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本期杂志主要内容是骨盆髋臼骨折 的相关研究，很多文章值得一读。
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Editorial Board
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PDF (41 K)
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Editorial
Advances in pelvic and acetabular surgery
P.V. Giannoudis, a, , M. Bircherb and T. Pohlemannc
aDepartment of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK
bDepartment of Trauma & Orthopaedics, St. George's Hospital, London, UK
cDepartment of Trauma & Orthopaedics, School of Medicine, University of Homburg, Germany
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Evolution of pelvic and acetabular surgery from ancient to modern times
N. Prevezas, a,
aGeniko Kratiko Hospital, Nikeas-Piraeus, Greece
Accepted 18 January 2007. Available online 17 April 2007.
Summary
Fracture stabilisation before the 19th century was in its infancy. The outcome was suboptimal, and quite often mortality was the end result. Advances in the stabilisation of long-bone fractures did not become apparent until the mid-1940s and for other bones, even later. In the mid-1960s, Judet and Letournel initiated a series of experimental and clinical studies focusing on pelvic and acetabular reconstruction surgery. Their work set the pace for all the subsequent advancements made in this field of surgery. Today, pelvic and acetabular reconstruction is a recognised subspecialty within the disciplines of trauma and orthopaedics. This review article traces the evolution of pelvic and acetabular surgery, from ancient to modern times.
Keywords: Pelvis; Acetabulum; Reconstruction; Ancient times; Modern times
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Pelvic and acetabular surgery within Europe: The need for the co-ordination of treatment concepts
Peter V. Giannoudisa, , , Tim Pohlemannb and Martin Bircherc
aAcademic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor A, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
bAcademic Department Trauma & Orthopaedic Surgery, Homburg Medical School, Homburg, Germany
cDepartment of Trauma & Orthopaedics, St. George's Hospital, London, UK
Accepted 16 January 2007. Available online 30 March 2007.
Summary
Pelvic and acetabular injuries are rare and represent the tip of the trauma iceberg. They often present with other associated injuries. Their management can pose difficulties even to the most experienced trauma surgeons and well-developed trauma systems. Despite the advancements made after the 1960s due to Judet and Letournel's contributions, the pelvic and acetabular sub-specialty has had difficulty in consolidating experience and developing realistic treatment protocols. By means of sharing ideas and results, “learning curves” of individuals and nations could be shortened. As a result, better health quality and advanced medical facilities for our future patients may be anticipated. In this article we examine the current problems affecting the provision of a high quality pelvic and acetabular service and analyse the needs for the co-ordination of treatment concepts within the European Landscape.
Keywords: Pelvis; Acetabular; Fracture; European network
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The German Multicentre Pelvis Registry: A template for an European Expert Network?
Tim Pohlemanna, , 1, , Georgios Tosounidisa, Martin Bircherb, Peter Giannoudisc and Ulf Culemanna
aUniversity Clinic of the Saarland, Department for Trauma-, Hand- and Reconstructive Surgery, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
bSt. George's Hospital and Medical School, London SW17 OQt, United Kingdom
cSt. James University Hospital, Leeds LS9 7TF, United Kingdom
Accepted 8 January 2007. Available online 30 March 2007.
Summary
The range of severity of pelvic injuries is wide and can include simple, undisplaced pelvic fractures, which may limit the activity of the individual patient for only a short period of time, and severe, complex or even open pelvic fractures, causing immediate life threatening situations. Even with continuous progress in development of techniques and treatment protocols, primary treatment and definitive reconstruction of pelvic ring injuries and acetabular fractures there is still an ongoing debate about specific problems in the evaluation of injuries and fractures.
