求运动中出现的急性骨折（闭合性、开放性）的救护方法！_百度知道
求运动中出现的急性骨折（闭合性、开放性）的救护方法！
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打120电话,向医生求救尽量让病人不要乱动,造成第二次骨折
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小儿骨盆骨折
摘要：小儿骨科医师认为，小儿骨盆只占到所有骨折的1%-2%，并且这种骨折与高能量创伤密切相关，且有危及生命的并发症，前后位的X线片与快速CT扫描用来诊断并分类这种骨折并辨别有无合并伤。治疗常因患儿年龄、骨折分类、骨盆环的稳定程度及合并伤的严重程度不同而异。绝大多数小儿的骨盆骨折可采用非手术治疗，即在保护下承重并逐步恢复到正常活动。但对于髋臼骨折移位&2mm和任何关节内骨折或Y形软骨骨折移位&2mm，都必须采取切开复位内固定进行治疗。对于骨盆环移位&2cm，为了防止下肢不等长，可行外固定进行治疗。骨盆骨折常使髋臼未发育成熟的Y形软骨发育受干扰，从而导致髋臼发育不良，髋关节半脱位及髋关节匹配程度欠佳。髋臼骨折合并髋关节脱位远期发生股骨头坏死的风险会增加，其他一些并发症包括：骨化性肌炎，以及神经病学缺陷引起的坐骨、股骨和（或）腰骶丛神经损伤。小儿骨盆骨折常与高能量损伤密切相关，这种损伤最常见的原因是汽车撞车事故和机动车-行人事故，其所引起的脑部、腹部及泌尿系的损伤要比骨盆骨折更严重。撕脱性骨折是骨盆骨折的一个亚组，主要发生从事体育运动，诸如足球、体操、田径比赛的青少年人群，这种撕脱性骨折往往没有危及生命的损伤，也不会引起严重的精神创伤。
Pediatric Versus Adult injuries小儿损伤与成人损伤的比较[/color]In contrast with adults, children have low mortality from pelvic injury.It is more likely that associated injuries, especially of the abdominalviscera and central nervous system, contribute to childhood mortality.1,3-6 Children have greater plasticity of the pelvic bones, thicker cartilage, and increased elasticity of the symphysis pubis a a high-energy mechanism is necessary to cause fracture.3,7,8 The increased force required for pelvic fractures is likely to result in concomitant soft-tissue injuries.骨折需要有高能量的损伤机制，并且这种力所引起的骨盆骨折还可导致与其相伴发的软组织损伤，尤其是腹部损伤和中枢神经系统创伤。与成人相比，小儿的骨盆骨质有很强的柔韧性，较厚的软骨层和良好弹性的耻骨联合与骶髂关节。由此小儿因骨盆创伤的死亡率较低。[color=teal]Hemorrhage is a common cause of morbidity and mortality in adults following pelvic fracture, but it rarely occurs in children. This may be related to the ability of children’s vessels to undergo vasoconstriction more readily than the more atherosclerotic, friable vessels of adults. Children have smaller-diameter vessels that can vasoconstrict rapidly. Adult and pediatric pelvic injuries also have differe therefore, the fracture patterns vary. Children are usually involved in automobile and motor vehicle–pedestrian accidents. Theseresult in lateral compression injuries without disruption of the sacroiliacjoint. Adults are usually drivers or front-seat passengers in motor vehicleaccidents, and these result in anteroposterior (AP) compression injuries. AP compression injuries increase pelvic volume and are associated with sacroiliac joint disruptions and pelvic fracture–related blood loss. Lateral compression injuries decrease pelvic volume and are not associated with fracture-related exsanguinations. The higher elasticity of pediatric bone, coupled with increased flexibility at the sacroiliac and pubic symphysis joints, results in a is proportionately high rate of single-bone pelvic injuries in children.Single-bone fractures of the pelvis are associated with a decreased incidence of vascular disruption and hemorrhage.在成人，骨盆骨折引起的出血常常是病死率的主要原因，但这一点却很少发生在小儿，可能与小儿的血管收缩能力较成人强有关，且小儿的血管管径较成人小，所以能够快速的进行收缩，而成人的血管更容易出现和脆性增加。成人和小儿的骨盆损伤有不同的机制，因此骨折的类型也不同。在小儿，损伤往往与机动车-行人交通事故有关，从而引起侧方挤压性损伤而没有骶髂关节的破坏；在成人，往往是交通事故的主体，从而引起前后位挤压性损伤，这种损伤增大的骨盆容积，并伴有骶髂关节的破坏，从而导致血液丢失；侧方挤压降低了骨盆容积，与骨折后引起的驱血效应无直接关系。具有良好弹性的小儿骨质，加上骶髂关节与耻骨联合良好的柔韧性，使小儿发生骨盆单骨骨折的几率增加，而骨盆发生单一骨折与血管发生破裂出血风险的降低有相关性。