经皮骶髂关节空心螺钉置入联合骨盆外固定架治疗C型骨盆骨折48例:回顾性病例对照

Percutaneous iliosacral articulation screws plus pelvis external fixation for 48 cases of Tile C type pelvic fractures:Retrospective case contrast

目的:观察经皮骶髂关节空心螺钉置入联合骨盆外固定架治疗C型骨盆骨折的临床疗效。方法:选择2001-01/2008-12广东省人民医院骨科收治采用经皮骶髂螺钉固定技术治疗的不稳定型(TileC型)骨盆骨折患者48例作为实验组。收集同期广东省人民医院科骨科收治行开放前路和/或后路手术治疗的不稳定型(TileC型)骨盆骨折患者39例作为对照组。比较两组的临床疗效、术后Matta评分和Majeed功能评分及并发症的发生情况。结果:全部患者均获得随访,实验组随访8～49个月,平均27个月;对照组随访6～30个月,平均22个月。实验组48例患者共置入空心钉157枚,置入后进行了骨盆CT检查,发现143枚空心钉位置准确,占91.11%;14枚螺钉位置欠佳,但未引起临床症状;3例置入后X射线平片及CT片上提示固定欠牢固,加用下肢皮牵引,所有骨折均Ⅰ期愈合,未发生严重并发症。对照组39例患者切口Ⅰ期愈合35例,Ⅱ期愈合4例,其中1例术后3d发现深静脉血栓形成,经溶栓、抗凝、祛聚等对症治疗后痊愈。28例骨盆骨折3个月达骨性愈合,8例4个月达骨性愈合,3例6个月达骨性愈合;3例患者在气候变化或劳累后臀部遗留轻度不适,偶需服止痛剂,1例残留足部麻木。术后6个月两组患者的Matta评分和Majeed功能评分相比,差异无显著性意义(P>0.05)。结论:X射线透视引导下经皮骶髂关节空心螺钉联合骨盆外固定架治疗C型骨盆骨折创伤小、操作简单、固定可靠、手术时间短、术后患者可立即恢复活动、手术感染率低。

OBJECTIVE： To explore the clinical effects of percutaneous iliosacral articulation screws and pelvis external fixation in the treatment for Tile C type pelvic fracture. METHODS： From January 2001 to December 2008, 87 cases of Tile C type pelvic fracture were treated with the percutaneous iliosacral articulation screws and pelvis external fixation （experimental group）, and 39 cases treated through the anterior and/or posterior approach were selected as control group. The clinical effects, complications, Matta scores and Majeed function scores were compared between two groups. RESULTS： The 48 cases of experimental group were followed up for 27 months （range 8 49 months） and the control group was followed up for 22 months （range 6-30 months）. In the experimental group, 157 screws were implanted, and the CT scan showed that 143 were located well, with a right location rate of the screws of 91.11%; 14 screws positioned below the mark but without clinical symptoms; 3 cases displayed insufficient fixation cued by X-ray or CT, and were treated by skin traction. All the fractures were healed at stage I without any serious complications. In the control group, 35 of 39 cases were healed at stage I and 4 cases were healed at stage Ⅱ. Three days after operation, deep venous thrombosis occurred in 1 case, and was treated by thrombolysis anticoagulation and antigathering; 28 cases developed bone union in 3 months, 8 cases in 4 months, and 3 cases in 6 months. In addition, 3 cases had buttocks uncomfortable during the climatic change or tired that was relieved by anodyne; 1 case had feet benumbed. There were no significant differences in Matta scores or Majeed function scores between the two groups （P〉0.05）. CONCLUSION： The treatment of the Tile C type pelvic fracture with the percutaneous iliosacral articulation screws and pelvis external fixation under X-ray perspective has the advantages including small wound, simple operation, reliable fixation, short operation time, quick reactivating and low operation infection rate.