pelvic ring injuries definitive management骨盆环损伤的明确的管理

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1、PelvicRingInjuries:DefinitiveManagementJamesC.Krieg,MDHarborviewMedicalCenterSeattle,WARevised2009CreatedbyStevenA.Olson,MDin2004FirstrevisedbyRafaelNeiman,MDin2007SecondRevisionbyJamesC.Krieg,MDin2009GoalsDefinepelvicringinstabilityDecisionprocess:operateornot?Non-operativetreatmentPrinciplesofop

2、erativetreatmentPreoperativeplanningSurgicalapproachesTechniquesofpelvicreductionandfixationBiomechanicsoffixationtechniquesOutcomesofpelvicringinjuryIntroduction:PelvicRingStabilityStabilitydefinedasabilitytosupportphysiologicloadPhysiologicloadmaybesitting,sidelying,orstanding,asdictatedbypatien

3、tneedsIntroduction:PelvicRingStabilityPosteriorringintegrityisimportantintransferringloadfromtorsotolowerextremitiesDefiningInstabilityLossofposteriorringintegrityoftenleadstoinstabilityLossofanteriorringintegritymaycontributetoinstability,andmaybeamarkertoposteriorringinjuryTileclassificationsche

4、mebasedoninstabilitypatternsIsitstable?Istheredeformity?DeformityonpresentationpredictsinstabilitlyIsitstable?Istheredeformity?Istheposteriorpelvicringintact?CTscanIsitstable?Istheredeformity?IstheposteriorpelvicringintactStressradiographsC-armimageinORIsitstable?Istheredeformity?Istheposteriorpelv

5、icringintactStressradiographsAretherecluestosofttissueinjury?LStransverseprocessfxIschialspineavulsionLateralsacralavulsionDescribingInstabilityRefertopreviouslectureonClassificationTileClassificationAstableBpartiallystableCunstableOperativeIndicationsResuscitationSeepreviouslectureonAcuteManagemen

6、tAssistinmobilizationJustasstabilizinglongboneshelpsinmobilizationofpolytraumapatientsPreventlongtermfunctionalimpairmentDeformityofpelvicringcanimpactfunctionNon-OperativeManagementLateralimpactiontypeinjurieswithminimal(<1.5cm)displacementPubicramifractureswithnoposteriordisplacementMinimalgappin

7、gofpubicsymphysisWithoutassociatedSIinjury2.5cmorless,assumingnomotionwithstressormobilizationThisnumberisnotabsolute,sootherevidenceofinstability(likeSIinjury)mustberuledoutNon-OperativeManagementX-raysare