Kharrazi F D, Rodgers W B, Kennedy J G, Lhowe D W
Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Orthop Trauma. 1997 May;11(4):277-81; discussion 281-2. doi: 10.1097/00005131-199705000-00009.
To describe our experience with four cases of severe pelvic dislocation associated with difficult parturition.
Retrospective case series.
Four patients, each with rupture of the symphysis pubis and sacroiliac joints during labor. All injuries were associated with significant initial pain and disability. All developed persistent symptoms related to the sacroiliac disruption.
The three patients who had presented acutely were freated with closed reduction and application of a pelvic binder. Two underwent closed reduction of their pelvic dislocation while anesthetized with a general anesthetic. One patient (N.A.), who presented late, had not been treated with a binder.
All four patients had persistent posterior pelvic (sacroiliac) pain. In two patients a postpartum neuropathy persisted.
Severe pelvic dislocations are rare during labor, with conservative treatment reported to be successful in most cases. The persistence of symptoms in our patients emphasizes the need for careful examination and follow-up of these rare injuries. Because the outcome in our patients was poor and results in the literature are equivocal, we suggest the consideration of an operative approach to treatment in patients with symphyseal diastasis of > 4.0 cm.
描述我们处理4例与难产相关的严重骨盆脱位病例的经验。
回顾性病例系列。
4例患者，均在分娩时发生耻骨联合和骶髂关节破裂。所有损伤均伴有明显的初始疼痛和功能障碍。所有患者均出现与骶髂关节破坏相关的持续症状。
3例急性就诊的患者接受了闭合复位并应用骨盆固定带。其中2例在全身麻醉下接受了骨盆脱位的闭合复位。1例（N.A.）就诊较晚的患者未使用固定带治疗。
所有4例患者均有持续性骨盆后部（骶髂关节）疼痛。2例患者产后神经病变持续存在。
分娩期间严重骨盆脱位罕见，据报道大多数病例保守治疗成功。我们患者症状的持续存在强调了对这些罕见损伤进行仔细检查和随访的必要性。由于我们患者的预后较差且文献结果不明确，我们建议对耻骨联合分离>4.0 cm的患者考虑手术治疗方法。
