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中华诊断学电子杂志 ›› 2026, Vol. 14 ›› Issue (01) : 1 -16. doi: 10.3877/cma.j.issn.2095-655X.2026.01.001

指南与共识

骨盆骨折现代救治专家共识:从现场处理到康复管理(2025)
临床多学科共识专家小组   
  • 收稿日期:2025-10-16 出版日期:2026-02-26

Expert consensus on modern management of pelvic fractures: from on-site care to rehabilitation (2025)

Expert Panel for Multidisciplinary Clinical Consensus   

  • Received:2025-10-16 Published:2026-02-26
引用本文:

临床多学科共识专家小组. 骨盆骨折现代救治专家共识:从现场处理到康复管理(2025)[J/OL]. 中华诊断学电子杂志, 2026, 14(01): 1-16.

Expert Panel for Multidisciplinary Clinical Consensus. Expert consensus on modern management of pelvic fractures: from on-site care to rehabilitation (2025)[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2026, 14(01): 1-16.

骨盆骨折是临床严重外伤,占骨折总数3.0%~8.0%,多因高能暴力引发,半数以上合并其他损伤或多发伤。根据致伤外力(低能/高能暴力)可分为稳定型与不稳定型骨折。其致残率达50.0%~60.0%,最严重合并伤为创伤性失血性休克及盆腔脏器损伤,救治不当死亡率为13.0%~22.6%。因此,早期处理须严格遵循高级创伤生命支持原则,优先挽救生命、稳定生命体征,再行骨盆骨折相关检查与处理。若明确休克由骨盆骨折出血所致,需按标准化抢救流程实施救治。本共识意见内容基于现有循证医学文献制定;无明确证据时,相关标准由专家共识制定小组提出推荐性建议。

Pelvic fractures represent severe clinical trauma, accounting for 3.0%-8.0% of all fractures. They are predominantly caused by high-energy violence, with over half of cases involving concomitant injuries or polytrauma. Based on the mechanism of injury (low-energy vs high-energy violence), pelvic fractures can be classified into stable and unstable types. The disability rate caused by pelvic fractures ranges from 50.0% to 60.0%, with the most severe complications including traumatic hemorrhagic shock and pelvic organ injuries. Improper management can lead to a mortality rate of 13.0%-22.6%. Therefore, early intervention must strictly adhere to the principles of Advanced Trauma Life Support (ATLS), prioritizing lifesaving measures and stabilizing vital signs before proceeding with pelvic fracture related examinations and interventions. If it is confirmed that the shock is caused by pelvic fracture-related hemorrhage, standardized resuscitation procedures must be implemented. The content of this consensus is based on current evidence-based medical literature; in the absence of clear evidence, recommendations are provided by the consensus development group.

表1 GRADE证据质量分级、推荐强度分级
图1 骨盆骨折院前创伤急救DRCAB评估步骤注:DRCAB为危险、反应、循环、气道、呼吸;CAB为循环、气道、呼吸
表2 骨盆骨折物理止血法紧急止血技术
表3 骨盆骨折APC指数评分标准
表4 骨盆骨折危险分层与临床意义
表5 骨盆骨折急诊救治时效质控指标
图2 骨盆骨折影像学分层检查流程注:ATLS为高级创伤生命支持;FAST为创伤超声重点评估
表6 骨盆骨折影像学检查方法比较
图3 骨盆骨折合并血流动力学不稳定的诊疗流程注:FAST为创伤超声重点评估;MTP为大量输血方案;REBOA为复苏性主动脉球囊阻断术;1 mmHg=0.133 kPa
表7 骨盆骨折患者血流动力学不稳定的干预指征
表8 骨盆骨折外固定方案
表9 骨盆骨折Tile分型与Young-Burgess分型对照表
分型系统 类型 损伤机制与影像特征 稳定性与临床意义
Tile分型 A型(稳定)    
  A1 未累及骨盆环的骨折,如髂前上棘、坐骨结节撕脱骨折 骨盆环完整,完全稳定,多保守治疗
  A2 轻度移位,不影响骨盆环稳定性,如髂骨翼分离 骨盆环稳定,保守治疗为主
  B型(旋转不稳)    
  B1 前后挤压伤,耻骨联合分离或耻骨支纵向骨折,骶髂前韧带损伤,呈"开书样"损伤 旋转不稳定,垂直稳定,出血风险较高
  B2 侧方挤压伤,同侧前环和后环压缩,骶骨压缩或髂骨翼新月形骨折 旋转不稳定,垂直稳定,合并伤风险高
  B3 双侧B型损伤,一侧前环压缩伴对侧后环压缩(桶柄状) 旋转不稳定,垂直稳定,损伤严重
  C型(旋转、垂直均不稳)    
  C1 单侧垂直不稳定,经骶髂关节或骶骨骨折,半骨盆向上移位 旋转和垂直均不稳定,需手术固定
  C2 双侧损伤,一侧旋转不稳伴对侧垂直不稳 完全不稳定,死亡率高,需紧急手术
  C3 合并髋臼骨折 最严重类型,需综合治疗
Young-Burgess分类 APC(前后挤压)    
  APC-Ⅰ 耻骨联合分离<2.5 cm或耻骨支纵向骨折,后方韧带完整 稳定型,出血量相对较少
  APC-Ⅱ 耻骨联合分离>2.5 cm,骶髂前韧带、骶棘韧带、骶结节韧带断裂,呈"开书样"损伤 旋转不稳定,垂直稳定,出血风险高
  APC-Ⅲ 耻骨联合完全分离,骶髂前后韧带完全断裂,半骨盆完全分离 旋转和垂直均不稳定,大出血和神经血管损伤风险极高
  LC(侧方挤压)    
  LC-Ⅰ 骶骨侧方压缩骨折,同侧耻骨支横行骨折,韧带结构完整 稳定型,合并膀胱损伤风险高
  LC-Ⅱ 髂骨翼新月形骨折,后方韧带复合体部分损伤 旋转不稳定,垂直稳定,损伤较重
  LC-Ⅲ 同侧LC-Ⅰ/Ⅱ损伤,伴对侧"开书样"损伤(风卷样骨盆) 旋转和垂直均不稳定,损伤严重
  VS(垂直剪切)    
  VS 轴向暴力致骶髂关节或骶骨骨折,半骨盆垂直移位 完全不稳定,大出血和神经损伤风险高
  CM(混合机制)    
  CM APC、LC、VS中任意2种或3种联合损伤,最常见LC+VS 损伤最复杂,死亡率最高
表10 老年骨盆骨折康复分期表
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