骶髂复合体损伤内固定的后路手术策略

Posterior Operative Strategy of Sacoiliac Complex Injury

目的探讨骶髂复合体损伤的后路手术方法。方法自2002年10月至2006年1月,应用后路重建钢板、经皮空心钛合金骶髂拉力螺钉、TSRH及改良Gavelston内固定技术,分别治疗6例、27例、13例、9例,共55例骶髂复合体损伤。按Tile分型,B1型6例、B2型19例、B3型14例、C1型9例、C2型5例、C3型2例,经螺旋CT扫描证实后环骨折或脱位。结果a)失血量比较,经皮骶髂螺钉组较少,其次是TSRH组及改良Gavelston组(两组无统计学差异,P>0.05),重建钢板组较多。b)术后并发症及疗效比较,经皮骶髂螺钉组并发症较少,重建钢板组并发症较多且有1例疗效是差,其余三组疗效均为优良。c)骨折愈合时间比较,经皮骶髂螺钉组骨折愈合时间较短,TSRH组及改良Gavelston组无统计学差异(P>0.05),重建钢板组时间较长(P<0.05)。结论经皮螺钉组失血较少,并发症较少,患者恢复较快,疗效较好;其次是TSRH组及改良Gavelston组;重建钢板组失血较多,并发症较多。

Objective To study the posterior internal fixation method of sacroiliac complex injury. Methods From October 2002 to March 2005,55 patients of sacroiliac complex injury were treated with reconstruction plate, percutanous sacroiliaclag screw,TSRH technique and modified Gavelston＇s technique separately. All posterior pelvic injury were confirmed by CT scan. According to Tile＇s classification,there were 6 cases of TileB1 type, 19 cases of Tile B2 type,14 cases of TileB3 type,9 cases of TileC1 type,5 cases of TileC2 type,2 cases of TileC3 type. Results The percutanous sacroiliac lag screw group had the least blood loss（P^0.05）. All patients were followed up for 3～36 months. The operation effectiveness of four groups were no obvious difference （P〉0.05）,only few complications in every group ,there were no severe complications. Conclusion Every operation technique had definite indications. The percutanous sacroiliac lag screw group had the best effectiveness.