不稳定型骨盆骨折矢状面旋转移位的临床病例研究  

Rotational displacement on the sagittal plane in unstable pelvic fractures： a clinical case study

作　　者：曹生鲁 汪祎然 冯凯[1] 凌伟[1] 彭庚[1] 王钢[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515

出　　处：《中华创伤骨科杂志》2016年第2期115-119,共5页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：国家自然科学基金（s1272008）;广东省自然科学基金（10151051501000085）

摘　　要：目的在骨盆前后位透视下，通过测量不稳定型骨盆骨折损伤侧半骨盆在矢状面旋转的影像学参数来判断移位类型，探讨不同移位类型的比率及其临床意义。方法收集2005年6月至2015年6月就诊的82例单侧骨盆环骨折患者资料，男48例，女34例；平均年龄为43岁；骨折按Tile分型：B型48例，C型34例。通过测量骨盆前后位X线片的髂嵴最高点至坐骨结节最低点的距离以及髂嵴最高点至耻骨结节最高点的距离改变来判断骨盆骨折矢状面的前后旋转移位。计算不同移位方向的比率并分析其临床意义。结果82例患者通过术前x线片测量，确定有矢状位移位者36例，占43．9％，其中后旋移位28例，占矢状位移位的77．8％；前旋移位8例，占22．2％。术前CT三维重建图片证实与术前X线片判断一致。48例B型骨折患者中21例（43．8％）发生矢状位移位，34例C型骨折患者中15例（44．1％）发生矢状位移位036例存在矢状位移位的患者闭合复位成功率为66．7％（24136），其中前旋、后旋移位患者的闭合复位成功率分别为62．5％（5／8）,67．9％（19128），均低于本研究82例患者的总体闭合复位成功率（84．1％）。结论骨盆骨折矢状面旋转移位（前旋和后旋）可通过骨盆正位X线片上特殊的线和点来确定，矢状面旋转移位患者中后旋移位更常见。存在矢状面旋转移位的骨盆骨折患者闭合复位成功率更低。Objective To investigate the clinical significance and distribution of different rotational displacements on the sagittal plane in unstable pelvic fractures radiologlcally. Methods We retrospec- tively reviewed 82 patients with unilateral pelvic fracture who had been treated at our department from June 2005 to June 2015. They were 48 men and 34 women, with an average age of 43 ± 18 years. By Tile clas- sification, there were 48 cases of type B and 34 cases of type C. Their rotational displacements on the sagittal plane of the pelvic ring were determined on the anteroposterior X-ray films of the pelvis by measuring the changed distances from the top of iliac crest to the lowest point of ischial tuherosity and to the pubic tubercle. The data were recorded for analysis of different displacements and their clinical significance. Results Of all the 82 patients, based on the preoperative radiographic evidence, 36 （43.9%） showed sagittal plane ro- tational displacement. Of them, 28（77.8% ） showed supinafion displacement and 8（22.2% ） pronation dis- placement. The preoperbtiveCT three-dimensional reconstruction confirmed the findings from the X-ray films. Twenty-one of the 48 cases of Tile type B （43. 8% ） and 15 of the 34 cases of Tile type C （44. 1% ） showed sagiual idane rotational displacement The success rate of aimed reduction was, respectively, 66. 7% （24/36） in the 36 cases with sagittal plane rotational displacement, 62. 5% （5/8） in those with pronation displacement and 67.9% （19/28） in those with supinatien displacement, all significantly lower than the total success rate of closed reduction in this cohort（84. 1% ） . The saglttal plane rotational （pronation and supinstien） displacement of pelvic fracture can be determined by measuring special points and lines on the anteroposterior radiographs of the pelvis. The supination displacement on the sagittal plane is more common. The unstable pelvic fracture with sagittal plane rotational displacement is more difficult to redu

关 键 词：骨盆 骨折 闭合复位 X线 旋转 

分 类 号：R683[医药卫生—骨科学]