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What’s more in pelvic crescent fractures,？

要知道“新月形骨折”為何物,，我們先來看看“新月”作何解釋，接下來看看“新月形骨折”出處的原意,，再來看看各家之言,，最后得出我們自己的結(jié)論。

一,、“新月”（crescent moon）作何解釋,？

此“新月”（crescent moon）非天文月相之“新月”（new moon），前者彎彎以致情意綿綿，后者淡淡以致肉眼難見,。在維基百科（Wikipedia）中收索“crescent moon”得到“a lunar phase waxing until 7 days after or waning since 7 days before the new moon”,，意為月相中天文新月之后7天的waxing crescent（峨眉月）或之前7天的waning crescent（殘月）。

再來看看權(quán)威的韋氏詞典（Webster dictionary）對crescent moon的解釋：1. the moon at any stage between new moon and first quarter and between last quarter and the succeeding new moon when less than half of the illuminated hemisphere is visible（科學(xué)解釋,，與維基百科意同）,；2. the figure of the moon at such a stage defined by a convex and concave edge（形象化解釋，有一個凸緣和凹緣的月亮形態(tài)）,。

二,、“新月形骨折”（crescent fracture）的原意

“新月形骨折”這一名詞來源于Andrew R. Burgess和Jeremy W.R. Young等學(xué)者的在骨盆損傷臨床實踐中的工作總結(jié)，在他們《Pelvic ring disruption: effective classification system and treatment protocols》一文中有詳盡的敘述,。摘抄原文如下：

A crescent fracture is created by a lateral force fracturing the iliac wing at or near the anterior border of the sacroiliac (SI) joint, the remainder of the ilium having rotated medially from this point at the time of impact, leaving a small crescent-shaped segment of posterior ilium firmly attached to the sacrum via the strong posterior SI ligaments.

The crescent fracture, produced by LC (internal rotation) forces to the pelvic ring, manifests as a distinctive posterior iliac wing segment that remains attached to the sacrum. Its crescent shape is composed of two edges, the relatively straight edge being the anterior fracture line and the curved edge being the most posterior portion of the iliac crest up to and including both posterior iliac spine; frequently, the curved edge also includes the most posterior portion of the roof of the greater sciatic notch. The fracture pattern thus created spares the posterior SI ligaments, forming a strong connection between the sacrum and the fragment.

翻譯如下：

新月形骨折是由側(cè)方暴力導(dǎo)致的位于或鄰近骶髂關(guān)節(jié)前緣的髂骨骨折,，髂骨的殘部在暴力作用當時發(fā)生內(nèi)旋移位，留下一小塊新月形髂骨后部骨塊借骶髂后韌帶與骶骨牢固相連,。

新月形骨折,，由側(cè)方擠壓（內(nèi)旋）暴力所致，以與骶骨相連的髂骨后份骨塊為獨特表現(xiàn),。該骨塊的新月外形由兩個邊緣組成,，相對平直的邊緣為前方的骨折線，弧形邊緣則為包括髂后上下棘在內(nèi)的髂嵴后份,，通常,，弧形邊緣也囊括坐骨大切跡頂狐的后份。骶髂后韌帶將此新月型骨塊與骶骨強力連接在一起,。

三,、“新月形骨折”的各家之言

1. Marvin Tile, David L Helfet, James F Kellam, Mark Vrahas主編的《Fractures of the pelvis and acetabulum: principles and methods of management》4th edition

Crescent fractures

Fracture dislocations ofthe sacroiliac joint with dislocation of the inferior sacroiliac joint and fracture through the posterior iliac crest have been termed “crescent” fracture dislocations.

譯文：骶髂關(guān)節(jié)下份脫位合并髂嵴后份骨折的骶髂關(guān)節(jié)骨折脫位被稱為“新月形”骨折脫位。

又多出了“新月形”骨折脫位這樣一個偽概念,。

The posterior lesion is, in some cases, confined to the ilium just anterior tothe sacroiliac joint and sometimes is a fracture dislocation of the sacroiliac joint with the fracture in the ilium being of varying size, producing the so-called crescent fracture.

譯文：后環(huán)損傷,，在一些病例中僅僅局限于恰恰位于骶髂關(guān)節(jié)前方的髂骨骨折，有時則表現(xiàn)為有著不同大小髂骨骨折塊的骶髂關(guān)節(jié)骨折脫位,，從而產(chǎn)生了所謂的“新月形骨折”,。

2.Wade R Smith, Bruce H Ziran, Steven J Morgan主編的《Fractures of the Pelvis and Acetabulum》

Crescent Fractures

When the posterior pelvic disruption passes through the lower portion of the sacroiliac joint and exits through the ilium, this is known as a “crescent fracture.” A portion of the iliac wing remains attached to the sacrum by means of the sacro-iliac ligaments. The piece of bone fractured from the iliac wing resembles a crescentic moon, hence the term (Fig. 3A-H). The most common mechanism of injury is lateral compression, resulting in the wing being impinged against the dense sacral bone (22). These fractures are rotationally unstable, and are classified as lateral compression type II in the Young-Burgess classification system (23).