[/color]DiagnosisHistory and Physical Examination诊断病史与查体[color=teal]Evaluation of a polytraumatized child with a suspected pelvic injury begins with assessment of airway,breathing, and circulatory status. Injuries of the head, chest, abdominal viscera, spine, and pelvis are carefully evaluated as potential sources of lifethreatening injury, particularly hemorrhage. A comprehensive neurologic examination is necessary if the child has a history of unconsciousness or is lethargic. A medical and surgical history should be obtained, with additional information regarding the cause or mechanism of injury taken from family members, emergency department staff, emergency personnel at the scene of the accident, and,when possible, the patient.评估一个受伤的小儿且怀疑其有骨盆损伤时，首先应注意气道的通畅情况、呼吸及循环状态，头部、胸腹及脊柱和骨盆的损伤要作为一项潜在危机生命的损伤仔细评估，尤其是出血。如果小儿受伤后有昏迷史或嗜睡，那么系统全面的神经查体是必要的。并且要了解患儿的用药及救治情况，并且可以从家属成员、急救中心人员、事故发生地的救治人员和，如果可能从病人那里了解受伤原因和过程。[/color]Life-threatening injuries should be the primary focus in a child wi the fracture itself can be treated once the respiratory, abdominal, and central nervous system injuries are managed. Visual inspection of the pelvis and perineum for lacerations, ecchymosis, and hematoma is indicated, and completeevaluation of the scrotum, vagina, and urethra is necessary to rule out injury.When a urethral injury is suspected,a retrograde urethrogram should be completed before catheterization is performed. A rectal examination is necessary to identify rectal tears, bony fragments, or a superiorly displaced prostate secondary to a urethral injury.一个小儿如果有骨盆骨折，那么危及生命的损伤应该给予足够的重视，一旦呼吸系统、腹部和中枢神经系统的损伤得到很好的监控，骨盆骨折本身可以得到治疗。通过对骨盆和会阴区的视诊，可以表明是否有撕裂伤、淤血和水肿，并且对于阴囊、阴道和尿道的完整评估是排除其损伤所必要的。当怀疑有尿道损伤，在行导尿术之前，应先行逆行尿道造影。之后直肠检查能够帮助鉴别直肠破裂、骨性碎片或前列腺移位。[color=teal]The child should be carefully log rolled to inspect for soft-tissue contusionand ecchymosis. The Morel-Lavellee lesion, a shearing of the subcutaneous fat and skin of the underlying fascia, can occur in overweight children. This lesion is very rare in young children but can occur in older, teenaged patients. Palpationof the anterior superior iliac spines, iliac crests, sacroiliac joints, and pubicsymphysis always should be performed.Posteriorly directed pressure on the iliac crests with gentle sideto-side rocking often produces pain at the fracture site. Compressing the pelvic ring at the iliac crest also may cause pain. Pain, crepitus, or excessive mobility is indicative of a potentially serious pelvic injury.小儿应该仔细查体来检查挫伤及局部淤血情况，Morel Lavellee损伤是一个在饰物下面的皮肤和皮下脂肪的剪切伤，常发生在超重的儿童中，这种损伤在幼儿时很少见，但可以发生在年长儿和青少年中。其次也应该进行髂前上棘、髂棘、骶髂关节及耻骨联合的触诊。直接挤压髂棘，则一侧一侧的振动可以引发骨折侧的疼痛，在髂棘处挤压骨盆环也可以引发疼痛。疼痛、捻发音，液波震颤常提示潜在的严重的骨盆损伤。[/color]Catheterization of the bladder is required to monitor urine output and to inspect for hematuria, which may indicate associated genitourinary injury.A urine specimen should besent to the laboratory to rule out occult bleeding. Hip range of motionmust be evaluated to determine whether a joint dislocation or acetabular fracture occurred. Injuries to the lumbosacral plexus, femoral, and sciatic nerves as well as vascular injuries may result from pelvic trauma.Neurovascular examination of thelower extremities should be performed and documented.经膀胱导尿被用来监测尿排出量，并可观察有无血尿，而血尿常提示生殖泌尿系损伤。尿液标本需送到实验室做潜血试验以排除有无 隐形失血，髋关节活动度必须进行评价以确定是否有关节脱位或髋臼骨折。