外固定支架结合锁定加压钢板在不稳定骨盆骨折治疗中的应用

External fixation combined with locking compression plate in treatment of unstable pelvic fractures

目的探讨外固定支架结合锁定加压钢板技术在不稳定骨盆骨折治疗中的应用及效果。方法对2007年6月至2008年7月获得随访的12例不稳定骨盆骨折患者进行回顾性分析，男9例，女3例；年龄22～51岁，平均36．2岁。均采用髋臼上方外固定架固定前环骨折，锁定加压钢板固定后环骨折的技术。按照Tile分型：B1型5例，B2型3例，B3型2例；C1型2例。合并直肠或膀胱损伤3例，血气胸、颅脑损伤3例，腰骶神经损伤2例，多发骨折8例。结果12例患者术后获3—12个月（平均6．3个月）随访。手术时间40～120min（平均70min）。支架保留时间6—16周（平均11周）。骨盆骨折或脱位的愈合时间为12～19周（平均14周）。骨折复位按照Tornetta评估标准：优7例，良4例，可1例。术后功能评定按Majeed评分标准：优6例，良4例，可2例。并发症包括2例早期负重行走时后方疼痛，经卧床休息延迟负重后缓解；6例有不同程度钉道感染，2例腰骶神经损伤患者3个月后神经功能部分恢复，无严重医源性并发症和合并症发生。结论髋臼上方置钉外固定支架技术可有效恢复骨盆前方稳定性，通过股骨牵引还可以达到对骶髂关节的加压。跨骶骨髂骨间锁定加压钢板对骨盆后方的固定有一定优势。两种技术结合应用，创伤较小、手术操作简单，能达到不稳定骨盆骨折微创治疗的目的。

Objective To explore the application and results of external fixation combined with locking compression plate in the treatment of unstable pelvic fractures. Methods From June 2007 to July 2008, 12 cases were treated with supraacetabular external fixation for anterior lesions and locking compression plate for posterior lesions. They were 9 males and 3 females, With a mean age of 36.2 （22 to 51 ） years. According to Tile＇s classification, there were 5 cases of type B1, 3 type B2, 2 type B3 and 2 type C1. Results All cases were followed up for an average of 6. 3 （3 to 12） months. The mean operative time was 70 （40 to 120） minutes. The external fixation was maintained for 11 （6 tol6） weeks. The mean fracture healing time was 14 （12 to 19） weeks. According to Tornetta assessment criteria, reduction of the fracture was excellent in 7 cases, good in 4 cases, and medium in 1 case. According to Majeed criteria, the postoperative functions were excellent in 6 cases, good in 4 and medium in 2. Early weight-bearing pain was found in 2 cases and relieved by bed rest. Pin tract infection occurred in 6 cases. The neurological function partially recovered in 2 cases of lumbosacral nerve injury after 3 months. There were no severe iatrogenie injuries or complications. Conclusions External fixation is a useful way for stability of anterior pelvic ring fractures and constant pressure on the sacroiliac joint through the femoral traction. The locking compression plate across sacroiliac joint is advantageous for posterior pelvic ring fractures. External fixation combined with locking compression plate can reconstruct pelvic ring simply and rapidly. It is a minimally invasive treatment for unstable pelvic fractures.