Becker Christopher A, Kammerlander Christian, Greiner Axel, Sommer Fabian, Linhart Christoph, Böcker Wolfgang, Rubenbauer Bianka, Weidert Simon
Klinik für Allgemeine Unfall-, Hand- und Plastische Chirurgie, Klinikum der Ludwig-Maximilians-Universität München.
Z Orthop Unfall. 2018 Oct;156(5):541-546. doi: 10.1055/a-0596-8018. Epub 2018 Apr 12.
The Morel-Lavallée lesion is one of the concomitant soft tissue lesions of pelvic fractures. Its role in spine fractures and its treatment in combination with osteosynthesis of pelvic or spine fractures have not yet been determined. The aim of this study was to analyse the best diagnostic and treatment options of both spine and pelvic fractures combined with Morel-Lavallée lesions (MLL).
An analysis of the literature was performed via PubMed and Medline. This revealed a total of 197 studies and case reports. After analysing the literature, 19 studies/case reports met our inclusion criteria.
There are several diagnostic options for MLL, including ultrasound, computed tomography or MRI. In spinal and pelvic lesions, ultrasound is capable of detecting MLL. Some authors tend to perform open debridement of the MLL, whereas others recommend percutanous treatment. Open debridement and vacuum-assisted closure are recommended in late diagnosed MLL, where primary suture of the soft tissue is impossible. Fracture fixation should be performed simultaneously to treatment of the MLL. Broad-spectrum cephalosporins combined with an aminoglycoside or piperacilline/tazobactam should be initiated.
Radical debridement and drainage are recommended, especially when MLL is diagnosed late. Repeated ultrasound examinations should be performed of the surrounding soft tissue of the fracture. When MLL is diagnosed within 2 days, percutanous fracture and MLL treatment should be performed. After more than 2 days, both fracture and MLL should be treated with open debridement, open fracture fixation and primary suture if possible.
莫雷尔-拉瓦利埃损伤是骨盆骨折伴发的软组织损伤之一。其在脊柱骨折中的作用以及与骨盆或脊柱骨折内固定联合治疗的方法尚未确定。本研究的目的是分析脊柱和骨盆骨折合并莫雷尔-拉瓦利埃损伤（MLL）的最佳诊断和治疗方案。
通过PubMed和Medline进行文献分析。共检索到197项研究和病例报告。分析文献后，19项研究/病例报告符合纳入标准。
MLL有多种诊断方法，包括超声、计算机断层扫描或磁共振成像。在脊柱和骨盆损伤中，超声能够检测到MLL。一些作者倾向于对MLL进行切开清创，而另一些人则推荐经皮治疗。对于诊断较晚、无法进行软组织一期缝合的MLL，建议采用切开清创和负压封闭引流。骨折固定应与MLL治疗同时进行。应开始使用广谱头孢菌素联合氨基糖苷类药物或哌拉西林/他唑巴坦。
建议进行彻底清创和引流，尤其是在MLL诊断较晚时。应对骨折周围软组织进行反复超声检查。若在2天内诊断出MLL，应进行经皮骨折和MLL治疗。超过2天后，骨折和MLL均应采用切开清创、切开骨折固定，并尽可能进行一期缝合治疗。