骨盆骨折可引发坐骨神经、股神经及腰骶丛神经和血管损伤，双下肢的血管神经检查也应该被记录下来。[color=teal]Diagnostic TestsAn AP radiograph of the pelvis should be taken in the emergency department as a standard assessment of the polytraumatized child. Although the AP radiograph is seldom necessary for the immediate management of the patient, a radiographicallyidentified pelvic injury, especially when accompanied by a lower extremity fracture or spine fracture,should alert the traumatologist to search for associated injuries.Once the patient is stable, additional radiographs may be necessary toevaluate specific fracture patterns.Inlet (60° caudal) and outlet (45 cephalad) radiographs should be taken to assess
oblique (Judet) views should be taken to assess for acetabular fractures.诊断测试对于一个受伤的儿童来说，骨盆前后位的X线作为一个标准检查应在急诊室完成，虽然AP-X线在紧急处理伤员时并不是必须的，但可证实骨盆损伤，尤其是当陪同人员受到严重的骨折并脊柱损伤时，应提醒医生去查找合并伤，一旦病人的情况稳定，需进行另外的放射学检查以判定特殊的骨折类型，出口位和入口位用以评价骨盆环的损伤情况，斜位可用以评价髋臼的损伤情况。[/color]Computed tomography (CT) is considered to be the most effective method of evaluating the full extent of pelvic injury. Although some have argued that CT does not significantly change the classification or management of pediatric pelvic fractures and that it adds cost, time, and radiation exposure, we believe that CTis useful in patients with complex pelvic injuries and is valuable in preoperative planning.Threedimensional CT reconstruction images can delineate complicated fracture patterns.Often in a polytraumatized child, concomitant injuries of the head and abdomen warrant evaluation by CT. When there is clinical suspicion of a spine injury, including the pelvis in this initial series of imaging studies can provide a more thorough and efficient injury assessment.CT被认为是一个评价骨盆损伤严重程度的最有效的方法，尽管一些人认为CT不能够对小儿骨盆骨折的分类和治疗提供良好的鉴别，并且认为CT成本高、耗时，且有放射损害，但我们深信如果患儿有严重的骨盆损伤，那么CT检查是有效的，并且对于术前计划的制定是有价值的。三维重建CT影像能够描绘出复杂骨折的形态，经常被用在小儿合并有头部及腹部创伤中。当临床上怀疑有脊柱骨折，包括骨盆骨折，CT可以提供一个较为完整的、有效的损伤评估。[color=teal]Magnetic resonance imaging (MRI) and bone scan have a minimal role in the acute evaluation of severe pelvic injuries. MRI may be helpful later, in the analysis of soft-tissue injury and/or cartilaginous injury.Bone scan may be used for evaluatingnondisplaced occult fractures or avulsion injuries.MRI与核磁和骨扫描对于急诊评估严重的骨盆损伤意义不大，但MRI对后期软组织和（或）软骨的损伤分析非常有用；骨扫描对评价无移位的稳定性骨折或撕脱性骨折。[/color]ClassificationChildren with open triradiate cartilage have different fracture patternsthan do children whose triradiate cartilage has closed.13 An immature pelvis with open triradiate cartilage most commonly sustains fractures of the pubic rami and iliac wings and rarely requires surgical treatment.Because of the immaturity of thepelvis, the iliac wing is weaker than the elastic pelvic ligaments, resultingin bone failure before pelvic ring disruption has a chance to occur.The triradiate cartilage of the acetabulum closes at approximately 14 years of age in boys and 12 years in girls. Adolescents with a closed triradiate cartilage most commonlysustain fractures of the acetabulum,diastasis of the pubic symphysis, and eparation of the sacroiliac joints.once an adolescent’s triradiate cartilage closes, the pelvic bones become stronger than the pelvic ligaments,and injuries are more likely to be pelvic ring disruptions. Avulsion injuries of the anterosuperior and inferior iliac spines, ilium, and ischium most commonly occur in adolescents and young adults from sportsrelated activities. These are lowenergy pelvic injuries.