脊柱钉棒系统治疗骨盆后环损伤

Treatment for the Injures in the Posterior Pelvic Ring with Pedicle Screw Fixation System

目的探索脊柱钉棒系统应用于骨盆后环损伤治疗的效果。方法对36例骨盆后环损伤,按照Denis分型,Ⅰ型20例,Ⅱ型12例,Ⅲ型4例。按照Tile分型,B3型16例,C1型10例,C2型6例,C3型4例。应用脊柱钉棒系统固定治疗,将万向椎弓根钉从双侧髂后上棘处开槽置入髂骨后部内外板间,钉尾沉于骨质内,连接棒通过双侧骶棘肌隧道放置固定后,在骨盆后环处形成一个强有力的"内支架"有效固定。结果30例获得6～18个月随访,平均11个月,患者均无螺钉松动、断棒、骶髂关节再次脱位及内固定物引起的血管、神经损伤并发症。按刘利民等功能评定标准,优15例,良13例,中2例。结论脊柱钉棒系统治疗骨盆后环损伤,固定有效牢靠,操作简便,无需复杂定位,创伤小,恢复快,无透视条件的基层单位也可行手术,极有推广价值。

Objective To investigate the therapeutic results of the posterior pelvic ring with pedicle screw fixation system. Methods 36 patients with the injures in the posterior pelvic ring were treated with pedicle screw fixation system. According to the Denis＇s and Tile＇s classification system：there were 20 of type Ⅰ , 12 of type Ⅱ,4 of type Ⅲ ,and 16 of B3,10 of C1,6 of C2,4 of C3. Two curvy incisions were made into bilateral posterior superior lilac spine and chiseled a hole in it to fit the pedicle screw.then drive an universal pedicle screw between inner and outer iliac plates until the screw were sunk,finally tranversed a rod through erector spinae to connect two pedicle screw. Results 30 of 36 were available at follow-up with a mean of 11 months （ranged from 6 months to 18 months） ,none of 30 cases with nerve or vessel injuries and breakage or loosening of the screws,and no redislocations of sacroiliac joint was observed. According to Liu LiminPs functional rating scale ,excellent results were in 15 cases ,good in 13 and fair in2, Conclusion The treatment for the injuries in the posterior pelvic ring with pedicle screw fixation system is simple and reliable with micro-trauma and little bleeding. It affords good recovery and can be employed in primary hospital without monitoring of X-ray,so it will deserve our popular practice.