不稳定型骨盆骨折的金属植入物治疗

Metal implants for treatment of unstable pelvic fracture

背景:骶髂关节骨折的治疗存在较大分歧,部分学者主张保守治疗,而有些学者则倾向积极的手术治疗,而方案的决定因素是骨盆稳定性。由于骶髂关节骨折、脱位破坏了骨盆的稳定性,易出现晚期不稳定和骨不连,引起骶髂关节疼痛,双下肢不等长,坐时疼痛和功能障碍,因此对不稳定型骨盆骨折金属植入物固定治疗预后明显优于保守治疗。目的:总结各种金属内外固定植入物置入治疗不稳定型骨盆骨折的特点及其临床应用情况。方法:由第一作者检索1991-01/2009-12 PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)。英文检索词为"Pelvic fractures,instability,surgical treatment",中文检索词为"骨盆骨折,不稳定,手术治疗"。检索文献量总计115篇,选择植入物置入治疗不稳定型骨盆骨折的特点及其临床应用方面的文献,排除陈旧及重复实验文章,同一领域文献则选择近期发表或发表在权威杂志的文章,最终纳入30篇符合标准的文献。结果与结论:骶髂关节骨折脱位是一种严重的高能量创伤,在治疗上越来越重视,尤其是不稳定的骶髂关节骨折脱位。稳定型的骶髂关节骨折脱位采取保守治疗,不稳定骶髂关节骨折脱位宜行外固定、内固定重建骨盆的稳定性,内固定的治疗方法多种多样,但内固定的治疗效果有待于提高,各种内固定方法的生物力学特点如何,以及各种内固定后何时下地负重活动,有待于基础和临的床进一步研究。不稳定的骶髂关节骨折脱位内固定方法很多,包括前路固定及后路固定。后路经CT引导下的经骶髂关节拉力螺钉等微创治是发展的趋势。

BACKGROUND：It is controversial to treat sacroiliac joint fracture.Some scholars advocated expectant treatment,and some others advocated surgery therapy.Pelvic stability was responsible for the scheme selection.Sacroiliac joint fracture-dislocation destroys pelvic stability,which easily induces instability and bone nonunion,resulting in sacroiliac joint pain,unequal size of lower limbs,sitting pain and dysfunction.Thus,prognosis of mental implant is significantly better than expectant treatment in treatment of unstable pelvic fracture.OBJECTIVE：To summarize the treatment of unstable pelvic fractures and their clinical application using various internal and external fixation of metal implants.METHODS：The computer-based research was done in Pubmed database（http：//www.ncbi.nlm.nih.gov/PubMed） and Wanfang database（http：//www.wanfangdata.com.cn） for articles published from January 1991 to December 2009 with the key words of ＂Pelvic fractures,instability,surgical treatment＂ by the first author.A total of 115 articles were retrieved,and those concerning characteristics and clinical application of implants in the treatment of unstable pelvic fracture.Articles addressing old and repetitive contents were excluded.Literatures of the same fields published in recent years or in authorized journals were selected.Finally,30 articles were included.RESULTS AND CONCLUSION：Sacroiliac joint fracture-dislocation is a severe,high-energy trauma,has been paid great attention in the therapy,particularly in unstable sacroiliac joint fracture-dislocation.A stable type of fracture and dislocation of the sacroiliac joint received a conservative treatment of unstable sacroiliac joint fracture-dislocation appropriate line of external fixation,internal fixation for reconstruction of pelvic stability and internal fixation treatment varied,but the therapeutic effect of internal fixation needs to be improved.What are bio-mechanical characteristics of various internal fixation methods,and how the timing of weight-bearing activities following various internal fixations require further basic and clinical studies.An unstable sacroiliac joint fracture-dislocation fixation has many ways,including the anterior and posterior fixed-fixed.Minimally invasive therapy such as posterior CT guided sacroiliac joint lag screw is the developmental trend.