垂直旋转不稳定型骨盆骨折的手术治疗探讨

Surgical treatment for rotationally and vertically unstable pelvis fracture

目的:探讨垂直旋转不稳定型骨盆骨折前联合入路内固定的临床疗效。方法:旋转垂直不稳定型骨盆骨折34例,男23例,女11例;年龄13～56岁,平均36岁。按Young-Burgess分类:APCⅢ型损伤9例,LCⅢ型损伤14例,VS损伤11例。入院骨盆外支架固定、抗休克处理,全身情况稳定后,均通过前联合人路切开复位钢板内同定。结果:34例术后获随访,时间12～48个月,平均21个月,术口愈合良好,骨折均3～6个月愈合。按Majeed疗效评价标准:优21例,良10例,中3例。无畸形愈合,遗留跛行3例,腰骶痛4例,双小腿、足麻木3例。结论:前联合入路切开复位内固定治疗旋转垂直不稳定型骨盆骨折,矫正畸形,重建骨盆环稳定性,效果满意。

Objective：To study the clinical results of surgery for rotationally and vertically unstable pelvis fracture. Methods-Thirty-four patients with rotationally and vertically unstable pelvis fractures were treated. There were 23 male and 11 female,with the average age of 36 years ranging from 13 to 56 years. There were 9 cases of type APC Ⅲ , 14 cases of type LC Ⅲ, and 11 cases of type VS according to Young- Burgess Classifiction. All patients＇pelvis were treated with temporary external fixation after hospitalization ,and were treated with open reduction and internal fixation through anterior approach after stabilization of body condition. Results：All patients were followed up for 12 to 48 months （average 21 months）. All the incisions healed well, and the fractures got union for 3 to 6 months. According to the Majeed evaluation, the results were excellent in 21 cases ,good in lO,fair in 3. All patients were not remained deformity of rotation and dislocation. But 3 patients remained lameness,4 remained low back pain, 3 remained both leg and feet numbness. Conclusion： In the management of the rotationally and vertically unstable pelvis fractures, a stable pelvis can be reconstructed by effective open reduction and internal fixation through the anterior approaches, so that further sequelae can be reduced.