Because of the low incidence of pelvic fractures (37/100,000) the individual experience, which can be acquired by the surgical team, even in major Trauma Centres, is limited and can only be acquired over a longer period of time. The German Multicentre Pelvic Study Group started with reporting of pelvic fractures in 1991 and included 10 University- and Major Trauma Hospitals. The intense work on definitions and classification during the first years generated a universal “language” of understanding, which also helped in unifying indications and even procedures in pelvic and acetabular fractures. With several modifications and expansion of the number of participating hospitals the Group has been active until now and is just entering a “third phase” converting into the “German Multicentre Pelvic and Acetabular Registry” being technologically modified to an Internet based data registry. As this registry is already designed as an open platform, not limited in capacity and regions, it provides a platform, which may easily be expanded to the European level allowing for international multicentre studies and case sampling.
Therefore this type of pelvic registry could act as a basis for further scientific evaluation of specific topics in the field of pelvic and acetabular surgery and could be a template for a European Expert Network. Driven by the differences of healthcare systems and organisation of trauma care within Europe and the challenge that pelvic fractures not only can lead to permanent disability, but also play an important role in posttraumatic fatalities, a clear need can be shown for detailed analysis of the present situation within the different European nations.
Keywords: Pelvic fractures; Multicentre studies; Epidemiology; Outcome evaluation
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Summary of controversial debates during the 5th “Homburg Pelvic Course” 13–15 September 2006
Tim Pohlemann, a, and Ulf Culemanna
aKlinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Germany
Accepted 8 January 2007. Available online 30 March 2007.
Summary
Based on low incidence and lack of personal experience only few evidence based studies exist on several questions in pelvic and acetabular surgery. As part of an international consensus pelvic and acetabular course personal preferences and experience of an distinguished faculty and senior participants were discussed and we summarize in the paper the consented opinions and trends. Topics included the emergency treatment of life threatening pelvic ring injuries, treatment strategies in unstable sacral fractures, preferred surgical methods for transiliosacral screw fixation of the posterior pelvic ring, the value of CT and conventional radiographs in diagnostic of acetabular fractures, the choice of approach for treatment of acetabular fractures, the open vs. arthroscopic treatment of the femoro acetabular impingement of the hip and the treatment modalities in pelvic and acetabular fractures in geriatric patients. One has to keep in mind that this statements may help in the process of personal decision making in this difficult surgical field, but should not act as evidence based recommendations.
Keywords: Pelvic surgery; Acetabular surgery; Emergency treatment; Sacral fractures; Geriatric patients
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Modified and new approaches for pelvic and acetabular surgery
Eero Hirvensalo , a, , Jan Lindahla and Veikko Kiljunena
aDepartment of Orthopaedics and Traumatology, Helsinki University Hospital, Topeliuksenkatu 5, HUS-00029 Helsinki, Finland
Accepted 16 January 2007. Available online 17 April 2007.
Summary
We analysed outcomes of new operative techniques for open reduction and internal fixation in 120 consecutive patients with fractures of the pelvic ring and 164 patients with acetabular fractures treated between 1989 and 1999. An anterior extraperitoneal approach was performed through a low midline incision to fix the anterior and lateral parts of the pelvis and for central involvement of different types of acetabular fractures. The anterior approach was combined with a lateral incision on the lateral crest for fractures of the iliac wing and with a posterior approach for sacroiliac injuries, or with Kocher–Langenbeck approach for posterior acetabular involvements.
The complication rate of the new techniques was low. Heterotopic ossification was rare. The functional recovery was good in 66 of the 81 patients with an unstable C-type pelvic injury, in 18 out of the 20 patients with a lateral compression, B-2-type injury and 13 out of 19 patients with a open book, B-1-injury. Neurological recovery was observed after adequate reduction in those patients suffering from lesions of the sacral plexus. The radiographic result was good in 73, 20 and 17 of the patients groups, respectively. The Harris Hip Score was more than 80 in 75% of the 164 patients with an acetabular fracture. The radiological result was good (residual displacement 0–2 mm) in 84%, fair (3–5 mm) in 9% and poor (more than 5 mm) in 7%. The new methods are less invasive than the basic approaches described in the literature. The whole pelvic ring, as well as all the acetabular fracture combinations may be treated with the combination of approaches used in the present study.
