髋骨内旋损伤,内旋不稳定。 B3: 对侧B型损伤。“桶柄状”损伤 B1型骨折 In Stage 1 the disruption of the symphysis pubis is less than 2.5 cm and there is no posterior lesion. In Stages 2 and 3 the separation at the symphysis pubis is greater than 2.5 cm. This implies disruption of the sacrospinous ligament and the anterior sacroiliac ligament .This may occur on one side only (Stage 2) or be bilateral (Stage 3). B3型骨折 Bucket Handle Lateral Compression Injury -Type B3. The diagram shows the typical appearance of a bucket handle injury, with the left hemi-pelvis internally and superiorly rotated by 40° . The radiograph shows internal rotation of the left hemi-pelvis with fracture of all four pubic rami. The CT scan confirms the internal rotation of the hemipelvis and the crush injury of the anterior sacrum. It shows avulsion of the posterior iliac apophysis (arrow). C型骨折 旋转和垂直不稳定的骨盆环损伤。盆底结构、后侧骶髂部稳定结构完全损伤,骶棘和骶结节韧带完全撕裂。前侧产生耻骨联合分离,或一侧、双侧耻骨上下支骨折,骨盆产生旋转和垂直方向不稳定,一侧骨盆可向上移位。 C1:单侧伤; C2:骨盆双侧不稳定,多为侧方挤压性损伤,受力侧髂骨后部骨折及耻骨支骨折,骶髂关节脱位,一侧旋转不稳,一侧旋转和垂直不稳。 C3:骨盆环破裂合并髋臼骨折。 C型骨折 Unstable Vertical Shear Injury - Type C. The drawing shows an unstable vertical shear fracture. The shearing forces cause massive disruption of the pelvic ring, its soft tissues and surrounding structures.The radiograph shows the fracture line through the sacrum and avulsion of the tip of the transverse process of L5 .Displacement appears to be minimal, but the unstable nature of this injury is best shown on the CT scan by the wide displacement of the sacral fragments. Young-Burge