Kenawey Mohamed
Sohag University Faculty of Medicine, Sohag University, Sohag, Egypt.
J Pediatr Orthop. 2020 Aug;40(7):e579-e586. doi: 10.1097/BPO.0000000000001548.
Disruption through the weak iliac apophysis growth plate is characteristic in unstable pediatric posterior pelvic injuries. Magnetic resonance imaging (MRI) scans would help in the assessment of bony injuries in addition to the trunk and abdominal wall muscles and the posterior sacroiliac and pelvic floor ligaments.
All children with displaced pelvic fractures Tile C and open triradiate cartilage between September 2010 and December 2017 who had computed tomography evidence of iliac apophysis avulsion and available MRI scans were reviewed. The paravertebral, anterior abdominal wall and iliacus muscles, and the sacroiliac and pelvic floor ligaments were evaluated.
Eight patients had pelvic MRI scans in addition to the standard computed tomography. All were males and the average age was 7.5 years (4 to 14 y). The iliac apophysis was attached posteriorly to the quadratus lumborum and erector spinae muscles and to the posterior sacroiliac complex. The bony iliac wing lost its connection to the axial skeleton and its muscular attachment to the erector spinae and quadratus lumborum. The iliacus muscle was elevated of the iliac fossa in all cases. The anterior sacroiliac ligaments were disrupted in all while the pelvic floor ligaments were disrupted in 5 patients, intact in 2 and could not be clearly visualized in 1 patient. In 2 patients, anterior abdominal wall muscles were split in 2 layers, the external oblique attached to the displaced bony ilium and the internal oblique and transversus abdominis attached to the iliac crest apophysis. This deep layer was continuous distally with the iliacus muscle. This could be explained by the anatomic arrangement of the thoracolumbar fascia and its middle layer.
The posterior pelvic ring would be disrupted through the weak chondro-osseous connection between the bony ilium and its well-fixed iliac crest apophysis which is attached to the posterior sacroiliac complex, paravertebral muscles, and the posterior and middle layers of the thoracolumbar fascia. This is central to our understanding for the pathomechanics of those injuries and for operative fixation.
不稳定型小儿骨盆后环损伤的特征是通过薄弱的髂骨骨骺生长板发生断裂。磁共振成像（MRI）扫描除了有助于评估骨骼损伤外，还能评估躯干和腹壁肌肉以及骶髂后韧带和盆底韧带。
回顾了2010年9月至2017年12月期间所有Tile C型骨盆骨折移位且三放射状软骨开放、有髂骨骨骺撕脱的CT证据且有可用MRI扫描的儿童。评估椎旁肌、腹前壁肌和髂肌以及骶髂韧带和盆底韧带。
除标准CT外，8例患者还进行了骨盆MRI扫描。均为男性，平均年龄7.5岁（4至14岁）。髂骨骨骺在后方附着于腰方肌和竖脊肌以及骶髂后复合体。髂骨翼失去了与轴向骨骼的连接以及与竖脊肌和腰方肌的肌肉附着。所有病例中髂肌均从髂窝抬起。所有患者的骶髂前韧带均断裂，5例患者的盆底韧带断裂，2例完整，1例无法清晰显示。2例患者的腹前壁肌分为两层，腹外斜肌附着于移位的髂骨，腹内斜肌和腹横肌附着于髂嵴骨骺。这一深层在远端与髂肌连续。这可以通过胸腰筋膜及其中层的解剖结构来解释。
骨盆后环会通过髂骨与其固定良好的髂嵴骨骺之间薄弱的软骨-骨连接发生断裂，髂嵴骨骺附着于骶髂后复合体、椎旁肌以及胸腰筋膜的后层和中层。这对于我们理解这些损伤的病理力学和手术固定至关重要。
