Fracture of the Plevis(骨盆骨折.ppt

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1、西南医院骨科许建中西南医院骨科许建中骨盆骨折FractureofthePelvis骨盆骨折FractureofthePelvis一、解剖概要Anatomicaloutline二、骨盆骨折分类ClassificationofthepelvicfractureTypeA:Stablepelvicringinjury稳定的骨盆环损伤A1:Avulsionoftheinnominatebone骨折块撕脱A2:Stableiliacwingfractureorstableminimallydisplacedringfractures稳定的髂骨翼骨折或稳定的无移位的环状骨折A3:Transverse

2、fracturesofthesacrumandcoccyx骶尾骨横型骨折TypeB:Partiallystable部分稳定骨折B1:Openbookinjury开书样损伤B2:Thelateralcompressioninjury侧方挤压伤B2.1:IpsilateraltypeB2.2:ContralateralType(bucket-handle桶柄样)B3:BilateralBinjuries双侧B型损伤Openbookinjury　ⅠOpenbookinjury　ⅡOpenbookinjury　ⅢLateralcompressionfractureLockedsymphysisA

3、variantofthetypeⅠinjuryoftenseeninyoungwomenLateralcompressioninjuryTypeB2.2AnteroposteriorradiographTypeB2.2TypeC:Unstable（verticalshear）不稳定骨折（纵向减切力）C1:UnilateralC1.1:IliumC1.2:Sacroiliacdislocationorfracturedislocation骶髂关节脱位或骨折脱位C2:Bilateral,onesideB,onesideCC3:BilateralClesionsTelltalesignofin

4、stabilitySacroiliacfracturedislocation三、Clinicalsituation临床表现Trauma外伤Shock休克Pain疼痛Localswelling,Patches&tenderness局部肿胀、皮下淤斑和压痛Lowerposteriorsuperioriliacspine髂后上棘双侧不等高Pelviscrushedorseparatetest骨盆挤压、分离实验阳性Affectedextremityshort患肢短缩XrayX线片四、Complications并发症Hemorrhagicshock失血性休克Injuryofanteriororpo

5、steriorurethra前、后尿道损伤Ruptureofbladder膀胱破裂Injuryofurether输尿管损伤Injuryoffemalegenitalorgan女性生殖道损伤Rectalinjury直肠损伤Nerveinjury神经损伤1、Lifesaving抢救生命：A.AirwaymaintenancewithcervicalspineprotectionB.Breathing&ventilationC.Circulation&HemorrhagecontrolD.Disability:NeurologicstatusE.Exposure/Environmentalco

6、ntrol五、Firstaidofpelvisfracture骨盆骨折的急救2、Woundcare创口包扎、止血3、Initialfixation妥善固定：稳定骨折、减轻疼痛、便于运送4、Quicktransportation迅速转运五、Firstaidofpelvisfracture骨盆骨折的急救救：Savethelife抢救生命(ATLS)治：Decreasedisability减少残疾骨盆骨折救治的目的六、Careofpelvisfracture骨盆骨折的治疗(一)骨盆外固定支架Externalfixationorpelvicclamp减少骨盆容积(B1、B3.1、C)暂时固定减少

7、出血及再损伤(B1、B3.1、C)确定性治疗(B1型骨折、B2骨折？)骨盆外固定支架的适应症：自制骨盆外固定架穿针点的选择依据穿针方向的确定骨盆吊带的适应症：对B1型骨折的治疗复位不确切对B2型骨折应视为禁忌更不适用于C型骨折（二）骨盆吊带Pelvichammock（三）骨盆骨折手术治疗OperationtreatmentStableinjuries70％±Unstabledisruptions30％Externalfixation