髋臼上方置钉外固定支架治疗伴腹部脏器损伤的骨盆骨折

Supracetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs

目的探讨髋臼上方置钉外固定支架治疗伴腹部脏器损伤骨盆骨折的疗效、特点及手术方法。方法2009年3月至2010年12月，治疗17例伴腹部脏器损伤的骨盆骨折患者，男9例，女8例；年龄21-75岁，平均42岁。根据Tile分型，B1型7例，B2型3例，B3型2例，C1型4例，C2型1例。其中合并失血性休克15例，合并会阴部损伤2例，合并四肢骨折12例。应用经髋臼上方置钉外固定支架复位和固定治疗。采用Cole等及Matta和Tornetta标准对术后疗效进行评价。结果17例患者全部获得随访，随访时间2~18个月，平均6．5个月，所有骨折均愈合，愈合时间8-12周，平均9．2周。术后3例患者出现一过性股外侧皮神经麻痹，口服营养神经药物弥可保1个月后缓解；5例发生软组织内钉道感染，经换药、清创、抗感染等综合治疗后4例愈合，1例在骨折愈合拆除外固定支架后愈合。根据Cole等提出的骨盆骨折效果评分表进行功能评价，优15例、良1例、可1例，优良率为94．12％。按照Matta和Tornetta标准对骨折复位进行评估，优12例、良3例、可2例，优良率为88．24％。结论经髋臼上方置钉外固定支架治疗伴腹部脏器损伤的骨盆骨折具有创伤小，操作简单，固定可靠的特点。

Objective To evaluate the technique and clinical outcomes of supra-acetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs. Methods There were 17 cases of pelvic fractures associated with injuries of abdominal organs. Nine were males and 8 were females, with the average age of 42 years （range, 21-75 years）. The injury was caused by traffic accident in 9 cases, fall-down from height in 4, and crush by heavy objects in 6. According to Tile classification of pelvic fractures, 7 were type B1, 3 were type B2, 2 were type B3, 4 were type C1 and 1 was type C2. Fifteen cases suffered with hemorrhagic shock, 2 with perineal injury and 12 with fractures of the limbs. All patients were treated with supra-acetabular external fixation and the outcomes were evaluated by Cole＇s clinical scoring, Matta and Tornetta＇s radiographic standards. Results All 17 cases were followed up with the mean period of 6.5 months （range, 2-18 months）. The average time of operation was 15 rain （range, 9-25 min）. The mean blood loss was 17 ml （range, 5-25 ml）. All fractures healed and the mean healing period was 9.2 weeks （range, 8-12 weeks）. Three had transient palsy of lateral femoral cutaneous nerve. Five had soft tissue infection while the bony structures were not involved. According to Cole＇s scoring for pelvic fractures, 15 cases were excellent, 1 case was good and 1 case was fair, with the good-excellent rate of 94.12%. According to Matta and Tornetta＇s standards of fracture reduction, 12 were excellent, 3 were good and 2 were fair, with the good-excellent rate of 88.24%. Conclusion Supra-acetabular external fixation is a minimal invasive and convenient method for treating pelvic fractures with abdominal organs injury which is mechanicaUy stronger than traditional external fixation via iliac crest.