Keywords: New operation techniques; Internal fixation; Pelvic and acetabular fractures; Results
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Preoperative planning in pelvic and acetabular surgery: The value of advanced computerised planning modules
Matej Cimerman, a, and Anze Kristana
aDepartment of Traumatology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
Accepted 22 January 2007. Available online 2 April 2007.
Summary
An experimental computer program for virtual operation of fractured pelvis and acetabulum based on real data of the fracture is presented. The program consists of two closely integrated tools, the 3D viewing tools and the surgeon simulation tools. Using 3D viewing tools the virtual model of a fractured pelvis is built. This procedure is performed by computer engineers. Data from CT of a real injury in DICOM format are used. With segmentation process each fracture segment becomes a separate object and is assigned a different colour. The virtual object is then transferred to the personal computer of the surgeon. Bone fragments can be moved and rotated in all three planes and reduction is performed. After reduction, fixation can be undertaken. The appropriate ostheosynthetic material can be chosen. Contouring of the plate is performed automatically to the reduced pelvis. The screws can be inserted into the plate or across the fracture. The direction and length of the screws is controlled by turning the pelvis or by making bones more transparent. The modeling of the plate in all three axes can be recorded as the exact length of the screws. There is also a simulation tool for intraoperative C-arm imaging in all directions. All the steps of the procedure are recorded and printed out. Postoperative matching of real operation and virtual procedure is also possible. We operated on 10 cases using virtual preoperative planning and found it very useful. The international study is still in progress. One case is presented demonstrating all the possibilities of the virtual planning and surgery. The presented computer program is an easily usable application which brings significant value and new opportunities in clinical practice (preoperative planning), teaching and research.
Keywords: Preoperative; Planning; Pelvis; Acetabulum fractures; Computer; Assisted virtual surgery
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Image guidance in pelvic and acetabular surgery—Expectations, success and limitations
Ulrich Stöcklea, , , Klaus Schaserb and Benjamin Königa
aDepartment for Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 München, Germany
bCentrum für Muskuloskeletale Chirurgie, CHARITÉ – Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburgerpl.1, 13353 Berlin, Germany
Accepted 16 January 2007. Available online 9 April 2007.
Summary
During the last decade navigation techniques in pelvic and acetabular surgery have been described. Nowadays, available techniques include CT-based navigation, 2D C-arm navigation and 3D C-arm navigation. The main indication is the navigated percutaneous SI screw fixation, but acetabular screw fixations are also reported. In this article, based upon a literature review and our own clinical experiences, the indications for and limitations of navigated techniques in pelvic and acetabular surgery are described.
Keywords: Image guidance; Navigation; 3D visualization; Pelvic and acetabular surgery
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Is there a role for percutaneous pelvic and acetabular reconstruction?
P.M. Rommens, a,
aDepartment of Trauma Surgery, University Hospitals of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55101 Mainz, Germany
Accepted 16 January 2007. Available online 30 March 2007.
Summary
The primary goal in the treatment of pelvic fractures is the restoration of haemodynamic stability. The secondary goal is the reconstruction of stability and symmetry of the pelvic ring. Percutaneous reconstruction can only be accepted if these goals are met. The type of definitive surgery is dependent of the degree of instability of the anterior and posterior pelvic ring. Retrograde transpubic screw fixation of pubic rami fractures is a good alternative to external fixation or plate and screw osteosynthesis. The technique of screw placement and image intensifier control is explained. Internal fixation of pure sacroiliac dislocations, fracture–dislocations of the sacroiliac joint and sacral fractures can be fixed with sacroiliac screws, placed percutaneously. Reduction of the fracture or dislocation is performed closed, or open if anatomy cannot be restored in a closed manner.
