前后环联合重建固定治疗C型骨盆骨折

Combinations of posterior and anterior pelvic ring fixation for treatment of type C pelvic fractures

目的探讨C型骨盆骨折前后环联合重建固定治疗的方法并观察其疗效。方法 29例C型骨盆骨折,C1型14例,C2型11例,C3型4例。骨盆前环骨折采用前方耻骨联合、髂腹股沟或改良stoppa入路,应用钢板螺钉或外固定器固定;骨盆后环骨折采用髂腹股沟入路钢板螺钉或经皮骶髂螺钉固定。结果随访6～38个月,平均14个月。29例均达骨性愈合。骨盆后环复位情况根据Tornetta和Matta评定标准,本组优20例,良6例,可3例;优良率89.7%。功能评估参照Majeed评分系统,优16例,良9例,可3例,差1例;优良率86.2%。其中前环钢板螺钉/外固器+后环骶髂螺钉固定组:优10例,良7例,可1例,差1例;优良率89.5%;前后环均钢板螺钉固定组:优6例,良2例,可2例;优良率80.0%,两组间比较差异没有统计学意义。结论前后环联合重建固定是治疗C型骨盆骨折的理想方法;应根据骨折情况选择合适的手术入路及固定方式;后环闭合复位经皮骶髂螺钉固定微创、疗效好。

Objective To study the operation methods of combinations of posterior and anterior pelvic ring fixation for treatment of type C pelvic fi＇actures and observe the clinical effects. Methods Totally 29 patients with type C pelvic fracture,including 14 cases of type C1,11 cases of type C2 and 4 cases of type C3, were treated with steel plate and screw or external fixator for anterior pelvic ring through pubic symphysis approach, ilioinguinal ap- proach or modified Stoppa approach;posterior pelvic ring fracture was treated with steel plate and screw using anteri- or ilioinguinal approach or posterior percutaneous sacroiliac approach. Results After follow-up visit for 6 to 38 months（ 14 months in average） ,all of 29 patients got bony united. The evaluation for posterior pelvic ring through X-ray according to Tornetta and Matta criteria showed excellent in 20 cases, good in 6 cases and fair in 3 cases,the excellent and good rate was 89.7%. The evaluation of functional outcome according to Majeed system showed 16 cases of excellent,9 cases of good,3 cases of fair and 1 case of poor, the excellent and good rate was 86.2% ; among them,patients treated with steel plate and screw or external fixator for anterior pelvic ring combined posterior percutaneous sacroiliac screw for posterior pelvic ring, 10 cases were excellent,7 cases were good, 1 case was fair and 1 case was poor, the excellent and good rate was 89.5 %. And patients treated with steel plate and screw for both an- terior and posterior pelvic ring, 6 cases were excellent, 2 cases were good and 2 cases were fair, the excellent and good rate was 80.0%. No significant difference was found between the 2 groups. Conclusion Combinations of posterior and anterior pelvic ring fixation for type C pelvic fracture is an ideal method. Proper surgical approach and fixation method should be adopted according to different types of pelvic ring fracture. Closed reduction and percutaneous sacroiliac screw fixation for posterior pelvic ring may be mini-invasive and can achieve excellent results.