Davis Donald D., Tiwari Vivek, Kane Steven M., Waseem Muhammad
Wellstar Atlanta Medical Center
Apollo Sage Hospital, Bhopal, India
The pelvis is naturally designed to be a highly stable structure. Pelvic ring fractures occur most commonly in the setting of a high-impact trauma and are often associated with additional fractures or injuries elsewhere in the body. Certain pelvic fractures do not disrupt the pelvic ring, eg, iliac wing fractures, and can typically be managed without operative intervention. Similarly, acetabulum fractures frequently occur, particularly in high-energy traumas, hip dislocations, and falls in older adults. These injuries are studied in detail and classified by the fracture's anatomy. The Young-Burgess classification is a valuable evaluation tool when diagnosing pelvic ring injuries. By correctly assessing a pelvic ring injury, trauma surgeons and emergency physicians can provide adequate initial treatment and convey important information about the injured structures' anatomy to the orthopedic surgeon managing the condition. To appropriately apply the Young-Burgess classification system of pelvic ring injuries, clinicians must understand pelvic ligamentous anatomy. The bony pelvis is comprised of the ilium, ischium, and pubis. These structures form an anatomic ring with the sacrum. The symphyseal ligaments stabilize the pubic symphysis on the anterior side. The pelvic floor ligaments and posterior sacroiliac complex stabilize the pelvic ring on the posterior aspect. The sacrospinous and sacrotuberous ligaments of the pelvic floor, anterior to the sacroiliac joint, resist both shear and external rotation through the sacroiliac joint. The posterior sacroiliac complex is the most posterior ligament in the pelvic ring and the most essential structure for pelvic ring stability. Injury to the posterior ligaments reveals a very high-energy injury mechanism. Pelvic ring injuries are usually accompanied by severe soft tissue disruption. Thus, vascular, neurologic, and visceral injuries are common and must be ruled out. The posterior pelvis' venous plexus accounts for most hemorrhage associated with pelvic ring injuries. The corona mortis is an anastomosis between the external iliac and obturator artery, a branch of the internal iliac artery. Intraoperative corona mortis damage can quickly result in a bad outcome due to excessive blood loss within the pelvis.
骨盆天生就是一个高度稳定的结构。骨盆环骨折最常发生在高能量创伤的情况下，并且常常伴有身体其他部位的额外骨折或损伤。某些骨盆骨折不会破坏骨盆环，例如髂骨翼骨折，通常无需手术干预即可处理。同样，髋臼骨折也经常发生，尤其是在高能量创伤、髋关节脱位以及老年人跌倒时。这些损伤会根据骨折的解剖结构进行详细研究和分类。Young-Burgess分类法是诊断骨盆环损伤时的一种有价值的评估工具。通过正确评估骨盆环损伤，创伤外科医生和急诊医生可以提供充分的初始治疗，并向处理该病情的骨科医生传达有关受伤结构解剖学的重要信息。为了适当地应用骨盆环损伤的Young-Burgess分类系统，临床医生必须了解骨盆韧带解剖结构。骨性骨盆由髂骨、坐骨和耻骨组成。这些结构与骶骨形成一个解剖环。耻骨联合韧带稳定耻骨联合的前侧。盆底韧带和骶髂后复合体稳定骨盆环的后侧。盆底的骶棘韧带和骶结节韧带在骶髂关节前方，通过骶髂关节抵抗剪切力和外旋。骶髂后复合体是骨盆环中最靠后的韧带，也是骨盆环稳定性最重要的结构。后韧带损伤表明损伤机制能量非常高。骨盆环损伤通常伴有严重的软组织破坏。因此，血管、神经和内脏损伤很常见，必须排除。骨盆后部的静脉丛是与骨盆环损伤相关的大部分出血的原因。死亡冠是髂外动脉与闭孔动脉（髂内动脉的一个分支）之间的吻合。术中死亡冠损伤可因骨盆内失血过多而迅速导致不良后果。
