pelvic injury
Introduction
Introduction Pelvic injury can be caused by a variety of factors, and the mechanism of occurrence is also diverse. The common phenomenon is fracture, accompanied by severe pain. The scope of diagnosis mainly includes damage mechanism, fracture type, stability degree, image evaluation, combined damage and so on. Most of the pelvic fractures are caused by direct violent impact, crushing the pelvis or colliding from a height. Sudden exertion of force during exercise, sudden and intense contraction of the muscles from the pelvis, can also cause the pelvic avulsion fracture at the starting point. Most of the fractures caused by low-energy injury do not destroy the stability of the pelvic ring, and it is relatively easy to treat. However, medium and high energy damage, especially motor vehicle traffic injuries, is not limited to the pelvis. When the pelvic ring is damaged, it often combines extensive soft tissue injuries, pelvic organ injuries or other bone and visceral injuries. Therefore, pelvic fractures are often one of the multiple injuries. 20% of patients with pelvic fractures in multiple injuries and 25% to 84.5% of those with pelvic fractures in motor vehicle injuries. Pelvic fracture is one of the three major causes of motor vehicle accident death, second only to head injury and chest injury. Early death after injury was mainly caused by massive bleeding, shock, multiple organ failure and infection. In the treatment of severe pelvic trauma, prevent life-threatening bleeding and timely diagnosis and treatment of combined injuries.
Cause
Cause
Sports injuries, etc.
Examine
an examination
Related inspection
Pelvic measurement
X-ray examination is an important basis for diagnosing pelvic fractures. Its method of projection includes
(1) X-ray film of anterior and posterior pelvis: the most commonly used, can partially show the whole fracture.
(2) X-ray film at the entrance of the pelvis: The X-ray film has a three-dimensional effect, which can show the fractured part of the anterior and posterior image to compensate for its deficiency. For the observation of the humerus, the posterior superior part of the humerus, and the bilateral ankle joint The upper, pubic symphysis, bilateral upper pubic symphysis and bilateral acetabular apical arches are of great value.
(3) X-ray film at the exit of the pelvis: it can show all the planes of the tibia, flaps, acetabulum and shame.
(4) For patients with acetabular fractures, X-ray films of oblique obturator and oblique X-ray of humerus should be taken.
With the popularity of CT technology, the effectiveness of pelvic injury diagnosis has been significantly improved. Currently commonly used examination methods include scanning a pelvic trauma CT (TCT) with a layer thickness of 10 mm and a high resolution CT (HDCT) of a pelvis with a layer thickness of 5 mm. CT images are used to observe the damage of the whole picture is not as good as the X-ray film, but it has its own unique features for evaluating the subtle changes in the fracture.
Diagnosis
Differential diagnosis
Natural abductor contracture and pelvic tilt: The disease is more common in clinical practice, and the incidence is higher than congenital dislocation of the hip, but it is often overlooked because of mild symptoms.
Female urethral cancer: Primary urethral tumors are clinically rare, and women have shorter urethra, but the incidence of cancer is higher than that of male urethral cancer. Occurs in the 40 to 60 years old, malignant tumors include cancer, sarcoma, melanoma and so on. Pathological classification is most common in squamous cell carcinoma, reaching about 40%. Followed by transitional epithelial cell carcinoma, accounting for 30%. Adenocarcinoma accounts for 23%. Undifferentiated cancer accounts for 1%. The incidence rate is 4 to 5 times higher than that of men, accounting for 0.017% of gynecological malignancies. In the early stage, there may be symptoms such as urinary tract bleeding, frequent urination, urgency, and dysuria. Increased tumors can also cause difficulty in urinating. The treatment is difficult and the prognosis is poor.
Pelvic fracture: A pelvic fracture is a serious trauma, mostly caused by direct violent pelvic compression. More common in traffic accidents and landslides. In wartime, it was a firearm injury. More than half of the pelvic fractures are accompanied by comorbidities or multiple injuries. The most serious is traumatic hemorrhagic shock, combined with pelvic organ injury, and a high mortality rate due to improper treatment.
X-ray examination is an important basis for diagnosing pelvic fractures. The method of projection includes:
(1) X-ray film of anterior and posterior pelvis: the most commonly used, can partially show the whole fracture.
(2) X-ray film at the entrance of the pelvis: The X-ray film has a three-dimensional effect, which can show the fractured part of the anterior and posterior image to compensate for its deficiency. For the observation of the humerus, the posterior superior part of the humerus, and the bilateral ankle joint The upper, pubic symphysis, bilateral upper pubic symphysis and bilateral acetabular apical arches are of great value.
(3) X-ray film at the exit of the pelvis: it can show all the planes of the tibia, flaps, acetabulum and shame.
(4) For patients with acetabular fractures, X-ray films of oblique obturator and oblique X-ray of humerus should be taken.
With the popularity of CT technology, the effectiveness of pelvic injury diagnosis has been significantly improved. Currently commonly used examination methods include scanning a pelvic trauma CT (TCT) with a layer thickness of 10 mm and a high resolution CT (HDCT) of a pelvis with a layer thickness of 5 mm. CT images are used to observe the damage of the whole picture is not as good as the X-ray film, but it has its own unique features for evaluating the subtle changes in the fracture.