分类小儿在外形软骨未闭合时有不同的骨折分型。一个未成熟Y型软骨未闭合的骨盆通常能够承受的住耻骨和髂骨翼的骨折，且很少需要外科治疗。因为对于一个未成熟的骨盆来说，髂骨翼要弱于富有弹性的骨盆韧带，从而使骨折先于骨盆环损伤成为可能。髋臼的Y型软骨在男性约14岁、女性约12岁闭合，Y型软骨闭合后的青少年通常可以经得住髋臼骨折、耻骨联合移位及骶髂关节分离。一旦青春期Y型软骨闭合，骨盆要比骨盆韧带更坚强。与此同时，损伤也更容易引起骨盆环的破坏。髂前上棘、髂前下棘、髂骨、坐骨的撕脱性骨折更容易发生在青少年及从事运动的年轻人，这种损伤属于低能量的骨盆损伤。[color=teal]Because fracture patterns vary with maturity, no ideal classification system exists for children’s pelvic injuries. Most pediatric pelvic fractures do not require surgical management and heal without complication.Accordingly, a classificationsystem may not be warranted. When a classification system is referenced,the Torode and Zieg4 classification of pelvic fractures in children is the one most commonly cited由于骨折的分型因骨成熟度的不同而异，因此没有一个理想的小儿骨盆损伤分类标准，大部分的小儿骨盆骨折并不需要外科治疗，且愈合过程中无并发症出现，由此分类标准不能起到保障性作用。当分类标准被引用时，常引用Torode和Zieg的骨折分类标准。[/color]Another pelvic fracture classification system commonly used in adults is the T however,this system has limited usefulness in the pediatric population.14 When dealing with acetabular injuries in children with open riradiate cartilage, the Salter-Harris classification of physeal injury is used.还有一个是成人骨盆骨折的分类标准及”Tile”分类标准。但是此种分类在小儿人群中有局限性，当处理Y型未闭合儿童的髋臼损伤时，“Salter-Harris”骨骺损伤分类常被使用。[color=teal]TreatmentTreatment of pediatric pelvic fractures is based on multiple factors, includingpatient age, type of fracture,whether the pelvic ring is stable, and the hemodynamic status of the patient.The patient’s age is important because, as the child gets older and the triradiate cartilage closes, the elasticity of the pubic symphysis and sacroiliac ligaments decreases.However, most pediatric pelvic fractures heal without complication,and surgical intervention usually isnot required.15,16 In a polytraumatized patient, the pelvic injury is oftenof lower priority and need not be addressed immediately unless hemodynamiccompromise (ie, excessive pelvic bleeding) is present.治疗小儿骨盆骨折的治疗措施取决于多种因素。包括患儿年龄、骨折分型、骨盆环稳定程度及血流动力学情况。其中年龄因素的重要性在于：当小儿逐渐长大，Y型软骨逐渐闭合，耻骨联合与骶髂关节周围的韧带弹性在逐渐降低，但大部分小儿骨盆骨折无并发症出现，也不需要外科手术而自行愈合。对于一个多发伤病人来说，骨盆损伤经常作为最后一级处理，除非有出血风险。[/color]Avulsion fractures (type I), iliac wing fractures (type II), and iliacapophyseal separations (type II) are treated symptomatically with protectedweight bearing for 2 to 4 weeks, followed by a stretching and strengthening program. Children may resume normal activity within 6 to 8 weeks.（Ⅰ型）撕脱性骨折、（Ⅱ型）髂骨翼股折算、（Ⅲ型）髂骨骨折分离可针对症状在牵引及康复训练之后行2-4周保护性承重，小儿通常在6-8周可恢复到正常活动。[color=teal]Simple ring fractures (type III) are stable fractures of the pelvis with intactposterior pelvic structures.They include fractures of the pubis or separation of the pubic symphysis.In the compliant patient, these fractures may be managed with pain control and weight bearing as tolerated for 6 weeks. In the noncompliantor very young patient, bed rest or bed-to-chair activity is indicated untilthe child can ambulate without pain. Because these pelvic ring fracturesoccur anteriorly, it is important to rule out associated genitourinaryinjuries10,17 and posterior pelvic ring disruptions.18 When tendernessis present over the sacroiliac joints,a CT scan is recommended.