Guimarães Joao Antonio Matheus, Mendes Pedro Henrique B, Vallim Frederico C M, Rocha Leonardo R, Rocha Tito H N, do Val Isabel Cristina C, Duarte Maria Eugenia L
National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
Injury. 2014 Nov;45 Suppl 5:S40-5. doi: 10.1016/S0020-1383(14)70020-8.
To present the results and conclusions of our study on surgical treatment for unstable pelvic fractures in children subjected to surgical reduction and stabilisation.
We analysed the cases of fourteen skeletally immature patients with unstable pelvic fractures who underwent surgery for this condition between March 2004 and January 2011. The surgical technique used was based on the principle of surgical reduction and stabilisation of anterior and posterior lesions of the pelvic ring. This was a retrospective study, based on clinical assessment and X-ray analyses.
The mean age of patients at the time of the condition was 9.4 years (range 2-13 years). Eight patients were female and six were male. The cause of the trauma was being hit by a car in ten cases, falls in three cases and an accident involving a motorcycle in one case. Five patients presented with other associated injuries, including fracture of the clavicle, femur shaft, proximal humerus, tibial shaft or olecranon, and bladder damage. All the patients assessed showed excellent clinical progress. Pelvic asymmetry prior to surgery varied from 1.1 to 2.9 cm (mean 1.5 cm) and dropped to a range of 0.2 to 0.9 cm (mean 0.4 cm) after reduction. In none of the cases was there a change between the pelvic asymmetry measured immediately after surgery and at the end of the follow-up period.
Pelvic fracture in skeletally immature patients is rare and surgery is not normally indicated. Various authors have questioned this conservative type of treatment due to complications encountered. Bone remodelling does not seem to be sufficient to ensure an improvement in pelvic asymmetry, which justifies opting for surgery to reduce and correct deformities in the pelvic ring.
介绍我们对接受手术复位与固定的儿童不稳定骨盆骨折进行手术治疗的研究结果与结论。
我们分析了2004年3月至2011年1月期间因不稳定骨盆骨折接受手术的14例骨骼未成熟患者的病例。所采用的手术技术基于骨盆环前后部损伤的手术复位与固定原则。这是一项基于临床评估和X线分析的回顾性研究。
患者发病时的平均年龄为9.4岁（范围2 - 13岁）。8例为女性，6例为男性。创伤原因：10例为被汽车撞击，3例为跌倒，1例为摩托车事故。5例患者伴有其他损伤，包括锁骨、股骨干、肱骨近端、胫骨干或尺骨鹰嘴骨折以及膀胱损伤。所有接受评估的患者临床进展均良好。术前骨盆不对称度在1.1至2.9厘米之间（平均1.5厘米），复位后降至0.2至0.9厘米（平均0.4厘米）。术后即刻测量的骨盆不对称度与随访期末相比，无一例发生变化。
骨骼未成熟患者的骨盆骨折罕见，通常不建议手术。由于出现并发症，多位作者对这种保守治疗方式提出质疑。骨重塑似乎不足以确保骨盆不对称得到改善，这证明选择手术来复位和纠正骨盆环畸形是合理的。
