骨盆机能不全骨折的诊治

doi:10.3877/cma.j.issn.2096-0263.2025.04.009

骨盆机能不全骨折是正常应力或轻微外伤作用在骨质弱化的骨盆上，而引起的非特异性的腰骶部和/或臀部疼痛并影响活动功能，且影像学变化较为细微的一类特殊的骨盆骨折。随着老龄社会加剧，骨盆机能不全骨折的发生率越来越高。常见的病因有骨质疏松症、局部放疗、长期服用皮质类固醇等。但往往因起病隐匿、疼痛部位难以确定而诊断困难。骨盆X线检查多用于筛查及随访，而CT及MRI检查能明确诊断，并有助于治疗方案的选择。早期可采取镇痛、卧床休息、理疗及支具等保守治疗。若效果不佳、疼痛加剧，可用手术治疗干预，如经皮骶髂螺钉固定、骶骨成形术等。本文就近年来有关骨盆机能不全骨折的文献进行系统综述，以期为临床医生诊治骨盆机能不全骨折提供参考。

关键词: 骨盆, 机能不全骨折, 骨质疏松, 骶髂螺钉, 骶骨成形术

Pelvic insufficiency fractures (PIF) are a special category of pelvic fractures with normal stress or minor trauma acting on the weakened pelvis, whereas those that cause nonspecific lumbar and/or groin pain, and interfere with ambulation with subtle radiographic imaging changes. With the aggravation of the aging society, the incidence of PIF is increasing. PIF commonly results from osteoporosis, and may also occur due to radiation and chronic steroid usage. PIF is often misdiagnosed because of its insidious onset without special clinical symptoms. Pelvic X-ray is mostly used for screening and follow-up, whereas CT and MRI can confirm the diagnosis and is helpful to therapy. The conservative treatment of PIF includes analgesics, bed rest, physical therapy and orthoses. Patients who are unresponsive to this management and who have intractable pain are candidates for percutaneous iliosacral screw fixation or sacroplasty. We reviewed the literature on PIF in recent years, in order to provide reference for clinicians in the diagnosis and treatment of PIF.

Key words: Pelvis, Insufficiency fractures, Osteoporosis, Iliosacral screw, Sacroplasty

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Diagnosis and treatment of pelvic insufficiency fractures

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Diagnosis and treatment of pelvic insufficiency fractures