不稳定骨盆骨折的救治经验和教训

Experiences and lessons learned from treatment of unstable pelvic fractures

目的探讨不稳定骨盆骨折的临床治疗。方法回顾自2008年6月至2010年6月收治的不稳定骨盆骨折32例，包括AO分型B型20例和C型12例。行保守治疗4例；急诊外支架固定1例；择期手术固定27例，手术时间为伤后4～43d，固定方式包括外固定架7例，钢板9例，骶髂螺钉4例，钢板联合外固定架4例，骶髂螺钉联合外固定架2例，骶髂螺钉联合钢板1例。结果30例随访3～24个月（平均15个月），27例骨折愈合良好，2例畸形愈合，1例未愈合。对29例随访满12个月者进行Majeed功能评分：优17例，良9例，差3例，优良率为90％。2例保守治疗过程中发生继发损伤，2例复位骨折时发生医源性损伤。结论不稳定骨盆骨折保守治疗效果不佳，应尽早手术固定，充分恢复骨盆环稳定性，防止继发损伤。治疗中应注意避免医源性损伤，特别是神经损伤。

Objective To discuss the clinical treatment of the unstable pelvic fractures. Methods A retrospective study was conducted based on the clinical data of 32 patients with unstable pelvic fractures who were admitted to the Third Hospital of Hebei Medical University from June 2008 to June 2010. There were 20 patients with type B injury and 12 with type C injury according to AO classification scheme. Of all, four patients were treated conservatively, one was treated with emergency external fixation followed by angiagraphic management, and the remaining 27 patients received selective surgeries. The surgeries were carried out at days 4-43 after trauma by using the external fixators in seven patients, the plates in nine, the iliosacral screws in four, the plate plus external fixator in four, the iliosacral screw plus external fixator in two and the iliosacral screw plus plate in one, respectively. Results The follow-up for an average 15 months among 30 patients showed bony union in 27 patients, malunion in two and nonunion in one. The clinical outcomes of 29 patients was assessed with the Majeed＇ s scoring system, which showed excellent result in 26 patients, good in nine and poor in three, with excellence rate of 90%. Secondary injuries caused by unstable fractures occurred in two patients and iatrogenic injuries caused by fracture reduction in two. Conclusions Unstable pelvic fractures should he treated surgically as early as possible to restore the sta- bility of the full pelvic ring and prevent the secondary injury, while the conservative treatment is unreliable. Attentions should be paid to avoidance iatrogenic injuries, especially nerve injuries, during the course of treatment.