【正文】 骨外緣的撕脫骨折 旋轉(zhuǎn)骨盆不穩(wěn)定 前后位相 前后位相 通過測(cè)量雙側(cè)股骨頭到 骶骨軸線的垂線之距離 . 投照方法： 患者仰臥于 X線臺(tái)上，射線從足側(cè) 指向恥骨聯(lián)合與垂線約成 40176。 B23: Four Rami type ? Type C pletely unstable (vertical shear) pelvic ring fractures: Type C1: Unilateral Type C2: Bilateral, one side B, one side C Type C3: Bilateral C lesions TILE 1984/1991 Type C2:Bilateral one side B, one side C Type C3: Bilateral C lesions 骨盆的 x線評(píng)定 Radiologic Evaluation of the Pelvis 骨盆的標(biāo)準(zhǔn) x線評(píng)定 前后位像 入口位像 出口位像 Judet位像 軸相斷層像 用于判定骨盆創(chuàng)傷的 放射學(xué)方式 平片 常規(guī)斷層掃描 其它用于判斷伴隨的軟組織和 盆腔臟器損傷的 輔助技術(shù) 血管造影術(shù) 磷酸锝骨掃描 核磁共振影象 患者仰臥于 x線床上，射線垂直于骨 盆中部和放射線板。骨盆及髖臼骨折 Fractures of Pelvis and Acetabulum 王 滿 宜 北京積水潭醫(yī)院 Fractures of Pelvis ? Pelvic pathology: Undisplaced/minmally displaced/displaced: Stable fracture Partially stable fracture (rotational) Completely unstable (rotational and vertically/translationally) Isolated iliac wing fractures Undisplaced pubic ramii fractures Transverse fractures of sacrum below pelvic ring Os coccygis fractures All pelvic ligaments intact! ? Unstable pelvic fractures: Partially stable: Rotationally unstable: External/internal rotation (lateral pression) Flexion/extension Abduction/adduction Completely unstable: Rotationally and vertically (translationally) unstable ? Partially stable pelvic fractures: Rotationally unstable: Open book fractures external rotation Lateral pression fractures internal rotation ? External rotation: Mechanisms of injury: Posterior crush Direct pressure ASIS External rotation through femur(s) Rupture symphysis/sacrospinous lig./anterior sacroiliac lig Always posterior and interosses sacroiliac ligaments intact! ? External rotationally unstable fracture: Partially stable pelvic fractures: Disruption of symphysis only: Slight external rotation Widening of symphysis max. cm = Open book injury ? External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament and anterior sacroiliac ligament: Open book injury Massive external rotation PSIS abuts sacrum: External rotational instability ? External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament, all sacroiliac ligaments: Open book injury with: Massive external rotation Flexion Transition to vertical/translational instability ? Internal rotation: Mechanisms of injury: Direct pressure to iliac crest Force against greater trochanter femoral head acetabulum Force parallel to sacral plane through (s) ? Internal rotationally unstable fractures: Partially stable pelvic fracture: Crush of lateral sacrum Disruption of posterior sacroiliac ligament Always anterior lesion: Transsymphyseal Transpubic Lateral pression injury Always pelvic floor intact! ? Vertical shear: Mechanisms of injury: Force perpendicular to: Sacral plane SIjoint plane (s) ? Rotationally and vertically (translationally) unstable fractures: Completely unstable pelvic fractures: Always plete disruption of: Posterior plex Pelvic floor Anterior plex Completely unstable fracture ? Rotationally and vertically (translationally) unstable fractures: Completely unstable pelvic fracture: Always plete disruption of: Posterior plex: Ligamentous SIjoint fracturedislocation Transiliac fracture Transalar/transforaminal sacral fracture S1/S2 transverse fracture Anterior plex! ? Applicable c