譯文：經(jīng)髂骨骨折的骨盆后環(huán)損傷累及骶髂關(guān)節(jié)的低位部分，就形成所謂的“新月形骨折”,。髂骨翼骨折塊借骶髂韌帶連接于骶骨,，形似新月，因而得名（圖3A-H,，選B及D）,。可致使髂骨與骶骨撞擊的側(cè)方擠壓暴力是最常見的損傷機制,。這種骨折有旋轉(zhuǎn)不穩(wěn)定性,，在Young-Burgess骨盆骨折分型系統(tǒng)中屬LC-II型。

3.S. Terry Canale, James H. Beaty主編的《Campbell’s Operative Orthopaedics》12th editon

For fracture-dislocations of the sacroiliac joint (the so-called crescent fracture; Young and Burgess type LC II), the fracture can be reduced and fixed anteriorly or posteriorly, with or without hardware trans-fixing the sacroiliac joint.

譯文：對于骶髂關(guān)節(jié)骨折脫位（即所謂的“新月形骨折”，也即Young-BurgessLC-II型骨盆骨折）,，其骨折部可通過前方或后方（入路）進行復(fù)位固定,，骶髂關(guān)節(jié)可固定或不固定。

骶髂關(guān)節(jié)骨折脫位即所謂的“新月形骨折”,，表述不精確,，嚴格來講，經(jīng)髂骨的骶髂關(guān)節(jié)骨折脫位才是“新月形骨折”,。

4.Charles M. Court-Brown, James D. Heckman, Margaret M. McQueen, William M. Ricci, Paul Tornetta III主編的《Rockwood & Green’s Fractures in Adults》8th editon

… the typical LC II has an iliac wing fracture or the “crescent” fracture, which is a fracture dislocation of the SI joint through the iliac wing…

譯文：…典型的LC-II型骨盆骨折有著一個髂骨骨折部或者說是“新月形骨折”,，后者是經(jīng)髂骨的骶髂關(guān)節(jié)骨折脫位…

此“新月形骨折”的表述才算貼切。

The posterior lesion can be represented by a sacral fracture, SI joint dislocation, crescent fracture (SI fracture-dislocation), or an iliac wing fracture.

譯文：骨盆后環(huán)損傷可表現(xiàn)為骶骨骨折,、骶髂關(guān)節(jié)脫位,、“新月形骨折”（骶髂關(guān)節(jié)骨折脫位）或者髂骨翼骨折。

此處的髂骨翼骨折應(yīng)該是位于骶髂關(guān)節(jié)前方且累及坐骨大切跡的骨折,。

四,、“新月形骨折”的真面目

追本溯源,，Andrew R. Burgess和Jeremy W. R. Young最有發(fā)言權(quán),。原著者關(guān)于“新月形骨折”的本意有幾個不爭的事實：①骨折由側(cè)方暴力導(dǎo)致，②髂骨骨折線可位于或鄰近骶髂關(guān)節(jié)前緣,，③小塊新月形髂骨后部骨塊借骶髂后韌帶與骶骨牢固相連,，④新月形骨折塊直邊在前，為骨折線,，弧邊在后,，包括髂后上下棘甚至部分坐骨大切跡，⑤髂骨骨折遠端在損傷當時發(fā)生內(nèi)旋,。

要知道,，Young-Burgess骨盆骨折分型系統(tǒng)出自162例有著完整資料的骨盆損傷病例，其中LC-II僅12例（7.4%）,，就算是LC-III型【15例（9.3%）】中有可能也存在“新月形骨折”,，其最高例數(shù)為12+15=27（16.7%），根本無法將“新月形骨折”的形態(tài)學(xué)及影像學(xué)表現(xiàn)盡可能全面地包括在內(nèi)并闡述清楚,。有沒有髂骨骨折線基本完全位于骶髂關(guān)節(jié)前方而骶髂關(guān)節(jié)穩(wěn)定或者骨折線完全位于骶髂關(guān)節(jié)后方（不經(jīng)骶髂關(guān)節(jié)）而骶髂關(guān)節(jié)不穩(wěn)定等情況呢,？

所以說，為知者要知其根本,，為學(xué)者要學(xué)其要義,，動態(tài)地發(fā)展地學(xué)，靈活地用,。相信,，我們心中已然對骨盆“新月形骨折”有了清晰的再認識。

最后，對于目前書籍和文獻資料中比較容易混淆的概念加以梳理,，請大家通過學(xué)習(xí)和思考加以明晰：

骶髂關(guān)節(jié)脫位：是單純的脫位,？包不包括骨折脫位？

骶髂關(guān)節(jié)骨折脫位：具體是經(jīng)何部位的骨折脫位,？

還是讓我們表述的確切些吧?。?！

1. 經(jīng)髂骨的骶髂關(guān)節(jié)骨折脫位,；

2. 經(jīng)骶骨的骶髂關(guān)節(jié)骨折脫位；

3. 經(jīng)髂骨且經(jīng)骶骨的骶髂關(guān)節(jié)骨折脫位,。