（Ⅲ型）单环型骨折，是后方结构完整的稳定的骨盆骨折。它包括耻骨骨折或耻骨联合分离。对于治疗依从性高的病人，可通过止痛和承重耐受6周治疗；而对于依从性低或年龄更小的病人可卧床休息或进行“椅子-床”有关性活动，直到可以达到无痛性行走。由于这种骨盆环的骨折发生在前部，因此有必要排除与其相关的泌尿性损伤以及后骨盆环损伤。当疼痛越过了骶髂关节则推荐使用CT扫描。[/color]Type III fractures involving extension of a nondisplaced fracture intothe acetabulum are usually stable fractures. They can be treated initiallywith no weight bearing, with the patient advanced to weight bearing as tolerated. Spica cast immobilization may be needed for the very young, noncompliant patient. Nondisplaced acetabular fractures in children are relatively stable. Distalfemoral skeletal traction may be used in certain specific fracture patternsto improve the alignment of displaced fractures. Buck’s traction may improve comfort level and improve compliance with no weight bearing in the acute setting. As discomfort subsides, crutch training is initiated, starting with no weightbearing and advancing to weight bearing as tolerated.（Ⅲ型）骨折也包括了髋臼的无移位骨折，通常是稳定性骨折。治疗初期可行非承重性训练，而后过渡到承重训练。对于年龄较小依从性差的患儿可给予髋人字石膏固定。在儿童无移位的髋臼骨折是相对稳定的，股骨髁上骨牵引可用于治疗一些特殊类型的骨折，以利于复位移位的骨折块。Buck牵引可提高患儿舒适度，并且可提高在紧急环境下无重力支撑的依从性，但不适感减退时可开始进行扶柺训练，非负重行走，并逐步行负重训练。[color=teal] Femoral head dislocation can accompany acetabular fracture and constitutes an orthopaedic emergency. To decrease the chance of osteonecrosis, reduction should be achieved within 6 to 8 hours of injury.19,20 Postreduction radiographs and/or CT scans should be compared to assess incongruity or difference in the joint space.19 Incongruity of the femoral acetabular joint suggests an intra-articular fragment within the joint and the need for arthrotomy and removal of small ost internal fixation may be required for a larger fragment. Intraarticular fractures or triradiate cartilage displacement &2 mm also requires open reduction and internal fixation to restore joint congruity. The child should begin ranging the hip joint as soon as the initial pain subsides10,19 and should remain non–weight-bearing until the fracture heals, usually within 6 to 8 weeks.髋关节脱位可合并有髋臼骨折，并由于构成矫形外科的急症。为降低股骨头坏死的发生率，复位通常在损伤后6-8h内完成，复位后的X线和（CT）检查可用以比较和评估髋关节间隙的匹配程度。髋关节股骨侧匹配欠佳提示关节内有碎骨并需要关节切开术，取出小的软骨碎片，对于大的骨碎片常进行内固定。关节内骨折或Y型软骨移位&2mm也需要切开复位内固定来重塑关节的正常结构，小儿应该在疼痛刚有所减轻时复位髋关节，并且应该保持非负重活动，直到骨折愈合，这段时间通常持续6-8周。Type IV pelvic fractures produce an unstable segment. These fractures include bilateral inferior and superior pubic rami fractures (“straddle” fractures), fractures involving the anterior pubic rami or symphysis in conjunction with posterior structures (Malgaigne fractures), and fractures that result in an unstable segment between the anterior pelvic ring and the acetabulum. These fractures have an increased potential for genitourinary injury. A urology consultation should be obtainedⅣ型骨盆骨折可产生一个不稳定区，包括双侧持股上下肢的骨折（骑跨伤的骨折），骨折部位位于耻骨支或耻骨联合前方与后方结构相连的地方，且骨折常导致骨盆前环与髋臼之间的不稳定，这型骨折可增加泌尿系统损伤的可能性，因此泌尿外科医生有必要进行会诊。There is a marked correlation between type IV pediatric pelvic fractures and the risk of life-threatening hemorrhage.10,22 Injury to the iliac vessels often accompanies disruption of the sacroiliac joint and results in retroperitoneal hemorrhage. 