骨盆创伤诊查：CT扫描总“实话实说”吗？（中英对照）

蔡鸿敏 | Miles Stone  [e-mail]

河南省洛阳正骨医院（河南省骨科医院） 髋中心

河南省骨科微创工程技术中心

原创声明：本文所有内容均100%原创。请大家多多支持、交流、转发！谢谢！

Foreword前言

Like wings as to a bird, English is a great tool to help a surgeon to fly high. So I do my best and take my spare time to learn and practice English everyday, expecting to get more knowledge, earn more insights, and hold more abilities.

  就像翅膀之于飞鸟，英语之于医者乃一绝佳武器，使之得以有机会振翅高飞！因此，吾每日均尽吾之最大努力，利用业余时间，学习和练习英语，以期可获取更多知识、赢得更深见解和掌握更精技艺。

To spread knowledge while improving my written English, I typed this WeChat article in both English and Chinese, and I will do this at times, hoping that it will trigger your impetus for English learning. Will you join me? Ok, let’s do it.

在提高书面英语能力的同时以传播知识，是吾写这篇中英文对照微信公众平台文章的初衷，吾将时常如是，希冀以吾小小之努力能激发起同道们学习英语的原动力。您会与我同行吗？好吧，着手去干吧！

蔡鸿敏（Miles Stone）

河南省洛阳正骨医院（河南省骨科医院）髋中心

2017/5/24 （on my birthday）

Does computed tomographic (CT) scan always tell the truth in the screening of pelvic fractures?

骨盆创伤诊查：CT扫描总“实话实说”吗？

1

To date, CT scan is a necessary tool in the screening and evaluating process for pelvic disruptions. The serial radiographs consisting of the pelvic anteroposterior (AP), outlet, and inlet views and pelvic axial CT scan with 2D and/or 3D reconstructions comprise the common diagnostic protocol for pelvic trauma. The truth is that CT scan often provides the surgeons with subtleties of the pelvic disruption that the x-rays fail to present. But does the CT scan always tell the truth so that one can get correct diagnoses and make proper decisions without considering the serial radiographs?

 时至今日，在骨盆损伤的诊查和评估过程中，CT扫描成为不可或缺的工具。骨盆创伤系列平片检查（包括骨盆正位、出口位及入口位）和骨盆轴向扫描（结合冠状面和矢状面的2维重建，甚至骨盆3维成像）构成骨盆创伤的诊断规程。事实上，CT扫描常可为医者提供普通平片无法呈现的细节。但是，CT扫描总是“实事求是”以至于医者不借助平片就可做出正确诊断和确立合理处置吗？

2

The answer is negative. Here, an example is taken to explore the reality.

答案是否定的。下面，我用一个病例来细说端详。

3

After scrutinizing the following pelvic axial CT scan, regardless of the pelvic anterior ring injury, an incomplete pelvic posterior ring fracture will come to be the diagnosis. The fracture line (Line A) starts from the mid-crest, spreads downward, crosses the iliac fossa (IF) caudal to which the line stops just anterior to the sacroiliac joint (SIJ) and turns sharply to be narrow and incomplete. Here, a virtual 3D reconstruction in mind is recommended. At this point, a decision of carrying out a conservative therapy will emerge. Hold on a second. Does it necessitate further information to secure the plan?

在仔细阅读下面的骨盆轴向CT扫描后，暂且不论骨盆前环损伤，骨盆后环损伤的诊断则是不完全性骨折。骨折线（A）始自髂嵴中份，向远端延伸，通过髂窝（iliac fossa，IF）后即开始变窄并成为不完全性，最后止于骶髂关节（sacroiliac joint，SIJ）稍前方。在此，推荐在脑海中对骨折进行虚拟三维重建。到此为止，医者会决定对此骨折进行保守治疗。稍等片刻，还需要额外信息以使得治疗方案更加周全吗？

4

Here comes the CT coronal reconstruction. What? The fracture is complete and SIJ involved! What’s more, another occult incomplete fracture line (Line B) is detected. How can it be? As to the treatment plan, change will be adjusted.

    下面是骨盆冠状面CT重建图像。什么？骨折线（A）竟然是完全性的而且累及SIJ！而且，髂骨翼的前份还有一个不完全性的骨折线（B）。这怎么可能？！此时，治疗方案将需调整。

5

The pelvic 3D reconstruction, while presenting the real nature of the fracture, uncovers the reason why the axial CT scan “cheats.” The lower limb of Line A and the whole course of Line B are nearly transverse which means that they are collinear to the pelvic axial cut. The “radiographic blade” slides in between the transverse fracture gap without purchasing any bone mass, namely that when the gun trigger is pulled, the bullet misses its target. But after applying the other cross-sectional CT reconstruction perpendicular to the axial cut (also the fracture Lines), the “target” can escape to nowhere.

    以下是骨盆3维重建图像，在呈现骨折真实面貌的同时也揭示了骨盆轴向CT扫描“骗人”的真相。骨折线A的远段和整个骨折线B近乎水平，意思是折线与骨盆轴向CT扫描的射线共线。射线的“刀锋”自水平指向的折端间隙“划过”而未“斩到”些许骨质，也就是说，当扣动扳机后，子弹却落空而未击中目标。但是，在增加一个与骨盆轴向CT扫描平面（亦上述骨折线）垂直的断层扫描后，“目标”将无处遁逃。

6

Now, the personality of the pelvic posterior ring fractures is fully understood, followed by the alteration of the treatment plan. Conservative or surgical? Open or closed? Of course, there exists some debates. Conservative plan is OK with bed rest lasting for 4 to 6 weeks, followed by crutch-assisted weight-bearing-restricted ambulation till full healing of the fractures. Surgical intervention is also reasonable, allowing for early weight-bearing-restricted mobilization and then rehabilitation. But how the surgery is programmed? Open reduction and internal fixation (ORIF) with plating or done in a closed fashion? In my opinion, if surgical procedure is planned, it is finished in a closed and percutaneous manner, or, the conservative therapy is the right choice.

此时此刻，骨盆后环骨折的整体特性全然呈现，接下来，治疗方案需要进行变动。保守或手术？开放或闭合？存有争议理所当然。保守治疗未尝不可，卧床4到6周后进行拄拐限制性负重行走活动直至骨折愈合。手术治疗当然也无可厚非，其允许早期限制负重性行走锻炼以及加快康复。但是，问题是如何手术？切开复位内固定（open reduction and internal fixation，ORIF）或是通过闭合的方式进行？以我之见，如若手术，则须以闭合及经皮的方式进行，否则，保守治疗是合适选择。

7

Then, one may be curious about what do the pelvic serial radiographs look like. Here they are. Try to correlate them to the above-showed CT images.

然后，或许某些同道会很好奇，想知道此病例的骨盆系列片到底是什么样子的。喏，下面这几张图就是啦。试着把它们和上面所呈现的CT图像联系起来。

8

In the end, it comes the final result of the patient. It is operated on by ORIF.

最后，是此例病人的治疗结局——ORIF。

9

Again, the minimally invasive way of treatment is strongly recommended.

再次推荐微创的方式治疗此类骨折。

附：LC-II螺钉经皮置入技术——手术视频

感谢各位老师、同道的支持与厚爱！

   让我们携手努力，共筑美好！