经皮骶髂螺钉固定治疗不稳定骨盆骨折的临床分析

Unstable pelvis fractures fixed with percutaneous iliosacral screws

目的比较经皮骶髂螺钉固定与传统切开复位内固定冶疗不稳定骨盆骨折的临床疗效,评价其安全性和实用性。方法选择创伤骨科经皮骶髂螺钉固定技术治疗的不稳定骨盆骨折患者19例,收集同期行传统切开复位固定治疗的不稳定型20骨盆骨折患者,比较两组患者的围手术期参数、术后Matta评分和Majeed功能评分。结果全部随访6-48个月,平均26个月。经皮骶髂螺钉固定组与切开复位固定组在手术时间、术中出血、切口长度及拆线时间比较均有统计学意义,术后6个月两组患者的Majeed功能评分和Matta复位效果评分相比较,差异无统计学意义(P>0.05)。结论两种方法均可以获得良好的临床效果,经皮骶髂螺钉固定治疗不稳定骨盆骨折其具有创伤小、出血少、痛苦小等优点,术中采用合适的监测手段,经皮骶髂螺钉固定技术是安全可行的。

Objective To evaluate the clinic outcomes of percutaneous iliosacral screws osteosynthesis and open reduction and internal fixation in treatment of unstable pelvic fractures,and to evaluate the use of stimulus-evoked electromyography to decrease the risk of iatrogenic nerve.Methods 19 cases of unstable pelvic fracture were treated by using the percutaneous iliosacral articulation screws under intraoperative monitoring with X-ray and electromyography,and 20 cases with the treatment of open reduction and internal fixation.perioperative parameter,Matta scores and Majeed function scores were compared between two groups.Results All patients were followed-up for 24 months（range 6-48 months）.There were statistically significant differences in the consumed time of operation,bleeding of operation,length of incision,post-operative pain and the time after suture removal between the two group（P〈0.05）.There were no significant differences in Matta scores and Majeed function scores between the two groups（P〉0.05）.Conclusion Both the perctuaneous sacroilial screws osteosynthesis and open reduction and internal fixation are the effective method for the unstable pelvic fracture.And perctuaneous sacroilial screw fixation has superiority of minimal trauma,less bleeding and light pain.