5,22-24 Initial treatment should focus on stabilizing the child with volume replacement and blood transfusion while ruling out the possibility of intra-abdominal injury. A pelvic sling may be used as a temporary measure to assist in reduction in order to prevent fracture bleeding and resuscitation. If hemorrhage persists, emergent external fixation is indicated to grossly align and stabilize the pelvis, thus limiting the pelvic volume. When these measures are not sufficient, pelvic arteriography and embolization of pelvic vessels may be necessary.对于Ⅳ型小儿骨盆骨折与威胁生命的出血密切相关，与髂血管的损伤常合并有骶髂关节的破坏，并由此导致腹膜后出血，最初的治疗措施在排除腹部脏器损伤可能性后主要放在扩容并输血以稳定小儿的生命体征。骨盆兜带可作为一个临时治疗措施来协助复位，以防止骨折后出血，并利于复苏。如果出血呈持续性，应急诊行外固定用以重塑骨盆的序列和稳定性，限制其容积。当这些措施还不够时，则需要进行骨盆血管造影和栓塞术。The patient with a hemodynamically stable type IV fracture may be treated with bed rest, with or without skeletal traction, provided that pelvic ring displacement is &2 cm. In pelvic fractures with sacroiliac jointdisruption and vertical displacement, skeletal traction can be used to reduce the sacroiliac joint into an improved position. A spica cast also may be used either immediately, for minimally displaced injuries, or after skeletal traction, for more displaced injuries. Pelvic ring disruptions are tolerated well in children as long as the leg-length inequality is &2 cm at the end of healing.18,24 Fractures with &2 cm of displacement must be reduced and stabilized. External fixation is not ideal for vertical shear injuries, but it is appropriate when emergent stabilization is needed to control blood loss. Internal fixation with anterior pubic symphysis plating and percutaneous sacroiliac screw fixation may be required. Older children and adolescents with unstable ring fractures may have an improved outcome with internal fixation and early mobilization对于血流动力学稳定的Ⅳ型骨盆骨折可以卧床休息，骨牵引可根据病人的情况，如骨盆环移位&2mm、骨盆骨折合并骶髂关节分离并有垂直移位，则骨牵引可用以复位骶髂关节。对于微小移位的骨折、骨牵引之后，及多处骨折病人可使用髋人字石膏固定，对于小儿来说，只要在骨折愈合后下肢不等长&2mm，骨盆环的损伤是可以接受的。骨盆骨折如移位&2mm，则必须进行复位内固定。外固定并不是治疗垂直剪切伤的理想方法，但为了控制出血进行急诊固定是适宜的。内固定可采取前路耻骨联合接骨板和经皮骶髂螺钉固定，年长的小儿和青少年的不稳定性骨盆骨折，为了改善其预后，常采取内固定治疗以早日恢复正常活动。ComplicationsMost pediatric pelvic injuries heal without long-term complication. onunion and ligamentous inst when they do, they usually cause no long-term problems. 5 Malunion is well tolerated because of the remodeling potential of the pediatric pelvis. Leg-length inequality, with associated low back pain, may occur after an unstable fracture when vertical displacement of the hemipelvis is &2 cm.18,24 Most late complications are related to acetabular or sacroiliac injuries. Osteonecrosis of the femoral head may develop in association with acetabular fractures after hip dislocation. Patients with displaced acetabular fractures may develop premature degenerative joint disease of the hip even after anatomic realignment 并发症绝大多数小儿的骨盆骨折愈合后无远期并发症，发生骨不连和韧带不稳的几率非常小，但如发生也不会有远期影响，小儿骨盆骨折由于其塑形能力很强，可以接受畸形愈合，当半骨盆的垂直移位&2cm时，可致骨折不稳定，由此产生下肢不等长及与之相关的下腰痛。大部分远期并发症都与髋臼和骶髂相关，髋脱位所引起的髋臼骨折可使股骨头坏死的发生率增加，并且移位的髋臼骨折可使髋关节过早的发生退行性变。Fractures of the triradiate cartilage, especially in children younger than age 10 years, may lead to premature triradiate fusion and resultant acetabular growth disturbances. 