经皮微创治疗不稳定型骨盆骨折的临床疗效观察

Clinical efficacy of minimally invasive percutaneous internal fixation in treatment of unstable pelvic fractures

目的观察经皮微创内固定治疗不稳定型骨盆骨折的临床疗效。方法收集2008年8月~2010年12月在本院骨科就诊的不稳定型骨盆骨折患者21例,前环给予经皮耻骨联合螺钉、耻骨上支螺钉,后环给予以髂骨后部螺钉、骶髂关节螺钉或经皮重建钢板内固定等经皮微创内固定治疗,采用Matta及Majeed标准进行疗效评估。结果随访12~19个月,平均15.2个月,切口均Ⅰ期愈合,无内固定松动、断裂,未见感染或脂肪液化及神经损伤加重等并发症。骨折平均愈合时间（14.6±2.5）周。采用Matta标准评定,满意复位者20例,可1例。采用Majeed评分评估术后1年功能,20例优良,优良率：95.23%。结论经皮微创内固定治疗不稳定骨盆骨折中有明显的优势,取得较好的疗效。具有创伤较小,愈合时间较短,稳定性较好等优点,降低了并发症的发生率,值得在临床中推广应用。

Objective To observe the clinical efficacy of minimally invasive percutaneous internal fixation in treatment of unstable pelvic fractures.Methods A retrospective study was done to analyze 21 patients who were hospitalized for unstable pelvic fractures in our hospital from August 2008 to December 2010.According to fracture type,the 21 patients were treated with percutaneous pubic symphysis screw,superior ramus of pubis screw,posterior iliac screw,sacroiliac joint screw or percutaneous reconstruction plate.The clinical efficacy was assessed with Matta criteria and Majeed score.Results A mean follow-up of 15.2 months（12 to 19 months） was conducted.All of the incisions healed by primary intention.There were no surgical complications such as internal fixation loosening or breaking,wound infections,fat liquefaction,and nerve injury aggravation.The mean time of fracture healing was 14.6±2.5 weeks.Overall,there were 20 patients with very good recovery,and 1 good recovery in accordance with Matta criteria.Function one year after surgery was evaluated with 20 patients making excellent/good recovery with an efficacy rate of 95.23% according to Majeed score,and one patient was rated ＂fair＂ in clinical response.Conclusion Minimally invasive percutaneous internal fixation in treatment of unstable pelvic fractures is of significant therapeutic effect such as smaller incision,shorter recovery time,and better stability,thus effectively decreasing the occurrence of complications and being worthy to be popularized in clinical application.