The primary goal in the treatment of acetabular fractures is to restore anatomy. Reduction comes before fixation. The goal of minimising approaches cannot be more important. In most cases open reduction will be necessary to achieve anatomical reconstruction. Only the experienced acetabular surgeon will be able to decide when and how he can restore anatomy through a less invasive approach or with a percutaneous procedure. The anterior column screw can be inserted through a separate incision in addition to a Kocher–Langenbeck approach. It is the same screw as the retrograde transpubic screw but placed in the opposite direction. The posterior column screw is placed percutaneously from the lateral cortex of the ilium in the direction of the posterior column. Techniques of placement of both screws are demonstrated.
Open reduction and internal fixation remains the standard of care in stabilisation of pelvic and acetabular fractures. Only the experienced surgeon will be able to judge if percutaneous procedures can be an alternative or a useful additive to conventional techniques.
Keywords: Pelvis; Acetabulum; Fracture; Dislocation; Transpubic screw; Sacroiliac screw; Anterior column screw; Posterior column screw; Open reduction internal fixation; Percutaneous procedure; Minimal invasive approach
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Femoral head injuries: Which treatment strategy can be recommended?
Philipp Henlea, Peter Kloenb and Klaus A. Siebenrocka, ,
aDepartment of Orthopaedic Surgery, Inselspital, University of Berne, CH-3010 Berne, Switzerland
bDepartment of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
Accepted 16 January 2007. Available online 2 April 2007.
Summary
Despite different operative and non-operative treatment regimens, the outcome after femoral head fractures has changed little over the past decades. The initial trauma itself as well as secondary changes such as posttraumatic osteoarthritis, avascular necrosis or heterotopic ossification is often responsible for severe loss of function of the afflicted hip joint.
Anatomic reduction of all fracture fragments seems to be a major influencing factor in determining the outcome quality.
Eight years ago we inaugurated a new surgical approach for better access and visualisation for the treatment of femoral head fractures, using the “trochanteric flip” (digastric) osteotomy. Thus inspection of the entire hip joint and accurate fragment reduction under direct visual control are possible. After good initial experiences with this operative procedure we changed our standard treatment regimen to this approach in an attempt to achieve the most accurate anatomic reduction of the femoral head in every affected patient.
Between 1998 and 2006 we operated on 12 patients with femoral head fractures associated with posterior hip dislocation, using the new surgical approach. Patients were followed for 2–96 months and outcome was documented with the Merle d’Aubigne and Postel score as well as the Thompson and Epstein score. The posttraumatic formation of heterotopic bone was documented with the Brooker score. Retrospective analysis of these 12 patients showed good or excellent results in 10 patients (83.3%). The two patients with poor outcome developed an avascular necrosis of the femoral head and underwent total hip arthroplasty. Periarticular heterotopic ossification was seen in five patients. In four patients this caused a significantly reduced range of motion and was therefore considered as a posttraumatic complication. The two patients with the most severe heterotopic bone formation (Brooker III and IV) had initially sustained multiple injuries including brain injury.
Comparing our results with earlier published series including our own before changing the treatment protocol, the data suggest a favorable outcome in patients with trochanteric flip (digastric) osteotomy for the treatment of femoral head fractures.
Keywords: Femoral head fracture; Pipkin; Hip fracture-dislocation; Avascular necrosis; Heterotopic ossification; Trochanteric flip osteotomy
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Nonunions and malunions after pelvic fractures: Why they occur and what can be done?
Michel Oransky, a, and Mauro Tortora1, a,
aII Unit of Orthopaedics and Trauma, Az. Osp. San Camillo Forlanini, Piazza Carlo Forlanini, 1, 00151 Rome, Italy
Accepted 16 January 2007. Available online 2 April 2007.
