Broos P, Vanderschot P, Craninx L, Reynders P, Rommens P
Département de Traumatologie et de Chirurgie d'urgence, Hôpitaux Universitaires de la Katholieke Universiteit, Leuven, Belgique.
Acta Orthop Belg. 1993;59(2):130-8.
Pelvic ring injuries due to high-energy forces are among the most serious involving the musculoskeletal system. Life-threatening hemorrhage, local and distant associated injuries, deformity, pain and diminished functional capacity are all potential problems for a patient with a disrupted pelvis. There is a clear correlation between total blood loss, incidence of associated injuries, final functional result and the type of pelvic ring injury. Between January 1987 and December 1990, 66 patients with an unstable lesion, type B or type C in Tie's classification, were treated in the University Hospital Gasthusiberg of the Katholieke Universiteit Leuven. In 42 cases, primary stabilization was achieved by means of an external fixator, of the type "Monofixateur". The overall mortality rate was less than 7%, and 53 patients could be seen for follow-up 6 months to 4 years after injury. Our findings confirm that compared to type B lesions there is a higher incidence of pain, permanent deformity and diminished functional capacity in type C lesions (P < 0.05). The external fixator used in the immediate post-injury period provides an effective splint that reduces bleeding from bone and veins but cannot maintain reduction in lesions with rotational and vertical instability. In these cases, a semi-elective internal fixation, after defining the exact pathoanatomy by means of a CT-scan, should be performed in selected centers.
高能暴力导致的骨盆环损伤是肌肉骨骼系统中最严重的损伤之一。危及生命的出血、局部和远处的合并伤、畸形、疼痛以及功能能力下降都是骨盆骨折患者可能面临的问题。总失血量、合并伤发生率、最终功能结果与骨盆环损伤类型之间存在明显的相关性。1987年1月至1990年12月，鲁汶天主教大学加斯图西贝格大学医院收治了66例蒂氏分类中B型或C型不稳定损伤的患者。其中42例采用“单臂外固定架”进行了一期固定。总死亡率低于7%，53例患者在受伤后6个月至4年接受了随访。我们的研究结果证实，与B型损伤相比，C型损伤疼痛、永久性畸形和功能能力下降的发生率更高（P<0.05）。伤后立即使用的外固定架可提供有效的夹板，减少骨和静脉出血，但对于存在旋转和垂直不稳定的损伤无法维持复位。在这些情况下，应在选定的中心通过CT扫描明确确切的病理解剖结构后进行半选择性内固定。
