前路跨骶髂钢板固定治疗骨盆后环损伤

Trans-sacroiliac joint with plate via the anterior approach in management of posterior pelvic injuries

目的评价前入路跨骶髂钢板固定方法在骨盆后环损伤治疗中的应用价值。方法收集29例（30侧）采用前入路跨骶髂钢板固定方法治疗的骨盆后环损伤病例的临床资料进行回顾性分析。骨折分型：TileB型16例，C型13例，后环损伤平均移位18mm（5～35mm）；手术跨骶髂双钢板固定20侧，单钢板固定10侧；前环损伤钢板固定22例。结果手术平均耗时3h，平均输血1200ml；手术损伤腰骶干神经3侧（10％），股外侧皮神经7侧（23％），术中大出血2侧（7％）；骨折复位优23侧（77％），好6侧（20％），可1侧（3％）；术后后环平均移位3mm（0～18mm）；21例获得平均35个月（9～65个月）随访，Majeed评分平均93分（75～100分），功能恢复情况均满意。结论前路跨骶髂钢板固定，对于骶髂关节脱位或经髂骨的骨折脱位，能获得满意复位及稳定固定，感染率低，但手术出血多，有较高神经损伤并发症。

Objective To report the clinical experience in trans-sacroiliac joint with plate via the anterior approach in management of posterior pelvic injuries. Methods The clinical data of 29 cases （ 30 sides） with pelvic injury, 16 being of type B, and 13 of type C according to the Tile classification ; with the average displacement of the posterior ring injuries of 18 mm; undergoing trans-sacroiliac joint with plate via the anterior approach from January 2002 to June 2007 were analyzed retrospectively, among which 20 sides were fixed by two plates across the sacroiliac joint and l0 sides by single plate. The anterior pelvic injuries of 22 cases were fixed by plates too. Twenty-one cases were followed up for 35 months on average. Results The average operation time was 3 hours, and the average blood transfusion was 1200 ml. Reduction was excellent in 23 sides （77%）, good in 6 sides （20%）, and fair in 1 side （3%）. Operative injury of lumbosacral trunk occurred in 3 sides （10%） and operative injury of lateral femoral cutaneous nerve occurred in 7 sides （23%）. Intra-operative major hemorrhage occurred in 2 cases. The average outcome score according to the Majeed grading system was 93, and the function results all were excellent or good. Conclusion Plating the sacroiliac joint through the anterior approach is an effective method for the management of sacroiliac dislocation or trans-iliac fracture dislocation, while the blood loss of the operation is obvious, and the risk of iatrogenic nerve injury is high.