Steinke Hanno, Hammer Niels, Lingslebe Uwe, Höch Andreas, Klink Thomas, Böhme Jörg
Universität Leipzig, Institut für Anatomie (Institute of Anatomy), Leipzig, F.R. of Germany.
Clin Anat. 2014 Jul;27(5):770-7. doi: 10.1002/ca.22312. Epub 2014 Jan 22.
Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy.
骨盆环的稳定性由骨性结构和韧带结构被动维持。治疗方法主要集中在骨折类型上，因此韧带常常被忽视。当骨盆环骨折后韧带与骨骼一同断裂，破坏了稳定性时，在重建和康复过程中就需要考虑韧带因素。我们的目的是使用两个尸体捐赠者实验模型来确定韧带对开书样损伤的影响。研究了与开书样损伤相关的骨撕脱机制。在人体骨盆上造成开书样损伤，随后通过解剖和内窥镜检查进行研究。将研究结果与开书样损伤的CT和MRI扫描结果进行比较。使用骨盆后环的塑化横断面进一步分析相关结构。观察到一块与开书样损伤相关的骶骨远端碎片。发现两条韧带导致了这种撕脱现象：骶髂前韧带的尾部以及另一条沿第三骶椎腹侧走行的韧带。开书样损伤后，骶骨碎片通过第二条韧带与髋骨相连。这些结果通过塑化得到验证，并确定了相关结构。骨盆韧带可能参与了侧方牵引导致的骶骨撕脱。因此，在开书样损伤的诊断和后续治疗中应考虑韧带因素。
