骨盆前后压缩损伤的区分及严重程度评佔

Differentiation of anteroposterior pelvic compression type I and II injuries and severity evaluation

目的探讨耻骨联合分离和紙骼关节前方分离距离对区分骨盆前后压缩(APC)损伤分型的可靠性,并评估损伤严重程度.方法取11具(男性7具,女性4具)新鲜尸体标本共22侧半骨盆,将标本按随机数字表法分为两组(每组11侧),分别制造半骨盆固定(限制组)和半骨盆不固定(非限制组)两种骨盆APC损伤测试模型,同时又将标本分为男性组(14侧)和女性组(8侧),模拟APC损伤外旋半骨盆。记录各组原始骨盆的耻骨联合间距及紙骼关节前方间距,两组紙骼前韧带损伤时耻骨联合分离距离、紙骼关节前方分离距离、患侧骨盆紙棘韧带及紙结节韧带损伤情况"结果限制组与非限制组原始骨盆的耻骨联合间距、紙骼关节前方间距差异无统计学意义(P>0.05);男性和女性原始耻骨联合间距分别为(5.13±0.61)mm、(4.03±0.84)mm(P<0.05)。当紙骼前韧带完全断裂或部分断裂时,耻骨联合分离距离为12~41mm[(23.36±7.27)mm],紙骼关节前方分离距离为5~18mm[(9.82±3.25)mm];男性和女性组间及限制组与非限制组差异均无统计学意义(P>0.05);而紙骼关节前方分离距离,男性和女性组间差异有统计学意义(P<0.05),限制组与非限制组差异无统计学意义(P>0.05)。限制组4侧岀现紙结节韧带损伤,5侧岀现紙棘韧带损伤。单纯耻骨联合间距≥23.36mm或紙骼关节前方分离距离≥9.82nun的标本数均为10侧(46%),而满足耻骨联合间距≥23.36mm或紙骼关节前方距离≥9.82mm至少一项的标本数为15侧(68%)。结论耻骨联合间距≥23.36mm或紙骼关节前方距离29.82mm时,可区分APCⅠ型和Ⅱ型骨盆损伤,耻骨联合结合紙骼关节前方分离距离更有利于评估骨盆损伤程度。

Objective To investigate the reliability of using the pubic symphysis diastasis of 25 mm and anterior separation distance of sacroiliac joint to differentiate anteroposterior compression (APC) type I and II injuries as well as assess the injury severity. Methods A total of 11 ( seven males and four females) fresh cadaver specimens with 22 hemipelvis were collected. The pelvic APC injury test models including fixed hemipelvis ( restricted group) and unfixed hemipelvis ( non-restricted group) were established, with 11 hemipelvis in each group according to the random number table method. Meanwhile the specimens were divided into male group ( 14 hemipelvis) and female group ( eight hemipelvis), simulating APC type injury external rotation hemipeivis. The public symophysis interval and anterior interval of sacroiliac joint of the original pelvis, the pubic symphysis diastasis and anterior diastasis of sacroiliac joint after anterior tibiofibular ligament failure, as well as the affected pelvis ligament and sacral ligament injury were recorded and compared between the restricted and non-restricted groups, male and female groups. Results There were no significant differences in the public symphysis interval of the original pelvis and anterior interval of sacroiliac joint between the restricted group and the non-restricted group (P >0. 05). The pubic symphysis interval of the original pelvis was [(5. 13 ±0. 61 ) mm] in male group and (4. 03 ± 0. 84 ) mm ] in female group ( P > 0. 05 ). When the anterior tibiofibular ligament ruptured, the pubic symphysis diastasis distance was ( 23. 36 ± 7. 27) mm, ranging from 12 to 41 mm, and the diastasis distance of anterior sacroiliac joint was (9. 82 ± 3. 25 ) mm, ranging from 5 to 18 mm. In terms of the public symphysis interval, there were no significant differences between male and female groups, restricted and the non-restricted groups ( P > 0. 05 ). In tenns of anterior interval of sacroiliac joint, there was significant difference between male and female groups ( P < 0. 05 ) but no significant difference between the restricted and non-restricted groups ( P >0. 05 ). In the restricted group, sacrotuberous ligament injuries were found in four patients, and sacrospinous ligament injuries in five,whhile there were no obvious sacrospinous ligament and sacrotuberous ligament injuries in non-restricted group. There were 10 specimens with the pubic symphysis diastasis M23.36 mm and 10 specimens with the diastasis distance of anterior sacroiliac joint ≥9. 82 mm (46%), and there were 15 specimens with at least the pubic symphysis interval ≥23. 36 mm or the anterior interval of sacroiliac joint ≥9. 82 mm (68%). Conclusions The public symphysis interval ≥ 23.36 nim or anterior interval of sacroiliac joint ≥ 9.82 mni can distinguish anteroposterior compression Ⅰ from Ⅱ injuries, and the combination of the two criteria can be beneficial to assessment of pelvic injury severity.