Webb L X, Gristina A G, Wilson J R, Rhyne A L, Meredith J H, Hansen S T
Department of Surgery, Wake Forest University Medical Center, Winston-Salem, North Carolina 27103.
J Trauma. 1988 Jun;28(6):813-7. doi: 10.1097/00005373-198806000-00016.
Techniques for managing traumatic diastasis of the pubic symphysis include bed rest, hip spica casting, pelvic slings, external fixation, and internal fixation. We report herein our experience with 14 consecutively managed patients in whom we successfully stabilized traumatic pubic diastasis with a single two-hole plate fixation. The average age of the 13 men and one woman was 30 years; followup averaged 17 months. Most of the patients had associated injuries (Injury Severity Score average, 19). Nine patients had concomitant disruption of the sacroiliac joint requiring either delayed open reduction and internal fixation or prolonged skeletal traction; among the five remaining patients, time to mobilization (bed to chair) averaged 1 day. There were no complications attributable to the procedure; i.e., no infections, and no failures of fixation. In this small series of patients early two-hole plate fixation of the traumatic diastasis of the pubis satisfactorily restored the disrupted anterior pelvic ring, contributed to early mobilization of the patients, and made reduction of a concomitantly disrupted sacroiliac joint easier, whether accomplished by skeletal traction or open reduction and internal fixation during a second procedure.
耻骨联合外伤性分离的处理技术包括卧床休息、髋人字石膏固定、骨盆吊带、外固定和内固定。我们在此报告连续14例患者的治疗经验，我们使用单块双孔钢板固定成功稳定了外伤性耻骨分离。13名男性和1名女性的平均年龄为30岁；平均随访17个月。大多数患者伴有其他损伤（平均损伤严重程度评分19分）。9例患者同时伴有骶髂关节脱位，需要延迟切开复位内固定或长期骨牵引；其余5例患者中，从卧床到坐椅活动的平均时间为1天。没有与手术相关的并发症，即无感染，无内固定失败。在这一小系列患者中，早期采用双孔钢板固定外伤性耻骨分离能令人满意地恢复骨盆前环的连续性，有助于患者早期活动，并使同时发生的骶髂关节脱位更容易复位，无论其复位是通过骨牵引还是在二期手术中切开复位内固定来完成。
