骶髂关节脱位并耻骨联合分离、骨折的手术治疗

Surgical Treatment of Dislocation of Sacroiliac Joint Complicated with Diastasis of the Symphysis Pubis or Pubic Fracture

【目的】探讨骶髂关节脱位合并耻骨联合分离或耻骨骨折的诊断、最佳手术时机、方法及其近、远期疗效。【方法】自2002年8月至2007年3月共手术治疗骶髂关节脱位合并耻骨联合分离或耻骨骨折31例。手术入路包括前后联合入路(10例)和经前路(21例)两种方式。伤后距手术治疗的时间:两周内手术治疗者11例(经前后联合入路5例,经前路6例),两周后20例(经前后联合入路5例,经前路15例)。手术前、后均行X线平片、CT三维重建检查并通过X线平片随访。【结果】31例患者中满意复位22例,复位可9例。伤后两周内经前后联合入路或经前路手术治疗者疗效比较差异无显著性(P>0.05);但两周后经前路复位较经前后联合入路其疗效更为满意(P<0.05)。【结论】①伤后两周内为其最佳手术时机。②两周内两种手术入路均可致满意复位。③两周后手术以前路复位较为满意。

[Objective] To explore the diagnosis, the best operation opportunity, the operation methods and effect of dislocation of sacroiliac joint complicated with diastasis of the symphysis pubis or pubic fracture. [Methods] From August 2002 to March 2007,31 cases with dislocation of sacroiliac joint complicated with diastasis of the symphysis pubis or pubic fracture were treated with following approaches ： combined anterior and posterior approach in 10 cases, and anterior approach in 21. Based on the time from injury to treatment, 11 cases were treated in two weeks（combined anterior and posterior approach in 5 cases, anterior approach in 6）, and 20 cases were treated at or after the third week（combined anterior and posterior approach in 5 cases, anterior approach in 15）. All of them were checked with X-ray radiography and three-dimensional CT scan before and after operation and followed up by using X-ray radiography. [Results]Of all, 22 cases reached perfect reduction and 9 cases gained imperfect. There was insignificant statistical difference between two approaches in two weeks（ P 〉0.05）, but there was significant statistical difference between two approaches at or after the third week（ P 〈0.05）. But the only anterior approach was even better than combined anterior and posterior approach. [Conclusion]①The optimal operation time should be in 2 weeks after injury. ②Both the two surgical approaches can obtain satisfactory reduction in two weeks.③The only anterior approach is better than combined anterior and posterior approach at or after the third week.