Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
J Orthop Trauma. 2018 Sep;32 Suppl 6:S31-S35. doi: 10.1097/BOT.0000000000001247.
Pelvic fractures are common after high-energy trauma and are often associated with ligamentous injury. Treatment is guided by assessing stability of the pelvic ring, and unstable injuries frequently require surgery to achieve a desirable outcome. Assessment of pelvic ring stability is often possible with physical examination and standard imaging studies (plain radiographs and computed tomography); however, these "static" imaging modalities may not adequately identify dynamically unstable pelvic injuries that require surgery. Cadaveric and clinical data suggest that the injured pelvis may recoil significantly from the point of maximal displacement, and some unstable injuries may not be recognized until patients present with clinical symptoms. This article presents the case of a patient who sustained a minimally displaced pelvic ring injury that was stable on bedside examination and static imaging, but ultimately was unstable. She developed a substantial pelvic malunion with significant pain and activity limitations. The patient subsequently underwent successful pelvic ring reconstruction, and she remains asymptomatic at 2 years.
骨盆骨折常见于高能创伤后，常伴有韧带损伤。治疗方法取决于骨盆环稳定性的评估，不稳定的损伤通常需要手术以获得理想的结果。骨盆环稳定性的评估通常可以通过体格检查和标准影像学研究（平片和 CT）进行；然而，这些“静态”影像学方式可能无法充分识别需要手术的动态不稳定骨盆损伤。尸体和临床数据表明，受伤的骨盆可能会从最大位移点显著回缩，一些不稳定的损伤可能在患者出现临床症状之前无法被识别。本文介绍了一位患者的病例，该患者的骨盆环损伤轻微且无移位，床边检查和静态影像学检查均显示稳定，但最终不稳定。她发展为严重的骨盆畸形愈合，伴有明显的疼痛和活动受限。患者随后接受了成功的骨盆环重建，2 年后仍无症状。
