Search

不稳定骨盆骨折合并双柱髋臼骨折的修复重建

目的 总结不稳定骨盆骨折合并双柱髋臼骨折手术方法及效果。 方法 2002 年5 月－ 2007 年6 月，收治12 例不稳定骨盆骨折合并双柱髋臼骨折患者。其中男9 例，女3 例；年龄16 ～ 59 岁，平均32 岁。骨折类型结合Marvin Tile 及Judet-Letoumel 分类：B2 型骨盆骨折合并髋臼骨折C2 型1 例、C3 型2 例；C1 型骨盆骨折合并髋臼骨折C1 型3 例、C2 型1 例；C2 型骨盆骨折合并髋臼骨折C2 型2 例、C3 型1 例；C3 型骨盆骨折合并C1 型髋臼骨折2 例。受伤至手术时间5 ～ 14 d，平均7 d。分别采用髂腹股沟入路2 例，Kocher-Langenbeck 入路4 例，前后联合入路6 例修复重建手术。 结果 术后1 例切口脂肪液化经换药愈合，其余切口均Ⅰ期愈合。12 例均获随访，随访时间10 ～ 72 个月，平均30 个月。骨盆骨折均获复位；髋臼骨折复位采用Matta X 线评估标准，优8 例，良2 例，一般2 例，优良率83.33%。术后3 个月X 线片示骨折均愈合，骨盆环无畸形，无深静脉血栓及肺栓塞等并发症。临床效果采用改良的Merled Aubigne和Postel 评分系统评估，优2 例，良7 例，一般2 例，差1 例，优良率75.00%。 结论 不稳定骨盆骨折合并双柱髋臼骨折早期手术修复重建可获得较满意的疗效。

EVALUATION OF PERCUTANEOUS ILIOSACRAL SCREWS FOR UNSTABLE PELVIC FRACTURES

【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation with il iosacral screw in the management of unstable pelvic fractures. Methods From March 2003 to January 2007, 15 patients with unstable pelvic fractures were treated by percutaneous fixation with il iosacral screws. There were 6 males and 9 females, aged 21-56 years. Fractures were caused by traffic accident in 8 cases, high fall ing in 6 cases and crushing injury in 1 case. The disease course ranged from 4 hours to 3 days. Of 15 patients, 7 had fractures of pubium and sacrum; 2 had fractures of il ium and sacrum; 4 had dislocation of sacroil iac joint with fractures of pubic rami; and 2 had dislocation sacroil iac joint with fracture of sacrum of pubium. Anterior fixation was performed by means of plating in 3 cases, by external fixation in 7 cases, and by both in 5 cases. Results The blood loss was from 1 000 to 1 500 mL in 4 patients with acetabular fracture and about 50 mL in the others. The average operative time was 153.6 minutes (range, 60-305 minutes). Fifteen patients were followed up 6 months to 3 years with an average of 18months. According to Matta criterion for fracture reduction, the results were excellent in 14 cases and good in 1 case. After a follow-up of 28.8 months, fracture union was achieved in all patients. Screw loosening occurred in 1 case, pain of lumbosacral region in 3 cases after tiredness and mild claudication in 2 cases. Nine patients returned to their occupation, three patients changed occupation, and 3 patients could not work at last follow-up. According to Majeed functional scoring, the results were excellent in 11 cases and good in 4 cases. Conclusion Percutaneous il iosacral screw fixation is a useful method in treatment of unstable pelvic fracture.

垂直不稳定骨盆骨折的治疗

Comparison study of minimally invasive percutaneous bridge internal fixator and traditional external fixator in treatment of unstable pelvic fractures

ObjectiveTo evaluate the effectiveness of unstable pelvic fractures treated with minimally invasive percutaneous bridge internal fixator or traditional external fixator.MethodsThe clinical data of 45 patients with unstable pelvic fractures who met the selection criteria between January 2013 and February 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into two groups. In the observation group (25 cases), minimally invasive percutaneous bridge internal fixators were used, and three-dimensional printing pelvic models were used to simulate the reduction and fixation before operation to develop individual reduction strategies. In the control group (20 cases), external fixators were used. There was no significant difference between the two groups in gender, age, cause of injury, fracture type (according to Tile classification), and time from injury to operation (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between the two groups. The reduction quality was evaluated according to the Matta standard, and functional recovery was evaluated according to the Majeed scoring standard.ResultsAll patients were followed up 12-20 months (mean, 15 months). The operation time of the observation group was significantly longer than that of the control group (t=2.719, P=0.009); no significant difference in intraoperative blood loss was found between the two groups (t=0.784, P=0.437). There was no significant difference between the two groups in fracture healing time (t=0.967, P=0.341). According to the Matta standard, the excellent and good rate of the observation group was 92%, and that of the control group was 70%, showing no significant difference between the two groups (χ2=3.748, P=0.053). At last follow-up, according to the Majeed scoring standard, the excellent and good rate of the observation group was 88%, and that of the control group was 60%, showing significant difference between the two groups (χ2=4.717, P=0.030). The incidences of incision and nailway infection, secondary displacement of fracture, and malunion in the observation group were significantly lower than those in the control group (P<0.05); the differences in incidences of iatrogenic injury of lateral femoral cutaneous nerve, deep vein thrombosis, and loosening of fixation between the two groups were not significant (P>0.05).ConclusionMinimally invasive percutaneous bridge internal fixator is a safe and effective method for the treatment of unstable pelvic fractures. It has the advantages of minimal trauma, stable fixation, less interference to patients’ daily life, early functional exercise, and quickly recovery after operation.