Summary
Materials and methods
Between 1987 and 2005, 55 patients were treated operatively to correct 44 malunions and 11 nonunion of the pelvic ring. These pathologies were the consequence of a nonoperative initial treatment for 38 cases, or of an inappropriate indication, such as the use of an external fixator as the definitive treatment of an unstable pelvic fracture in 15 and symphysis cerclage wiring in 2. Three patients had undergone ORIF of the lumbar spine performed by neurosurgeons, but the pelvic fractures below were ignored. On the basis of damaging mechanisms and of the main instability plane, initial lesions were classified as follows: 32 shearing lesions, 11 rotatory by antero-posterior compression, 7 by lateral compression, 5 mixed. In 23 cases the site of the posterior lesion was the sacrum, 4 of which were H fractures type; 13 were sacroiliac joint dislocations, or rotatory instability of the joint (in 2 cases the lesion was bilateral), 8 were sacroiliac dislocation fractures (crescent fractures); 7 were fractures of the iliac wing. Four patients only had pubic symphysis diastasis. Indications for surgery were pain associated with deformity or instability. Surgery was performed through a multistage procedure. Mean surgery time was 6 h (range: 2–10 h), with a mean blood loss of 700 ml (range: 200–5000 ml). Follow-up ranged from a minimum of 16 months to a maximum of 14 years (mean: 5.85 years).
Results
At the last follow-up, all patients but one had consolidated and were considered stable. All patients had improved walking ability. Six patients still report pain. Even if most of the deformity were corrected with a significant decrease of pre-operative symptoms achieved, deformity correction was considered satisfactory but not anatomic, in 12 patients (21%). Complications occurred in 24% of patients but most were temporary.
Conclusions
The most frequent cause of pelvic malunion or nonunion was inadequate treatment. To reduce the number and the percentage of disabilities, it is necessary that specialised centres provide patients with early treatment that is adequate and definitive.
Keywords: Pelvis; Malunion; Nonunion; Deformity; Pain; Heterometry; Sitting imbalance; Sacrum; Multistaged correction; Osteotomy
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Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone
P. Vanderschot, a,
aDepartment of Traumatology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
Accepted 16 January 2007. Available online 30 March 2007.
Summary
The incidence of pelvic ring and acetabular fractures in the elderly is climbing relentlessly. This increase is attributed to a greater longevity and a decrease in the incidence of alcohol-related trauma in younger adults. Often, the elderly trauma patient has compromised physiological reserve and healing capacity due to concomitant morbidities, resulting in a less favourable clinical outcome. The presence of osteopenic or osteoporotic bone and other treatments for existing comorbidities hamper some treatment alternatives, especially those designed for younger patients.
Diverse clinical presentations include minor trauma, major polytrauma and insufficiency fractures. An assessment of the general health and functional status of the patient is of utmost importance to determine the optimal treatment. The different treatment options of pelvic and acetabular fractures in the presence of osteoporosis vary mainly according to the clinical presentation and include: conservative methods, percutaneous or minimally invasive procedures, open reduction and fixation, and primary total hip arthroplasty.
Whichever treatment is chosen, even for elderly people, the aim is a rapid mobilisation of the patient in order to reduce complications to some extent inherent to this age group.
Keywords: Elderly; Acetabulum; Pelvic ring; Osteoporosis; Fracture; Surgery; Total hip arthroplasty; Cables; Minimal invasive; Conservative
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Evaluation and treatment of pelvic metastases
Panayiotis J. Papagelopoulos, a, , Andreas F. Mavrogenisa and Panayotis N. Soucacosa
aFirst Department of Orthopaedics, Athens University Medical School, Attikon General University Hospital, Athens, Greece
Accepted 8 January 2007. Available online 30 March 2007.
Summary
Advances in systemic treatment of cancer have improved patients’ survival and increased the number of patients presenting with metastases of the pelvic ring. Pelvic metastatic lesions may cause severe pain and functional disability. A multidisciplinary approach is fundamental for the management of these lesions. Lesions of the pelvis not directly involving the hip joint such as the ischium, pubis or sacroiliac area can generally be treated non-operatively with radiation alone or using minimally invasive procedures of radiofrequency ablation, cryosurgery and percutaneous osteoplasty. Periacetabular destructive lesions may require total hip replacement with reconstruction of the acetabulum dependent on the extent of the defect. Operative treatment should restore the mechanical stability of the hip joint, and preserve the mobility, independence and comfort of these patients.
