影响Tile C型骨盆损伤髂腰固定术后疗效的相关因素分析

EFFECT OF ILIOLUMBAR FIXATION IN PATIENTS WITH Tile C PELVIC INJURY AND ANALYSIS OF RELATIVE FACTORS

目的探讨影响Tile C型骨盆损伤髂腰固定术后疗效的相关因素。方法 2007年3月-2010年3月,收治Tile C型骨盆损伤患者60例。其中男39例,女21例;年龄17～66岁,平均37岁。Tile分型:C1型27例,C2型20例,C3型13例。术前损伤严重程度计分法(ISS)评分12～66分,平均29.4分;伤后至手术时间2～25 d,平均8.1 d。均采用髂腰固定术治疗,采用非条件logistic回归模型探讨患者年龄、性别、体重指数、术前合并伤、手术时机、功能锻炼时间、骨折类型、术后并发症、复位质量、骶神经损伤程度与术后疗效的关系。结果 60例均获随访,随访时间12～56个月,平均27.3个月。术后切口感染、损伤12例,经清创、换药后痊愈;余患者切口均Ⅰ期愈合。其他术后并发症包括迟发型骶神经损害15例,行骶神经减压6例,保守治疗9例,病情缓解;髂后上棘处Schanz钉钉尾过度突出10例,局部疼痛不适3例,取出内固定物后缓解;骶髂关节植骨不融合1例,给予加压植骨,植骨融合;横连杆断裂5例,对术后功能无明显影响;下肢深静脉血栓形成6例,4例行滤网植入术,2例保守治疗。患者骨盆骨折愈合时间3～6个月,平均3.9个月。末次随访时根据Matta标准评价骨折复位质量,获优31例、良24例、可3例、差2例,优良率91.7%。Majeed评分为58～100分,平均86分;获优28例、良12例、可16例、差4例,优良率66.7%。logistic回归分析显示,年龄、性别、体重指数、术后并发症与术后疗效无明显相关;尽早手术治疗(10 d内)、早期功能锻炼(7 d以内)、复位质量越好、骶神经损伤程度越轻有利于术后功能恢复;术前合并损伤、骨盆损伤越重,术后疗效越差。结论手术时机、术前合并伤、骨折类型、骨折复位质量、骶神经损伤程度、功能锻炼时间均是影响Tile C型骨盆损伤髂腰固定术后疗效的重要因素。

Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation.Methods Between March 2007 and March 2010,60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation,including 39 males and 21 females with an average age of 37 years（range,17-66 years）.Of them,27 cases were classified as Tile C1,20 as Tile C2,and 13 as Tile C3.The preoperative injury severity score（ISS） was 12-66（mean,29.4）.The time from injury to surgery was 2-25 days（mean,8.1 days）.Iliolumbar fixation was performed in all patients.Unconditional logistic analysis was used to analyze the relationship between the age,sex,body mass index（BMI）,operation opportunity,the preoperative combined injury,classification of fracture,the postoperative complication,reduction outcome,sacral nerve injury,and the time of physical exercise and the prognosis.Results All 60 patients were followed up 12-56 months（mean,27.3 months）.Infection of incisions occurred in 12 cases and were cured after dressing change;healing of incision by first intention was obtained in the other patients.Delay sacral nerve injury was found in 15 patients,6 patients underwent nerve decompression,and 9 underwent conservative treatment.Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine,and 3 patients had pain,which was relieved after removal of the internal fixator.One patient had bone-grafting nonunion of sacroiliac joint,which was improved by pressured bone graft.Five patients had the beam breakage without significant effect.Six patients had deep vein thrombosis,among them 4 underwent filter and 2 underwent nonsurgical treatment.The healing time of fracture was 3-6 months（mean,3.9 months）.According to the Matta function score,the results were excellent in 31 cases,good in 24 cases,fair in 3 cases,and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up.Majeed score was 58-100（mean,86）,28 were rated as excellent,12 as good,16 as fair,and 4 as poor with an excellent and good rate of 66.7%.The logistic analysis showed that the age,sex,BMI,and postoperative complications were not prognostic factors;early operation（within 10 days）,early function exercises（within 7 days）,the better reduction quality,and the less sacral nerve injury were in favor of prognosis;and the worse preoperative combined injury and pelvic injury were,the worse the prognosis was.Conclusion Operation opportunity,the preoperative combined injury,reduction outcome,sacral nerve injury,and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries.