骨科英文书籍精读（189）｜骨盆损伤（9）
FRACTURES OF THE PELVIC RING
It has been cogently argued that, because of the rigidity of the pelvis, a break at one point in the ring must be accompanied by disruption at a second point; exceptions are fractures due to direct blows (including
fractures of the acetabular floor), or ring fractures in children, whose symphysis and sacroiliac joints are springy. Often, however, the second break is not visible – either because it reduces immediately or because
the sacroiliac joints are only partially disrupted.
Mechanisms of injury
The basic mechanisms of pelvic ring injury are anteroposterior compression, lateral compression, vertical shear and combinations of these.
Anteroposterior compression
This injury is usually caused by a frontal collision between a pedestrian and a car. The pubic rami are fractured or the innominate bones are sprung apart and externally rotated, with disruption of the symphysis – the so-called ‘open book’ injury. The anterior sacroiliac ligaments are trained and may be torn, or there may be a fracture of the posterior part of the ilium.
Lateral compression
Side-to-side compression of the pelvis causes the ring to buckle and break. This is usually due to a side-on impact in a road accident or a fall from a height. Anteriorly the pubic rami on one or both sides are fractured, and posteriorly there is a severe sacroiliac strain or a fracture of the sacrum or ilium, either on the same side as the fractured pubic rami or on the opposite side of the pelvis. If the sacroiliac injury is much displaced, the pelvis is unstable.
Vertical shear
The innominate bone on one side is displaced vertically, fracturing the pubic rami and disrupting the sacroiliac region on the same side. This occurs typically when someone falls from a height onto one leg. These are usually severe, unstable injuries with gross tearing of the soft tissues and retroperitoneal haemorrhage.
Combination injuries
In severe pelvic injuries there may be a combination of the above.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
cogently /'kəudʒəntli/adv. 痛切地；中肯地
rigidity /rɪˈdʒɪdəti/n. [物] 硬度，[力] 刚性；严格，刻板；僵化；坚硬
springy /ˈsprɪŋi/adj. 有弹力的
collision /kəˈlɪʒn/n. 碰撞；冲突；（意见，看法）的抵触；（政党等的）倾轧
externally /ɪkˈstɜːrnəli/adv. 外部地；外表上，外形上
buckle /ˈbʌkl/n. 带扣，搭钩；（尤指鞋的）扣形饰物v. 扣住，用搭扣装饰；屈服，弯曲，退让；使弯曲变形；（人）精神崩溃
gross tearing 严重撕裂
retroperitoneal haemorrhage.腹膜后出血。
/'retrəu,peritə'ni:əl/adj. 腹膜后的
/ˈhemərɪdʒ/n. 出血
百度翻译：
骨盆环骨折
有人提出，由于骨盆的刚性，环中某一点的断裂必须伴随着第二点的破裂；例外情况是由于直接撞击造成的骨折（包括髋臼底骨折）或儿童环状骨折，其联合体和骶髂关节有弹性。然而，第二次中断通常是看不见的，要么是因为它立即减少，要么是因为骶髂关节仅部分破坏。
损伤机制
骨盆环损伤的基本机制是前后向压迫、侧向压迫、垂直剪切及其综合作用。
前后压迫
这种伤害通常是由行人和汽车的正面碰撞造成的。耻骨支断裂或无名骨分开并向外旋转，导致联合体断裂，即所谓的“开卷”损伤。骶髂前韧带训练，可能撕裂，或髂骨后部骨折。
侧向压缩
骨盆两侧的挤压会导致吊环弯曲和断裂。这通常是由于交通事故中侧面碰撞或从高处坠落造成的。前面一侧或两侧的耻骨支骨折，后部有严重的骶髂关节拉伤或骶骨或髂骨骨折，要么在耻骨支骨折的同一侧，要么在骨盆的另一侧。如果骶髂关节损伤严重移位，则骨盆不稳定。
垂直剪切
一侧无名骨垂直移位，耻骨支断裂，同一侧骶髂区断裂。这种情况通常发生在有人从高处跌落到一条腿上时。这些通常是严重的，不稳定的损伤，软组织撕裂和腹膜后出血。
复合伤
在严重的骨盆损伤中，可能有上述两种情况的结合。