Tomer Divya, Tupe Rishikesh, Bartakke Girishchandra, Bhoi Kedar
Department of Orthopaedics, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India.
J Orthop Case Rep. 2022 Oct;12(10):5-9. doi: 10.13107/jocr.2022.v12.i10.3342.
Trauma is the leading non-obstetric cause of maternal mortality during pregnancy and pelvic fractures are challenging to manage in such cases due to the effect of trauma on the gravid uterus and altered maternal physiology. About 8-16% of pregnant females can have fatal outcome after trauma, with pelvic fractures contributing majorly to the same, and also can have severe fetomaternal complications. There are only two cases reported till date of hip dislocation in pregnancy, with very little literature available on its outcome.
We, hereby, present a case of a 40-year-old pregnant female hit by a moving car with the right superior and inferior pubic rami fracture and left anterior hip dislocation. Closed reduction of the left hip was done under anesthesia and pubic rami fractures were managed conservatively. On follow-up after 3 months, the fracture was completely healed and the patient had a normal vaginal delivery. We have also reviewed management protocols for such cases. Aggressive maternal resuscitation is important for both maternal and fetal survival. Pelvic fractures should not be left unreduced in such cases to prevent mechanical dystocia and can have a good outcome with both closed and open reduction and fixation techniques.
Pelvic fractures in pregnancy should be treated by careful maternal resuscitation and timely intervention. The majority of such patients can deliver vaginally if the fracture heals before delivery.
创伤是孕期孕产妇非产科死亡的首要原因，由于创伤对妊娠子宫及孕产妇生理状态的影响，骨盆骨折在这类情况下的处理颇具挑战性。约8% - 16%的妊娠女性创伤后会有致命结局，其中骨盆骨折是主要原因，且还会引发严重的母婴并发症。迄今为止，仅报告过两例孕期髋关节脱位病例，关于其结局的文献极少。
在此，我们呈现一例40岁妊娠女性，被行驶中的汽车撞击，导致右侧耻骨上下支骨折及左侧髋关节前脱位。在麻醉下对左侧髋关节进行了闭合复位，耻骨上下支骨折采用保守治疗。3个月后随访，骨折完全愈合，患者经阴道正常分娩。我们还回顾了此类病例的处理方案。积极的孕产妇复苏对母婴存活均至关重要。在此类情况下，骨盆骨折不应不进行复位以预防机械性难产，闭合复位及切开复位固定技术均可取得良好效果。
孕期骨盆骨折应通过仔细的孕产妇复苏及及时干预进行治疗。如果骨折在分娩前愈合，大多数此类患者可经阴道分娩。
