移位的耻骨下支骨折与骨盆后环损伤关系的临床观察

目的 :探讨移位耻骨下支骨折和骨盆后环损伤之间关系。方法 :回顾性研究2012年8月至2015年8月就诊且有完整资料的51例耻骨支骨折患者,男27例,女24例;年龄9~90岁,平均(49.1±19.0)岁;受伤到就诊时间从0.3~48 h,平均10.1 h;Tile骨盆骨折分型:A型28例,B型17例,C型6例;详细评估患者X线片和CT影像学资料,明确是否合并骨盆后环损伤;同时将耻骨支骨折分为耻骨下支移位组、耻骨下支无移位组、耻骨上支移位组和耻骨上支无移位组,确定各组合并骨盆后环损伤比率并进行比较。结果:26例患者存在耻骨下支移位骨折,均发现骨盆后环损伤;20例患者存在耻骨下支无移位骨折,6例(30%)合并骨盆后环损伤;28患者存在耻骨上支移位骨折,22例(78.5%)合并骨盆后环损伤;12例患者存在耻骨上支无移位骨折,5例(41.6%)合并骨盆后环损伤;合并骨盆后环损伤比率方面,移位耻骨下支骨折组与无移位耻骨下支骨折组比较,两组差异有统计学意义(P=0.028 80.05);与耻骨上支无移位骨折组和移位骨折组比较,差异均无统计学意义(P=0.055 80.05;P=0.168 30.05),但合并骨盆后环损伤比率均明显高于两组(100%vs 41.6%,78.5%)。结论:移位的耻骨下支骨折合并出现骨盆后环损伤率最高,往往提示骨盆后环损伤可能,移位的耻骨下支骨折是骨盆后环损伤的间接证据。

Clinical study on the relationship between the displaced fracture of the inferior ramus of pubis and the posterior pelvic ring injury

Objective: To investigate relation between displaced inferior ramus fractures and posterior pelvic ring injury.Methods: From August 2012 to August 2015,51 patients of pubic ramus fractures with complete record were retrospective reviewed including 27 males and 24 females with an average age of(49.1±19.0) years old ranging from 9 to 90 years old. The time from injury to treatment ranged from 0.3 to 48 hours with an average of 10.1 hours. According to Tile classification of pelvic fractures,28 cases were type A,17 cases were type B,6 cases were type C. Pelvic radiographs and computed tomography scans were detailed and evaluated for whether there were posterior pelvic ring injury,meanwhile pubic rami fractures were divided into 4 groups as follow:displaced inferior ramus fractures group,undisplaced inferior ramus fractures group,displaced superior ramus fractures group,undisplaced superior ramus fractures group;the incidence rate of association of posterior pelvic ring injury was determined and compared.Results: Twenty-six patients had displaced inferior ramus fractures,all of them (100%) were combined with posterior pelvic ring injury. Twenty patients had undisplaced inferior ramus fractures,6 of them(30%)were combined with posterior pelvic ring injury. Twenty-eight patients had displaced superior ramus fractures,22 of them(78.5%) were combined with posterior pelvic ring injury. Twelve patients had displaced superior ramus fractures,5 of them(41.6%) were combined with posterior pelvic ring injury. Compared with undisplaced inferior ramus fractures group,there was statistic difference(P=0.028 8<0.05)on the incidence rate of posterior pelvic ring injury,there were no statistic difference(P=0.055 8>0.05;P=0.168 3>0.05)while compared with other undisplaced superior ramus fractures group and displaced superior ramus fractures group,but the incidence rate of association with posterior pelvic ring injury much higher than both of two groups (100% vs 41.6%,78.5%).Conclusion: Displaced inferior pubic ramus fractures have the highest incidence rate of association with posterior pelvic ring injury,frequently prompted injury to the posterior pelvis. Displaced inferior ramus fractures were an indirect evidence of posterior pelvic injury.