骨盆稳定结构的生物力学及影像评价

Biomechanics and imaging evaluation on stable structure of pelvis

骨盆骨折的治疗难度和预后与骨折后的稳定性直接相关。临床上用于判断骨盆骨折稳定性的主要方法是基于骨盆解剖结构生物力学认识基础之上的影像学表现。随着生物力学试验技术的进步,以往的一些认识发生了变化:耻骨联合分离2.5 cm不能作为前后挤压损伤Ⅰ型和Ⅱ型的鉴别点,骶髂关节移位小于1 cm可以造成垂直稳定丧失,侧方挤压也能造成垂直不稳,Young-Burgess分型的部分描述与试验结果不符,韧带除了起到限制移位的作用外还具有本体感受器的作用,SPECT-CT等新的检查手段虽然可以提高骨折诊断的敏感性,但仍不足以准确地评估骨盆骨折的稳定性。

The treatment of difficulty and prognosis of pelvic fracture are directly related to the pelvic girdle stability. Diagnosis of pelvic fracture is mainly imaging manifestations based on biomechanics of pelvic anatomy. With the progress of biomechanics experiment technology,previousopinion has changed,such as separation of symphysis pubis 2.5 cm could not be seen as distinguishing feature of typeⅠandⅡfor anterior posterior compression;displacement of sacroilliac joints less than 1 cm could cause loss of vertical stability;lateral extrusion could also cause vertical instability;part description of Young-Burgess classification is not suitable for experiment results;ligament plays an important role in restricting displacement and having proprioceptors;SPECT-CT could improve sensitivity of diagnosis,but could not evaluate stability of pelvic fractures precisely.