骨质疏松性骨盆骨折的诊断与微创治疗研究进展

Research progress in diagnosis and minimal invasive treatment of pelvic fragility fractures

随着社会人口老龄化的加剧,骨质疏松性骨盆骨折的发病率逐年增高,与老年髋部骨折一样呈现高发病率、高病死率和高致残率等特点。诊断应考虑患者年龄、合并内科疾病、骨质情况、临床表现和影像学检查等综合因素。老年骨盆解剖结构的退变导致骨质疏松性骨盆骨折具有特殊的好发区域和骨折特点。标准骨盆X线片和CT检查多能明确诊断,但MRI有助于避免机能不全性骨盆骨折和后环隐匿骨折线的漏诊。基于X线片和CT检查的骨质疏松性骨盆骨折分型(FFP分型)是目前临床最常用且具有指导意义的一种分型。FFPⅠ型和Ⅱ型骨折多选择保守治疗,FFPⅢ型和Ⅳ型骨折多推荐手术治疗。手术应尽可能选择微创复位,骨盆前、后环同时固定。本文拟综述近年来骨质疏松性骨盆骨折的特点、分型和微创技术的进展,探讨未来老年骨盆骨折治疗的发展趋势。

Pelvic fragility fractures are increasing with the aging population in China,characterized by high incidence,high mortality and high morbidity just as geriatric hip fractures.In diagnosis of a pelvic fragility fracture in the elderly,the patient's age,comorbidities,osteogenic factors,clinical manifestations and imaging examinations should be taken into consideration,as well as the special anatomical features and morphologies resulted from degenerative anatomy of the pelvis in the aged.Standard pelvic X-rays and CT scans may confirm the diagnosis in most cases,but MRI may prevent missing a fracture of malfunctioning pelvis or an insidious fracture line on the posterior ring.Fragility fractures of pelvis(FFP)classification,base on X-ray and CT checks,is a common guiding system in current clinic.Usually,conservative treatment is indicated for fractures of FFP typesⅠ-Ⅱwhile surgery for those of FFP typesⅢ-Ⅳ.As far as possible,minimally invasive reduction and simultaneous fixation of the anterior and posterior rings are recommended.This article intends to review the characteristics,classification and development of minimally invasive techniques concerning pelvic fragility fractures in recent years,and to discuss the future trends in treatment of geriatric pelvic fractures.