Culemann U, Tosounidis G, Reilmann H, Pohlemann T
Chirurgische Universitätsklinik, Abteilung für Unfallchirurgie, Homburg/Saar.
Unfallchirurg. 2004 Dec;107(12):1169-81; quiz 1182-3. doi: 10.1007/s00113-004-0898-4.
Pelvic fracture, especially in combination with multiple trauma, can still lead to ife-threatening situations. Only clear inclusion criteria and decisions can ensure survival of the patient, the key task being mechanical stabilization using external fixators or pelvic clamps with or without surgical intervention for hemostasis. The basis for problem-orientated management is a precise classification, which is based on conventional X-rays in emergency situations and detailed analysis of computed tomography for the planning of definitive surgical interventions. The classification groups postulated are stable pelvic fractures (type A), rotational unstable pelvic fractures (type B -- partial stability of the posterior ring present), and translational instabilities (type C -- with a complete disruption of the anterior and posterior pelvic ring). This classification leads to clear indications for pelvic ring stabilization as surgical interventions are only exceptionally indicated in type A fractures, stabilization of the anterior ring is sufficient for type B fractures, and combined posterior and anterior stabilization is necessary for treatment of type C fractures. Following these concepts and by using standardized procedures and implants, the high rate of enclosed anatomical healing can be achieved even after type C injuries. Nevertheless, the role of concomitant soft tissue injuries and scar formation is not clear as the origin of the frequently observed long-term clinical impairments even after anatomical reconstruction of the osteoligamentous structures.
骨盆骨折，尤其是合并多发伤时，仍可导致危及生命的情况。只有明确的纳入标准和决策才能确保患者存活，关键任务是使用外固定器或骨盆夹进行机械稳定，无论是否进行手术止血干预。以问题为导向的管理基础是精确分类，在紧急情况下基于传统X线片，在计划确定性手术干预时基于计算机断层扫描的详细分析。假定的分类组为稳定型骨盆骨折（A型）、旋转不稳定型骨盆骨折（B型——后环部分稳定）和平移不稳定型（C型——前后骨盆环完全中断）。这种分类为骨盆环稳定提供了明确的指征，因为手术干预仅在A型骨折中例外使用，B型骨折稳定前环就足够了，而C型骨折的治疗需要前后联合稳定。遵循这些概念并使用标准化程序和植入物，即使在C型损伤后也能实现较高的封闭性解剖愈合率。然而，尽管骨韧带结构已进行解剖重建，但伴随的软组织损伤和瘢痕形成的作用仍不明确，因为这是经常观察到的长期临床功能障碍的根源。
