Duquennoy A, Tillie B, Fontaine C, Gougeon F, Mestdagh H
Rev Chir Orthop Reparatrice Appar Mot. 1985;71(5):311-8.
Involvement of the sacro-iliac joint is frequently associated with acetabular fractures. It was noted on 23 occasions in fractures of both columns of the acetabulum. Tomodensitometry is a key examination which shows lesions which could be missed on standard X-Rays. Dislocations of the sacro-iliac joint diminished the possibility of exact reduction. In 23 cases, only three sacro-iliac lesions were anatomically reduced and 13 hips were well centered. The results obtained after surgical treatment were better than after conservative treatment. This explained the finding that 10 hips developed arthrosis in 14 patients treated conservatively and only 3 in 9 treated surgically. The sacro-iliac involvement was either an anterior opening of the joint leading to an antero-posterior excentration of the hip, or an inferior opening leading to a lateral shift of the iliac bone and a vertical orientation of the acetabulum. In several cases, both types of displacement were present. The diagnosis of the sacro-iliac joint lesion is helped by tomodensitometry though it can also be made by good antero-posterior pelvic radiographs. Conservative treatment using traction was unable to reduce the sacro-iliac lesion, and in some cases it increased the displacement of the iliac bone. Treatment should be by reduction, either using external fixators or by internal fixation.
骶髂关节受累常与髋臼骨折相关。在髋臼双柱骨折中，这种情况出现了23次。断层扫描是一项关键检查，它能显示出标准X线片上可能遗漏的病变。骶髂关节脱位降低了精确复位的可能性。在23例病例中，只有3例骶髂关节损伤得到了解剖复位，13例髋关节对位良好。手术治疗后的结果优于保守治疗。这解释了以下发现：在14例接受保守治疗的患者中，有10例髋关节出现了关节炎，而在9例接受手术治疗的患者中，只有3例出现这种情况。骶髂关节受累表现为关节前方开口导致髋关节前后偏心，或下方开口导致髂骨向外侧移位以及髋臼垂直定向。在一些病例中，两种移位类型都存在。断层扫描有助于骶髂关节损伤的诊断，不过通过优质的骨盆前后位X线片也可做出诊断。采用牵引的保守治疗无法复位骶髂关节损伤，在某些情况下还会增加髂骨的移位。治疗应采用复位方法，可使用外固定器或内固定。
