经皮加压螺钉固定治疗耻骨联合漂浮损伤

Percutaneous compressive screw fixation for float injury to pubic symphysis

目的探讨经皮加压螺钉固定治疗耻骨联合漂浮损伤的疗效。方法2003年3月至2007年3月，采用经皮加压螺钉固定治疗48例耻骨联合漂浮损伤患者，男27例，女21例；平均年龄29．4岁。39例患者伴有不同程度的骨盆后环损伤，其中28例行后环经皮内固定术，11例患者后环稳定不需行内固定。对于耻骨联合漂浮损伤，固定前应用C型臂透视机结合导针或者预固定螺钉进行撬拨复位，术中应用不同角度的透视引导，使用直径6．5～7．3mm空心加压螺钉固定治疗耻骨联合漂浮损伤。急诊手术13例，3～7d内手术27例，7～14d内手术8例。结果48例患者平均手术时间55min（31～100min），手术出血量为20～30mL。41例患者获得良好复位和固定，7例复位欠佳。术后3～6个月骨折全部愈合，未见感染、骨不连、血管神经及脏器损伤。仅1例术后3d出现螺钉退出，予以重新置钉后结果良好。根据Orlando骨盆骨折评分标准评定疗效：优37例，良7例，可3例，差1例，优良率为91．7％。结论经皮加压螺钉治疗耻骨联合漂浮损伤手术创伤较小、手术时间短、并发症少，对伴有腹腔、盆腔脏器损伤的患者尤为有利。

Objective To discuss the functional results of percutaneous compressive screw fixation for float injury to the pubic symphysis. Methods From March 2003 to March 2007, 48 cases of float injury to the pubic symphysis were treated with percutaneous compressive screws, including 27 males and 21 females with an average age of 29.4 years. Of them, 39 cases were complicated with injury to the pelvic posterior ring. Emergency surgery was done for 13 cases, 27 cases were operated on within 3 to 7 days after injury and 8 within 7 to 14 days. Guided pins and screws were used during closed reduction and percutaneous pelvic fixation was done under the guidance of intraoperative fluoroscopic imaging. Float injury to the pubic symphysis was amended by percutaneous fixation after closed manipulation. Results The average operation time for the 48 patients was 55 （31 to 100） min. The intraoperative bleeding averaged 20 to 30 mL. Satisfactory reduction and fixation was achieved in 41 cases, but 7 cases had poor reduction. All the fractures healed 3 to 6 months postoperatively without infection, nonunion or injury to vessels, nerves or organs. All the patients could turn the body freely in bed the day after operation. Those without injury to the pelvic posterior ring could walk with crutches 3 days after operation. By the Orlando evaluation system for pelvic fractures, 37 cases were rated as excellent, 7 as good, 3 as fair and 1 as poor. Conclusions The percutaneous compressive screw fixation may decompress the pelvic hematoma, allowing early definitive fixation without the risk of additional hemorrhage. Complications associated with open posterior pelvic surgical procedures may be avoided by using pereutaneous techniques.