Rommens P M, Dietz S-O, Ossendorf C, Pairon P, Wagner D, Hofmann A
Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Acta Chir Orthop Traumatol Cech. 2015;82(2):101-12.
Due to the aging population, there is an increasing number of fragility fractures of the pelvis (FFP). They are the result of low energy trauma. The bone breaks but the ligaments remain intact. Immobilizing pain at the pubic region or at the sacrum is the main symptom. Conventional radiographs reveal pubic rami fractures, but lesions of the dorsal pelvis are hardly visible and easily overlooked. CT of the pelvis with multiplanar reconstructions show the real extension of the lesion. Most patients have a history of osteoporosis or other fragility fractures. The new classification distinguishes between four categories of different and increasing instability. FFP Type I are anterior lesions only, FFP Type II are non-displaced posterior lesions, FFP Type III are displaced unilateral posterior lesions and FFP Type IV are displaced bilateral posterior lesions. Subgroups discriminate between the localization of the dorsal instability. FFP Type I lesions are treated non-operatively. FFP Type II lesions are fixed in a percutaneous procedure when a trial of conservative treatment was not successful. FFP Type III lesions are treated with open reduction and internal fixation (ORIF). FFP Type IV lesions are treated with bilateral ORIF or with a bridging osteosynthesis. Iliosacral screw osteosynthesis is widely used, but has an elevated risk of screw loosening due to diminished bine mineral density. Transsacral bar osteosynthesis enable interfragmentary compression and does not have this danger of loosening. Bridging plate osteosynthesis is used as an additional fixation to iliosacral screw osteosynthesis. Lumbopelvic fixation is restricted to highly unstable lumbopelvic dissociations. More studies are needed to find the optimal treatment for each type of instability. Key words: pelvis, fragility fracture, diagnosis, classification, treatment.
由于人口老龄化，骨盆脆性骨折（FFP）的数量日益增加。它们是低能量创伤的结果。骨头断裂但韧带保持完整。耻骨区域或骶骨处的固定性疼痛是主要症状。传统X线片可显示耻骨支骨折，但骨盆背侧病变很难看清且容易被忽视。带有多平面重建的骨盆CT能显示病变的实际范围。大多数患者有骨质疏松症或其他脆性骨折病史。新的分类将不同程度且逐渐增加的不稳定性分为四类。FFP I型仅为前部病变，FFP II型为无移位的后部病变，FFP III型为移位的单侧后部病变，FFP IV型为移位的双侧后部病变。亚组根据背侧不稳定性的部位进行区分。FFP I型病变采用非手术治疗。FFP II型病变在保守治疗试验未成功时采用经皮固定。FFP III型病变采用切开复位内固定（ORIF）治疗。FFP IV型病变采用双侧ORIF或桥接接骨术治疗。髂骶螺钉接骨术被广泛应用，但由于骨密度降低，螺钉松动风险较高。经骶骨棒接骨术可实现骨折块间加压，且不存在这种松动风险。桥接钢板接骨术用作髂骶螺钉接骨术的附加固定。腰骶部固定仅限于高度不稳定的腰骶部分离。需要更多研究来找到针对每种不稳定性类型的最佳治疗方法。关键词：骨盆、脆性骨折、诊断、分类、治疗
