Calderazzi Filippo, Nosenzo Alessandro, Galavotti Cristina, Menozzi Margherita, Pogliacomi Francesco, Ceccarelli Francesco
Dipartimento Scienze Chirurgiche Ospedale Maggiore Parma, U.O. Clinica Ortopedica.
Acta Biomed. 2018 Nov 15;89(4):470-476. doi: 10.23750/abm.v89i4.7632.
Fractures of the pelvis classically occur in adolescent during sports activities with forceful and repetitive contractions or passive lengthening acting on not yet ossified growth plates. Their misdiagnosis lead to disability, chronic pain and decrease of performances. Evidence based treatment guidelines do not exist; aim of this paper is to point out clinical outcomes, return to sport rates and complications of surgical and conservative approach.
A systematic search based on MEDLINE database was performed in August 2017 to identify all published articles from 2010 to 2017 reporting outcomes, return to sport and complications rates after surgical and non-operative treatment of avulsion fractures of the pelvis.
Mean age was 14,5 years with anterior inferior iliac spine avulsion representing the most common injury (46%), followed by anterior superior iliac spine avulsion (32%), ischial tuberosity avulsion (12%) and iliac crest avulsion (11%). Rates of excellent outcome and return to sports at pre-injury levels were higher after surgical treatment; surgery has a higher risk of heterotopic ossification (9%) compared to conservative treatment (1,8%), whereas the risk of non-unions is lower (0% versus 2,5%).
Surgery is preferred for major dislocations and fragment sizes, providing a faster return to pre-injury level of activity, decreasing the risk of pseudoarthrosis. Conservative treatment is advisable for minimally displaced fractures when a rapid recovery is not required; patient and his family should be informed on the risk of non-unions and the eventuality of a delayed surgical approach.
骨盆骨折通常发生于青少年的体育活动中，由于强力且反复的收缩或被动拉伸作用于尚未骨化的生长板。其误诊会导致残疾、慢性疼痛及运动能力下降。目前尚无基于证据的治疗指南；本文旨在指出手术及保守治疗方法的临床疗效、恢复运动率及并发症情况。
2017年8月基于MEDLINE数据库进行了系统检索，以识别2010年至2017年期间发表的所有报道骨盆撕脱骨折手术及非手术治疗后的疗效、恢复运动及并发症发生率的文章。
平均年龄为14.5岁，其中髂前下棘撕脱是最常见的损伤（46%），其次是髂前上棘撕脱（32%）、坐骨结节撕脱（12%）和髂嵴撕脱（11%）。手术治疗后，优良疗效及恢复到伤前运动水平的比例更高；与保守治疗（1.8%）相比，手术发生异位骨化的风险更高（9%），而骨不连的风险更低（0%对2.5%）。
对于严重脱位和较大骨折块，手术治疗更佳，能更快恢复到伤前的活动水平，降低假关节形成的风险。对于移位极小且不需要快速恢复的骨折，建议采用保守治疗；应告知患者及其家属骨不连的风险以及可能需要延迟手术的情况。
