Department of Clinical Medicine, Jining Medical University, Jining City, Shandong Province, China.
Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, Shandong Province, China.
Medicine (Baltimore). 2024 Oct 11;103(41):e40015. doi: 10.1097/MD.0000000000040015.
Anterior dislocation of the sacroiliac joint combined with pelvic fractures is relatively rare in clinical practice. It is often associated with hemodynamic instability and severe injuries to other regions, resulting in a complex condition, prolonged treatment duration, and high rates of mortality and disability. However, there are few reports in the literature describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint. In this case, the patient sustained a pelvic fracture with anterior sacroiliac joint dislocation and rupture of both the internal and external iliac arteries following a motor vehicle accident, making it an even rarer and more challenging case to treat. Reporting such cases can enhance the understanding of the diagnosis and treatment of anterior sacroiliac joint dislocation with rupture of the iliac arteries and provide valuable references for similar cases.
The patient was riding an electric bicycle and was hit by a small truck, resulting in a pelvic fracture, anterior dislocation of the sacroiliac joint, and rupture of the internal and external iliac arteries.
The patient was diagnosed with open pelvic fracture (type C1.2), left complete anterior dislocation of the sacroiliac joint, left acetabular fracture, left internal and external iliac arteriovenous rupture.
emergency room resuscitation, intensive care unit resuscitation, 6 surgeries and perioperative management.
He has been discharged from the hospital for more than 1 year and was rechecked every month after discharge, the fracture has healed, there is no obvious pain and discomfort in and around the wound, he has been fitted with a prosthesis, and he is doing the walking function exercise.
Pelvic fracture with anterior sacroiliac dislocation is clinically rare and critical, and is associated with large vessel rupture, severe organ damage, and high mortality and disability rates. Rapid restoration of pelvic stability and hemodynamic stability is the key to treatment. Rapid transfer to a tertiary trauma center, rapid examination through the green channel to clarify the diagnosis, close intensive care, and reasonable multidisciplinary teamwork for surgical intervention are all valuable experiences that we have concluded.
骶髂关节前脱位合并骨盆骨折在临床上较为少见，常合并血流动力学不稳定和其他部位严重损伤，病情复杂，治疗周期长，死亡率和致残率高。但文献中对骶髂关节前脱位的诊治报道较少，本病例患者因车祸致骨盆骨折伴骶髂关节前脱位，同时合并髂内、外动脉断裂，更为罕见，治疗难度更大。报道此类病例有助于提高对合并髂血管断裂的骶髂关节前脱位的诊治认识，为类似病例提供有价值的参考。
患者骑电动车被小货车撞击，致骨盆骨折，骶髂关节前脱位，髂内、外动脉断裂。
开放性骨盆骨折（C1.2 型），左侧完全性骶髂关节前脱位，左侧髋臼骨折，左侧髂内、外动静脉断裂。
急诊复苏，入住重症监护病房复苏，6 次手术及围手术期管理。
患者已出院 1 年余，出院后每月复查，骨折愈合，伤口及周围无明显疼痛及不适感，已装配假肢，行走功能锻炼。
骶髂关节前脱位合并骨盆骨折临床少见且危急，常合并大血管破裂、多脏器损伤，死亡率及致残率高。快速恢复骨盆稳定性和血流动力学稳定是治疗的关键。快速转至三级创伤中心，通过绿色通道快速检查明确诊断，严密重症监护，合理多学科团队协作进行手术干预，均是我们总结的宝贵经验。
