Feinblatt Jeff S, Phieffer Laura S, Lawyer Ruskin B
Oregon Orthopedic and Sports Medicine Clinic, LLP, Oregon City, Oregon, USA.
Orthopedics. 2010 Dec 1;33(12):920. doi: 10.3928/01477447-20101021-32.
Although much has been written on the evaluation and management of pelvic ring injuries, only a single case of anterior sacroiliac joint dislocation exists in the literature and was reported in 1976. This article describes 2 additional cases, 1 of a pure anterior sacroiliac dislocation in a 25-year-old man, and 1 of an anterior sacroiliac fracture-dislocation in an 18-year-old man, each treated by a different orthopedic traumatologist at neighboring trauma centers. Both cases were the result of high-energy trauma, and both patients had significant complications resulting from severity of their injuries, including wound dehiscence and causalgia in 1 case and persistent L5-S1 paresthesias and paresis in the other. Closed reduction can be attempted, but in our experience was unsuccessful even with the use of external fixation pins for leverage. We recommend open reduction by an orthopedic traumatologist who will perform definitive fixation. The decision to use an anterior external fixation frame to assist during the patient's resuscitation should be based on the patient's hemodynamic status and concomitant injuries. Despite a high complication rate, operative intervention can return patients to a functional level with minimal residual pain.
尽管关于骨盆环损伤的评估和处理已有大量文献报道，但文献中仅存在一例1976年报道的骶髂关节前脱位病例。本文描述了另外2例病例，1例为25岁男性的单纯骶髂关节前脱位，另1例为18岁男性的骶髂关节前骨折脱位，分别由相邻创伤中心的不同骨科创伤专家进行治疗。两例均为高能量创伤所致，且两名患者均因伤势严重出现了显著并发症，其中1例出现伤口裂开和灼性神经痛，另1例出现L5 - S1持续感觉异常和轻瘫。可尝试进行闭合复位，但根据我们的经验，即使使用外固定针进行杠杆作用，复位也未成功。我们建议由骨科创伤专家进行切开复位并实施确定性固定。在患者复苏过程中决定使用前路外固定架辅助治疗应基于患者的血流动力学状态和伴随损伤情况。尽管并发症发生率较高，但手术干预可使患者恢复到功能水平，且残留疼痛最小。
