有限切开内固定结合外固定器治疗Tile C型骨盆骨折

Treatment of Tile C pelvic fractures with external fixator and limited internal fixation

目的探讨有限切开内固定结合外固定器治疗Tile C型骨盆骨折的临床价值。方法采用有限切开内固定结合外固定器治疗Tile C型骨盆骨折28例，男17例，女11例；年龄21-52岁，平均34岁；合并神经损伤4例，失血性休克16例，其他部位骨折15例。按照Tile分型均为C型骨折，C1型15例，C2型9例，C3型4例。结果28例中，23例复位满意，5例未完全复位，其中3例纵向移位≥1cm，2例横向分离移位（耻骨联合分离≥2cm，耻骨支分离≥1cm）。骨折愈合时间2-5个月，平均3．2个月。2例切开复位后骶髂部皮肤发生浅层感染，培养为表皮葡萄球菌，选用敏感抗生素治疗后感染得到控制。3例外固定针孔感染。1例骶髂螺钉固定术后CT证实螺钉穿出S1椎体前皮质。1例外固定支架固定螺钉穿出髂嵴外侧皮质。1例术后股外侧皮神经损伤。26例获得随访，随访时间18-58个月，平均48个月。根据Majeed制定评估标准，优17例，良7例，可2例，优良率92.3％。4例术前有神经损伤症状者，2例在术后4个月时完全恢复，2例未恢复。4例患者主诉腰骶部疼痛。结论有限切开内固定可纠正不稳定骨盆骨折纵向移位，而横向移位可以使用外固定器复位固定。

Objective To assess the clinical significance of limited internal fixation and external fixator for the treatment of unstable pelvic fractures. Methods 28 patients （17 males and 11 females） with unstable pelvic fractures were treated with external fixator and limited internal fixation. The average age of patients was 34 years （range from 21 to 52 years）. All fractures were rotationally and vertically unstable. According to the classification of Tile, 15 fractures were classified as type C1, 9 as type C2, 4 as type C3. The anterior ring was fixed with external fixator and posterior ring was fixed with cannulated lag screws, sacral bar or reconstruction plate. Results The posterior ring reduction was not satisfied in 5 patients, among these patients vertical displacement was more than or equal to 1 cm in 3 patients, 2 cases transversal displacement was not complete reduction （symphysis pubis segregation more than or equal to 2 cm, pubis ramus segregation more than or equal to 1 cm）. 26 patients were followed up from 18 to 58 months （average 48 months）. The average union time was 3.2 months. 2 cases suffered superficial infections and were controlled after subsequently treated with antibiotics. Pin tract infection was found in 3 cases. In 1 case the cannulated lag screw was found to be protruded through anterior cortex of the sacral bone by the CT scan. In another case the lateral cortex of the iliac crest was protruded through by the screw of external fixator. One patient developed numbness in the area supplied by the lateral femoral cutaneous nerve postoperatively. The outcome was assessed by the Majeed criteria. 17 cases were judged to be excellent, 7 were good and 2 were fair. The rate of excellent and good was 92.3%. 2 of the four patients with nerve injury before the surgery recoverd completely 4 months postoperatively. 4 patients complained of pain in lumbosacral area. Conclusion Limited internal fixation with external fixator is a satisfactory technique for the treatment of unstable pelvic fracture. It can minimize soft tissue disruption and provide stable fixation. No lost of reduction was reported in this study.