Keywords: Cancer; Pelvis; Metastatic bone disease; Hip joint; Radiation; Radiofrequency ablation; Cryosurgery; Percutaneous osteoplasty; Pathological fracture; Polymethylmethacrylate; Reconstruction; Acetabulum; Chemotherapy
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Bone healing: What is the effect of NSAIDS on endochondral and intramembranous ossification?
I. Pountos, a, E. Jonesa, T. Georgoulia, D. McGonaglea and P. Giannoudisa
aSchool of Medicine, University of Leeds, UK
Available online 16 February 2007.
Keywords: Endochondral; Intamembranous; Non steroidal anti-inflammatory drugs
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The impact of major trauma and fracture surgery upon neutrophil and monocyte leucopoiesis, maturation and function
W. Almonda, J. Stanley, a and I. Pallistera
aUniversity of Wales, UK
Available online 16 February 2007.
Keywords: Neutrophil; Monocyte; Leucopoiesis; Maturation
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The ability of various bone graft substitutes to attach mesenchymal osteoprogenitor cells
An in vitro study
Z. Dahabreha, , M. Howarda, P. Campbellb and P. Giannoudisa
aUniversity of Leeds, UK
bYork Hospital, UK
Available online 16 February 2007.
Keywords: Graft; Substitute; Osteoprogenitor
很需要啊lifuru@126.com
需要全文，谢谢
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骨盆和髋臼外科的发展过程
P.V. Giannoudis, a, , M. Bircherb and T. Pohlemannc
aDepartment of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK
bDepartment of Trauma & Orthopaedics, St. George's Hospital, London, UK
cDepartment of Trauma & Orthopaedics, School of Medicine, University of Homburg, Germany
Available online 2 April 2007.
Article Outline
Until the middle of the 20th century, surgical treatment of pelvic and acetabular fractures was non-existent. Conservative treatment was advocated which involved bed rest, compression devices, extensions and/or slings, traction and closed reduction techniques. This approach, especially for pelvic fractures, resulted in high rates of back pain, impaired gait, pelvic obliquity, sitting problems and neurological sequelae.
在20世纪中期以前，一直不存在骨盆和髋臼骨折的手术治疗。所主张进行的保守治疗包括卧床休息、加压法、牵伸和/或悬吊、牵引和闭合复位技术等。通过这些途径，尤其是对于骨盆骨折，导致了较高比率的腰痛、畸形步态、骨盆倾斜、坐相关的问题以及神经方面的后遗症。
In the 1950s George F. Pennal, a Canadian surgeon, developed an interest in the management of pelvic fractures and investigated the effect of antero-posterior compression, lateral compression and vertical shear forces on the pelvic ring. In addition he pioneered the early use of the external fixator for pelvic ring disruptions and developed the X-ray projections, called inlet and outlet views.4
在1950年代，德国外科医生George F. Pennal对骨盆骨折的治疗产生了兴趣，并就前后压缩、侧向挤压以及垂直剪切力对骨盆环的效用进行了观察。此外，他还率先早期应用外固定处理骨盆环中断的病例，并发展了X线投照技术，也就是我们所说的入口位和出口位像[4] 。
In the early 1960s, the management of acetabular fractures was revolutionised by the work of Judet and Letournel. They recognised that the principles applied to the treatment of displaced articular fractures (anatomic reduction, stable fixation and early movement) should also be applied to the acetabulum. Their work lead to the development of new surgical approaches and a classification system which has been tested in time and is currently used all over the world.3
1960年代早期，由于Judet和Letournel的工作而使髋臼骨折的治疗产生了个革命性的变化。他们认识到了应用在有移位的关节骨折的治疗原则（解剖复位，牢固固定和早期运动）也应该应用到髋臼中来，他们的工作导致了新的手术入路和分类系统的发展，而这些经过时间的考验，目前仍被在全世界范围内应用[3] 。
Pelvic ring disruptions are usually found in multiply injured patients and exacerbate the life-threatening character of their concomitant injuries. It has become clear over the years that these injuries should be managed in a multi-disciplinary fashion to minimise early mortality secondary to haemodynamic instability. Hypotensive patients with these fractures present a major challenge in the diagnosis and treatment of the source of bleeding. Improvements made in prevention of the injury, prehospital care, the widespread use of the ATLS protocol and the advances made in intensive care medicine contributed to a reduction in mortality rates.2 A thorough knowledge of the anatomical structures contributing to pelvic stability and the source of the bleeding is essential for the assessment and treatment of these injuries.
