不稳定型骨盆骨折三维空间移位的X线诊断方法及其在闭合复位术中的初步应用

X-ray diagnosis method for three-dimensional displacement of unstable pelvic fractures and its preliminary application in closed reduction

目的研究不稳定型骨盆骨折在三维空间上各种移位的X线诊断及其对术中进行闭合复位的指导意义。方法选取正常成人骨盆标本1具，剔除软组织，保留骨盆周围的韧带，使用木框固定骨盆于仰卧位姿势，然后锯断单侧骨盆前后环，分别制作半骨盆在水平面上的旋转、矢状面上的旋转及垂直上移模型。拍摄骨盆模型前后位X线片，利用影像归档和通信系统（picture archiving and communication system，PACS）测量髂骨翼宽度、半骨盆上下径、髂嵴、髋臼顶、耻骨结节及坐骨结节的垂直移位幅度及闭孔面积。总结半骨盆各种移位的X线片诊断方法并应用于治疗43例不稳定型骨盆骨折，统计手术时间、术中出血量，采用Matta标准进行术后影像学评价。结果水平面旋转分为外翻与内翻，半骨盆外翻时髂骨翼的宽度增大，闭孔的面积变小；内翻时髂骨翼的宽度变小，闭孔面积变大。矢状面旋转分为前旋与后旋，前旋时耻骨结节下移明显，髂嵴不变或轻度上移，上下径变长，髋臼顶及坐骨结节位置保持不变，闭孔面积变小；后旋时耻骨结节上移明显，髂嵴不变或轻度下移，上下径变短，髋臼顶及坐骨结节位置保持不变，闭孔面积变大；垂直上移时髂嵴、髋臼顶、耻骨结节及坐骨结节均等距离上移。本组手术时间15～85min，平均55min。出血量10～50ml，平均26ml。术后3d内复查骨盆X线片，按Matta标准，本组优31例，良12例，优良率100％。结论骨盆X线片能诊断不稳定型骨盆骨折在三维空间的各种移位，并能实时、快速指导术中闭合复位，取得满意的复位效果。

Objective To investigate the methods of X-ray diagnosis of various displacement of unstable pelvic fracture in three-dimensional space and its instructive significance in closed reduction. Methods A normal adult pelvic specimen was selected and fixed in a wood-frame at supine position after soft tissue rejection and ligament preservation. With the breakage at the unilateral anterior-posterior ring, models of hemipelvic rotation in the transverse and sagittal planes and hemipelvic vertically upward dis- placement were induced. Anteroposterior radiographs of the pelvic specimen were made and picture archiving and communication system （PACS） was used to measure width of iliac wing, suprainferior di- ameter of hemipelvis, vertical displacement of iliac crest, acetabulum roof, pubic tubercle and sciatic tu- ber and area of ohturator foramen. Methods of X-ray diagnosis of various displacements of hemipelvis were concluded and applied in treatment of 43 patients with unstable pelvic fractures. Operation time and intraoperative blood loss were recorded. Postoperative images were evaluated by Matta standard. Results Hemipelvic rotation in transverse plane included eversion and inversion. Width of iliac crest was enlarged and area of obturator foramen was shrunk while extroversion; on the contrary, an opposite result was ob- served while inversion. Sagittal rotation included pronation and supination. Pubic tubercle had obvious downward shift, iliac crest presented no change or slight upward shift, suprainferior diameter of hemipelvis was lengthened, iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was shrunk while pronation; on the contrary, pubic tubercle had obvious upward shift, iliac crest presented no change or slight downward shift, suprainferior diameter of hemipelvis was shortened, iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was enlarged while supination; iliac crest, acetabular roof, pubic tubercle and sciatic tuber presented equidistant upward shift while the hemipelvis displaced upward vertically. Average operation time was 55 minutes （ range, 15-85 minutes） and intraoperative blood loss was 26 ml （range, 10-50 ml）. According to Matta stand- ard, pelvic radiography evaluation at postoperative 3 days was excellent in 31 cases and good in 12 cases, with excellent and good rate of 100%. Conclusion Pelvis X-ray films are able to diagnose various three-dimensional displacement of unstable pelvic fractures and guide closed reduction timely and rapidly to achieve satisfactory result.