经皮骶髂螺钉固定治疗垂直不稳定型骨盆骨折

Treatment of vertical unstable pelvic fracture by percutaneous iliosacral screws fixation

目的:通过回顾性病例分析探讨应用经皮骶髂螺钉治疗垂直不稳定型骨盆骨折的技术要点及治疗效果。方法:2002年6月至2009年8月应用骶髂螺钉固定技术治疗垂直不稳定型骨盆骨折54例,获随访46例,男32例,女14例;年龄19～64岁,平均36.4岁。受伤至手术时间7～11d,平均8.5d。所有病例有垂直移位,移位8～40mm,平均28.5mm。术前大重量牵引,复位后在透视下应用骶髂螺钉固定技术以7.3mm空心钉过髂骨、骶髂关节、达S1椎体固定。术后患者均摄X线片,按Matta标准评价骨折复位情况,采用Majeed功能评分进行临床评价。结果:46例得到随访,时间1.5～3年,平均29个月;骨折均完全愈合,平均5.2个月恢复正常生活能力。按照Matta复位标准:优40例,良6例。根据Majeed疗效评价标准:优32例,良12例,一般2例。无严重血管损伤并发症。结论:严格掌握适应证及手术方法,经皮骶髂螺钉固定治疗垂直不稳定型骨盆骨折创伤小、恢复快,效果确实,是一种有效的治疗方法。

Objective：To retrospectively analyze the patients of vertically unstable pelvic fractures treated with percutaneous iliosacral screws fixation and to explore the operative techniques and its therapeutic efficacy. Methods：From June 2002 to August 2009,54 patients with vertical unstable pelvic fracture were fixed with percutaneous iliosacral screws. After operation,46 patients were followed up more than 18 monthes. Among them,32 patiens were male and 14 patiens were female,the average age was 36.4 years old（ranged from 19 to 64 years）. The average time from injury to operation was 8.5 days （ranged from 7 to 11 days）. All pelvic fractures had vertical dislocation ranging from 8 to 40 mm（averaged 28.5 mm）. After admitted,all patients were applied bone traction. After recuction,the fractures were fixed with percutaneous iliosacral 7.3 mm cannulated screws,wihich crossed the iliac and sacral-iliac joint and sacral promontory to S1 vertebrae. After operation,all patients took X-ray examination. The reduction and the fracture reduction were judged according to Matta critreion and clinical function was judged according to Majeed functional scoring. Results：Forty-six patients were followed up from 1.5 to 3 years with an average of 29 monthes. Fracture uninon was achieved in all patients. All patients got clinical recovery at mean time of 5.2 monthes and returned to nomal daily life. According to Matta critreion for fracture reduction,the results were excellent in 40 cases and good in 6 cases. Accoding to Majeed functional scoring,32 patients were excellent,12 good and 2 normal. There were no serious complications of vascular damage. Conclusion：Percutaneous iliosacral screw fixation is an effective technique with advantages of minimal invasive and faster recovery in the management of vertically unstable pelvic fractures.