骨盆环中断常见于多发伤的患者，他们伴随的损伤也常使危及生命的状况更加恶化。近年来，已经明确的是这种创伤应该以多学科的方式进行处理，以使继发于血液动力学不稳定的早期死亡率降至最小。有这种骨折的低血压患者，诊断和处理其出血的来源存在很大的挑战。创伤预防、院前处理、ATLS方案的广泛应用等方面的进步，以及危重病医学的进展导致了死亡率的下降[2] 。清楚地认识骨盆稳定性和出血来源相关的解剖结构，对于评估和处理这种创伤是必不可少的。
On the other hand, injuries of the acetabulum, if left untreated are associated with long term morbidity. Restoration of the normal anatomy of the hip joint is essential as any incongruity of the joint can lead to erosion of the articular cartilage resulting in post-traumatic osteoarthritis. In young adults this may be catastrophic, as it will lead to an early joint replacement.
另一方面，髋臼损伤，如果不做处理，这和长期的病态是有关系的。恢复髋关节的正常解剖关系是根本性的，关节的任何不协调都有可能导致关节软骨的破坏，进而导致创伤性关节炎。对于年轻患者，这可能是灾难性的，因为这意味着需要过早地进行关节置换。
During the last 20 years pelvic and acetabular surgery has continued to evolve.
在过去的20年间，骨盆和髋臼外科得到了进一步的发展。
In severely multiple injured patients who are in an ‘unstable’ or ‘in extremis’ clinical condition, damage control orthopaedics is the current treatment of choice. By performing limited surgical interventions, the subsequent reduction in blood loss and transfusion requirements can only be beneficial in these critically ill patients, reducing the risk of developing systemic complications and early mortality. In addition, modified, less invasive approaches have been developed. Newer generations of implants have been introduced as well as percutaneous stabilisation techniques and image-guided surgery for the reconstruction of both pelvis and acetabulum. Furthermore, the role of interventional radiology (embolisation of vessels) in the early pathway of patients has proved to be beneficial.
对于处于“不稳定”或“濒死”的临床状况的严重多发伤的患者，进行控制损害的骨科手术时目前治疗上的一个选择。进行有限的手术干预，减少继发性的失血和输血的需求量可能只对这些垂危的患者有好处，可以减少出现系统性并发症的风险，降低早期死亡率。此外，微创入路也已经发展起来。新一代的内固定物，以及经皮的固定技术和图像导航手术对骨盆和髋臼都进行重建均已有应用。此外，介入放射学（栓塞血管）应用于早期患者也被证明是有好处的。
Nowadays pelvic and acetabular reconstruction has been recognised as a distinct subspecialty within the trauma and orthopaedic surgical field. However, in the UK and other European countries, the different centres that have been developed are under threat due to lack of resources and the focus of government on NHS waiting list targets (rather than clinical priorities). The failure of the pelvic specialist services and the reasons for their decline has been attributed to several factors including error-coding, financial pressures, waiting list targets, unavailable theatre capacity, etc.1 This state of affairs is unacceptable and urgent attention is mandatory from the commissioners of health care across Europe.
