| Objective: The rate of pelvic fracture account of 3-8%, but its death rate is as high as 9-61%. Hemorrhage is the main reason of the death. .Foreign orthopedic surgeons assume the theory that: unstable pelvic fracture, especially open book pelvic fracture, with the increase of injury, the pelvic volume will increase distinctively. If we do not restore the pelvic stabilization and pelvic volume, which maybe cause the decrease of the pelvic pressure and increase blood loss more. So far, there are not reports about this issue in our nation however.We want to discuss the relationship between pubic diastrasis and pelvic volume in unstable pelvic injury by create a successive modle of unstable pelvic injury.Methods: Bilateral open book pelvic ring injuries were created in eight embalmed cadaveric pelvic specimens by directly disrupting the pubic symphysis ,bilateral sacroiliac joint and sacrospinous and sacrotuberous ligament . Pelvic volume was determined using CT for the intact pelvis and pelvis with which pubic diastrasis is 1cm 3cm 5cm 7cm respectively. Width of sacroiliac joint diastrasis was determined using CT for the pelvis with which pubicdiastrasis is 1cm ,3cm ,5cm ,7cm respectively.Results: In open book pelvic fracture ,with the pelvic diastrasis enlargement, pelvic volume gradually enlarge. In intact pelvic ,the average pelvic volume is 915±121cc.When pubic diastrasis is 1cm 3cm 5cm 7cm respectively ,the pelvic volume is 969 ±114cc,1074 ±112cc ,1162+ 103cc,1267 ±114cc.When we compare the pelvis which diastrasis is 1cm 3cm 5cm 7cm respectively with the intact pelvis, the average increase of pelvic volume is 54±8cc ,159±8cc,247± 8cc,352±8cc respectively. The enlargement of pelvic volume is 106 ±llcc between pubic diastrasis is 1cm and that is 3cm.. The enlargement of pelvic volume is 83±18cc between pubic diastrasis is3cm and that is 5cm..There is an obvious correlation between the pelvic diastrasis and pelvic volume,r=0.77.The liner regression is ipelvic volume (cc)=918+50 X width(cm).In open book pelvic fracture ,with the pelvic diastrasis enlargement, sacroiliac dastrasis gradually enlarge. When pubic diastrasis is 1cm ,3cm ,5cm ,7cm respectively , sacrciliac dastrasis are :left side 6.93±0.44 mm, right side 6.91±0.44 mm;Left side 9.63±0.21 mm, right side 9.63±0.19 mm;Left side 11.64±0.33 mm, right side 11.63±0.20 mm;Left side 14.35±0.29 mm, right side 14.30±0.49 mm. The enlargement of sacroiliac dastrasis is :Left side 2.588 +0.136 mm, right side 2.563±0.385 mm between pubic diastrasis is 1cm and that is 3cm..The enlargement of sacroiliac dastrasis is :Left side 2.263 +0.272mm, right side 2.075+ 0.349mm between pubic diastrasis is3cm and that is 5cm.. There is an obvious correlation between the pelvic diastrasis and sacroiliac dastrasis:r( left) the =0.991, r( right)=0.992.The liner regression is : (LEFT) sacroiliac dastrasis (mm)= 5.777+1.214 X distance (cm) . (RIGHT) sacroiliac dastrasis (mm)= 5.784+1.209 X distance (cm).Conclusion: In open book pelvic fracture ,with the pelvic diastrasis enlargement, pelvic volume gradually enlarge.In intact pelvic. We can deduce the level of the enlargement of pelvic volume from the pubic diastrasis in pelvic fracture .It can also be serve as a criterion to the validity of an emergency method A reduction in pubic diastrasis which is indicative of decreasing pelvic Volume .If we do not restore the stabilization and pelvic volume immmediately,which maybe delay the tamponade effect that it was supposed to have,and it will increase the blood loss.We think when the pubic diastrasis is 3cm,which can serve as an indication of applying pelvic external fixator.When the pubic diastrasis is 5cm,we should realize that it is an indication of serious damage to the pelvis. In open book pelvic fracture ,with the pelvic diastrasis enlargement, sacroiliac dastrasis gradually enlarge.We can affirm sacroiliac dastrasis from the pubic diastrasis . |
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