骨盆脆性骨折的诊治进展

Progress in diagnosis and treatment of fragility fractures of pelvis

骨盆脆性骨折是老年人少见的骨折类型,但其发病率正随着人口年龄的增长而升高,其发生机制与高能量损伤导致的骨盆骨折不同,一个新的综合分型系统可以区分骨盆不同程度的不稳定性和不同类型的骨盆后环骨折。骨盆脆性骨折治疗的主要原则是早期活动、止痛及抗骨质疏松治疗。单独的骨盆前环骨折是稳定的损伤,通常可以保守治疗;而累及骨盆后环的骨盆环损伤是不稳定的,如果患者情况允许,应及时进行手术固定。骨盆脆性骨折治疗的主要目标之一是功能恢复,恢复骨盆稳定性比解剖复位更重要。对于骨盆后环和前环不稳定性的手术治疗,微创技术优于开放复位和内固定。但目前关于骨盆脆性骨折的最佳治疗方法的相关报道较少,需要大量的临床及相关生物力学的研究。

Fragility fractures of the pelvis(FFP)are rare in the elderly,but thier incidence is increasing with the aging population.Their mechanism is different from that of the pelvic fracture caused by high energy injury.A new comprehensive classification system can distinguish different degrees of pelvic instability and different types of posterior pelvic ring fracture.The main principles for treating FFP are early activity,pain relief and anti-osteoporosis therapy.An anterior pelvic ring fracture alone is a stable injury and is usually conservatively treated.Pelvic ring injuries involving the posterior pelvic ring are unstable and should be stabilized if the patient′s condition permits.As one of the main goals of treating FFP is functional recovery,restoring pelvic stability is more important than anatomical reduction.Minimally invasive stabilization is superior to open reduction and internal fixation in the treatment of instable posterior and anterior pelvic rings.However,few reports are available about the optimal treatment of FFP,which requires much clinical and biomechanical research.