目前，骨盆和髋臼重建已经被认为是创伤和骨外科领域一个独特的专业方向。然而，在英国以及其他一些欧洲国家，各个能开展这一手术的医学中心都面临这样的窘境：缺乏资金，政府只是关注NHS的轮候对象（而不是临床优先）。骨盆专家开展手术的不足，以及他们下降的原因主要归于以下几个方面，担心（避免）犯错、财政上的困难、NHS轮候对象、手术室容量不足等[1]。这种状况不能任由发展，整个欧洲医疗保健行业的主管有义务对此加以注意。
这一段的翻译自己感觉就不好，不太明白，请高手指点。
The recent development of the European Society of Pelvis and Acetabulum has brought together a large number of clinicians with a declared interest in pelvic and acetabular surgery. The primary goal of the society is the improvement of patient care using improved skills (training, fellowship) and the generation of a network of excellence, using an evidence based approach. In this special issue, scientific contributions have been made by several surgeons across Europe. We would like to express our sincere appreciation to all of the authors for the contribution of their manuscripts. We believe that dissemination of knowledge is of paramount importance so that patient care will continue to improve across the European Landscape and beyond.
欧洲骨盆与髋臼协会近期的发展已经将很多声明对骨盆和髋臼外科感兴趣的临床医生汇聚起来。这个协会的主要目标是通过改进技术（训练、交流）进而改善病人的处理，并通过基于证据的途径做出一个优秀的网络。在这个特刊中，学术稿件是由欧洲范围内的几个外科医生撰写的。我们很想向所有投稿的作者表达我们诚挚的感激。我们相信传播知识是最重要的，以至欧洲范围内已经其他地方患者的处理都将继续得到改善。
References
1 M. Bircher and P.V. Giannoudis, Pelvic trauma management within the UK: a reflection of a failing trauma service, Injury 35 (2004) (January (1)), pp. 2–6. SummaryPlus | Full Text + Links | PDF (88 K) | View Record in Scopus | Cited By in Scopus
2 P.V. Giannoudis and H.C. Pape, Damage control orthopaedics in unstable pelvic ring injuries, Injury 35 (2004) (July (7)), pp. 671–677. SummaryPlus | Full Text + Links | PDF (119 K) | View Record in Scopus | Cited By in Scopus
3 R. Judet, J. Judet and E. Leturnel, Fractures of the acetabulum. Classification and sargical approaches for open reduction, J Bone J Surg 46A (1964), pp. 1615–1636.
4 G.F. Pennal and G.O. Sutherland, Fractures of the pelvis, American Academy of Orthopaedic Surgeons, Film Library, Park Ridge, IL (1961).
都需要 谢谢!!!!!
wyc541@yahoo.com.cn
楼主的外文资料非常及时的提供给我们,在这里表示非常的感谢!
3、
骨盆和髋臼外科从远古到现代的发展
N. Prevezas, a,
aGeniko Kratiko Hospital, Nikeas-Piraeus, Greece
Accepted 18 January 2007. Available online 17 April 2007.
Summary
Fracture stabilisation before the 19th century was in its infancy. The outcome was suboptimal, and quite often mortality was the end result. Advances in the stabilisation of long-bone fractures did not become apparent until the mid-1940s and for other bones, even later. In the mid-1960s, Judet and Letournel initiated a series of experimental and clinical studies focusing on pelvic and acetabular reconstruction surgery. Their work set the pace for all the subsequent advancements made in this field of surgery. Today, pelvic and acetabular reconstruction is a recognised subspecialty within the disciplines of trauma and orthopaedics. This review article traces the evolution of pelvic and acetabular surgery, from ancient to modern times.
Keywords: Pelvis; Acetabulum; Reconstruction; Ancient times; Modern times
摘要
19世纪之前，骨折的固定处于发展的初期，其疗效不太理想，最为常见的治疗结果就是死亡。直到1940年代中期，长骨骨折的固定才有了进展，而其他骨骼甚至更晚。1960年代中期，Judet 和 Letournel 针对骨盆和髋臼重建外科开始了一系列的实验和临床研究。他们的工作是外科中这一领域后来所有进步的开端。今天骨盆和髋臼重建成为了创伤和骨科专业内一个专门的专业方向。这一综述追述了骨盆和髋臼外科从远古到现代的发展过程。
关键词：骨盆；髋臼；重建；远古；现代