18,19,22,25 Because the growth potential of the physis decreases with age, the younger the patient is at the time of injury, themore severe the growth disturbance will be.25 Premature closure of the physis also may lead to acetabular dysplasia, hip subluxation, or hip joint incongruity. Because these fractures are easily missed on the initial radiographic examination,and because complications may not become significant until the patient has reached adulthood, it is important to identify and treat these fractures early and to follow the patient to maturity.当小儿在10岁之前有髋臼Y形软骨损伤，可导致软骨过早闭合并影响髋臼的正常发育，因为骨骺板的生长潜力随年龄的增加而递减，所以损伤时年龄越小，对髋臼发育的影响越大。骨骺板过早闭合还可能引起髋臼发育不良，髋关节半脱位或髋关节不匹配，因为这种骨折往往在最初放射学检查是容易漏诊，也可因为骨折引起的后遗症在成年后才表现出来。由此可见，早期诊断、治疗及跟踪随访患儿至成年的非常重要的。Nonskeletal complications include myositis ossificans and permanent neurologic deficits of the lower extremity. Lumbosacral plexus and sciatic nerve injury are associated with sacroiliac joint disruptions. and unstable sacral fractures.5 Unfortunately, lower extremity neurologic injury may not be noticed immediately because the initial focus is on resuscitation and stabilization非骨性并发症包括：骨化性肌炎、持久性下肢神经损伤。腰骶丛神经和坐骨神经损伤与骶髂关节破坏和骶椎不稳定性骨折密切相关。不幸的是，由于受伤后主要注意力都集中在患儿的生命体征复苏和稳定上，下肢的神经损伤很少在损伤后立即被注意。SummaryOverall, the long-term prognosis of pediatric pelvic fractures is better than that in adults. Children have more resilient bones and more flexible joints than do adults, resulting in less severe fractures and more single-bone pelvic ring breaks. Children’s bones also have a greater capacity to heal, remodel, and adapt to injury, resulting in fewer long-term complications. Mortality is seldom directly related to the pedia rather, mortality typically results from other injuries associated with the high-energy mechanism of injury.概要总体来说，由于小儿比成人有更富有弹性的骨骼，且有更柔韧的关节，小儿骨盆骨折的预后由于成人。且很少出现严重的骨折，一般只出现单一骨盆环的骨折。更何况小儿的骨有很强的愈合、塑形及抵抗损伤的能力，所以很少出现远期并发症。死亡很少与小儿骨折本身密切相关，而常常与高能力机械性损伤所致的其他合并伤相关。History, physical examination, and an AP radiograph of the pelvis are the standards of diagnostic care and dictate the need for other radiographic views and CT. Most pelvic injuries are treated nonsurgically, with protected weight bearing and gradual return to activity. Pelvic ring instability must be addressed in children as in adults. Treatment options include external fixation, open reduction with plate fixation, and percutaneous screw fixation. Open reduction and internal fixation is necessary to treat acetabular and triradiate cartilage fractures with displacement &2 mm. Patient age, fracture classification, stability of the pelvic ring, concomitant injuries, and hemodynamic stability should guide treatment. Following these guidelines, surgeons treating children with pelvic fractures will achieve excellent results in most cases. Although rare, co these patients should be followed until they reach maturity.病史、体格检查及骨盆前后位X线是诊断性治疗的标准，并可提示是否需要其他检查手段。大部分骨盆创伤不需要外科治疗，只需行保护性负重并逐渐恢复到正常活动。骨盆环的不稳定一定要给予记录。治疗上的选择包括外固定、切开复位内固定和经皮螺钉固定。对于髋臼和Y形软骨移位&2mm时，可采取切开复位内固定。患儿年龄、骨折分类、骨盆环的稳定性，合并伤及血流动力学情况都可指导治疗。在其指导下，外科医生处理小儿的骨盆骨折都取得了很好的疗效，虽然有很少一部分患儿出现了并发症，但都在其成年之前得到了随访跟踪。
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