骨科英文书籍精读（182）｜骨盆损伤（2）
Surgical anatomy
The pelvic ring is made up of the two innominate bones and the sacrum, articulating in front at the symphysis pubis (the anterior or pubic bridge) and posteriorly at the sacroiliac joints (the posterior or sacroiliac bridge). This basin-like structure transmits weight from the trunk to the lower limbs and provides protection for the pelvic viscera, vessels and nerves.
The stability of the pelvic ring depends upon the rigidity of the bony parts and the integrity of the strong ligaments that bind the three segments together across the symphysis pubis and the sacroiliac joints. The strongest and most important of the tethering ligaments are the sacroiliac and iliolumbar ligaments; these are supplemented by the sacrotuberous and sacrospinous ligaments and the ligaments of the symphysis pubis. As long as the bony ring and the ligaments are intact, load-bearing is unimpaired.
The major branches of the common iliac arteries arise within the pelvis between the level of the sacroiliac joint and the greater sciatic notch. With their accompanying veins they are particularly vulnerable in fractures through the posterior part of the pelvic ring. The nerves of the lumbar and sacral plexuses, likewise, are at risk with posterior pelvic injuries.
The bladder lies behind the symphysis pubis. The trigone is held in position by the lateral ligaments of the bladder and, in the male, by the prostate. The prostate lies between the bladder and the pelvic floor. It is held laterally by the medial fibres of the levator ani, whilst anteriorly it is firmly attached to the pubic bones by the puboprostatic ligament. In the female the trigone is attached also to the cervix and the anterior vaginal fornix. The urethra is held by both the pelvic floor muscles and the pubourethral ligament. Consequently in females the urethra is much more mobile and less prone to injury.
In severe pelvic injuries the membranous urethra is damaged when the prostate is forced backwards whilst the urethra remains static. When the puboprostatic ligament is torn, the prostate and base of the bladder can become grossly dislocated from the membranous urethra.
The pelvic colon, with its mesentery, is a mobile structure and therefore not readily injured. However, the rectum and anal canal are more firmly tethered to the urogenital structures and the muscular floor of the pelvis and are therefore vulnerable in pelvic fractures.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
innominate /ɪˈnɑːmənɪt/adj. 无名的；匿名的
sacrum /ˈseɪkrəm,ˈsækrəm/n. [解剖] 骶骨
symphysis pubis 耻骨联合
symphysis /ˈsɪmfəsɪs/n. [解剖] 联合；合生；骨的愈合
pubis /ˈpjuːbɪs/n. 耻骨；前胸侧部
pubic /ˈpjuːbɪk/adj. 耻骨的；阴毛的；阴部的
sacroiliac /ˌsækroʊˈɪliˌæk; ˌseɪkroʊˈɪliˌæk/n. 骶骼骨关节adj. 骶髂的；骶髂关节的
basin /ˈbeɪsn/n. 水池；流域；盆地；盆
trunk /trʌŋk/n. 树干；躯干；象鼻；
pelvic/ˈpelvɪk/adj. 骨盆的
viscera /ˈvɪsərə/n. 内脏；内容（viscus的复数）
rigidity /rɪˈdʒɪdəti/n. [物] 硬度，[力] 刚性；严格，刻板；僵化；坚硬
integrity /ɪnˈteɡrəti/n. 完整；正直；诚实；廉正
unimpaired /ˌʌnɪmˈperd/adj. 未受损伤的；没有削弱的，未减少的
the greater sciatic notch.坐骨大切迹。
sciatic /saɪˈætɪk/adj. 坐骨的；坐骨神经的；髋部的
notch. /nɑːtʃ/n. 刻痕，凹口；等级；峡谷vt. 赢得；用刻痕计算；在…上刻凹痕
sacral plexuses,骶丛
sacral adj. 骶骨的；圣礼的；祭典的
plexuses/ˈpleksəs/n. （血管、淋巴管、神经等的）[解剖] 丛
trigone /trɪ'gəʊn, 'trʌɪ-/n. 膀胱三角区；三角形体；三棱
prostate /ˈprɑːsteɪt/adj. 前列腺的n. 前列腺
levator ani, 肛提肌
cervix/ˈsɜːrvɪks/n. 子宫颈；颈部
the anterior vaginal fornix.阴道前穹隆
urethra /jʊˈriːθrə/n. [解剖] 尿道
membranous /ˈmembrənəs/adj. 膜的；膜性的；膜状的
static /ˈstætɪk/n. 静电；静电干扰adj. 静态的；静电的；静力的
grossly /ˈɡroʊsli/adv. 很；非常
mesentery, /ˈmesənˌterɪ/n. [解剖] 肠系膜
rectum /ˈrektəm/n. 直肠
anal canal 肛管
百度翻译：
外科解剖学
骨盆环由两块无名骨和骶骨组成，在耻骨前关节（前桥或耻骨桥）前关节，后关节在骶髂关节（后骶髂桥）处。这种盆状结构将重量从躯干传递到下肢，并为盆腔脏器、血管和神经提供保护。
骨盆环的稳定性取决于骨部件的刚性和将三个节段连接在耻骨联合和骶髂关节的坚固韧带的完整性。最坚固和最重要的栓系韧带是骶髂韧带和髂腰韧带；这些韧带由骶管韧带和骶棘韧带以及耻骨联合韧带补充。只要骨环和韧带完好无损，承重就不会受损。
髂总动脉的主要分支出现在骨盆内骶髂关节和坐骨大切迹之间。伴随着静脉，在骨盆环后部骨折时尤其脆弱。同样，腰骶神经丛也有后骨盆损伤的危险。
膀胱位于耻骨联合后面。三角区由膀胱外侧韧带固定，男性则由前列腺固定。前列腺位于膀胱和盆底之间。它由肛提肌的内侧纤维侧向固定，而在前方则由耻骨支撑韧带牢固地附着在耻骨上。女性的三角也附着在子宫颈和阴道前穹窿。尿道由盆底肌肉和耻骨尿道韧带共同支撑。因此，女性尿道更容易受伤。
在严重的骨盆损伤中，当前列腺被迫向后移动而尿道保持静止时，膜性尿道会受损。当耻骨支撑韧带撕裂时，前列腺和膀胱底部会从尿道膜上严重脱臼。
盆腔结肠及其肠系膜是一个可移动的结构，因此不易受伤。然而，直肠和肛管与泌尿生殖结构和骨盆肌层的联系更为牢固，因此在骨盆骨折中很容易受伤。