骶髂螺钉治疗不稳定型骨盆骨折的疗效分析

Analysis of the clinical results in iliosacral screw for treating unstable pelvic fractures

目的评价骶髂螺钉治疗不稳定型骨盆骨折的临床疗效,探讨骶髂螺钉在此类患者中的应用以及术中相关问题。方法 17例采用骶髂螺钉治疗的不稳定型骨盆骨折。按照AO骨盆骨折方法分型:B型骨折4例,其中B2型3例,B3型1例;C型骨折13例,C1型4例,C2型5例,C3型4例。术中根据骨盆后环损伤类型,采用闭合或切开复位骶髂螺钉内固定。术后参照Matta和Tornetta评分系统评价骨折复位情况,Majeed评分系统评价术后功能情况。结果所有患者均完整随访,随访时间22.5个月(6～42个月)。手术时间82min(35～155min),术中失血量350ml(50～1 100ml)。所有患者骨折均愈合,无术后感染、血管、神经损伤、螺钉松动、断裂等并发症发生。按Matta和Tornetta复位标准:优14例,良3例。Majeed功能评分:优11例,良5例,一般1例;优良率94.12%。结论骶髂螺钉内固定技术治疗不稳定型骨盆骨折,具有损伤小,出血少、疼痛轻、恢复快等优点,可有效恢复骨盆后环的稳定性,能够获得良好的功能康复,是一种有效的固定方式。

Objective To evaluate the effectiveness of iliosacral screws fixation in the management of unstable pelvic fractures and, in addition, discuss the issues related with operation. Methods From Aug. 2007 to Feb. 2011,17 patients with unstable pelvic fractures were treated in our department by iliosacral screws fixation. There were 14 males and 3 females, aging 36.0 ± 8.6 years （ 27-51 years ）. Fractures were caused by traffic accident in 14 cases,high falling in 3 cases. The disease course ranged from 1.5 hours to 3 days. According to AO classification system ： these were 3 of B2,1 of B3,4 of C1,5 of C2,4 of C3. According to the pattern of pelvic ring injury, closed or open reductions of the posterior pelvic ring disruptions were accomplished by using iliosacral screw techniques. Clinical results were evaluated by Matta and Tornetta reduction criterion and Majeed functional scoring. Results All patients were followed up for an average period of 22.5 months （ 6-42 months ）. The average operative time was 82 minutes（ range,35-155 minutes）. The average blood loss was 350ml（range,50-1100 ml）. All fractures were healed and there was no postoperative infections, blood vessel or nerve injury, screw loose and breakage in the follow-ups. According to Matta and Tornetta criterion for fracture reduction, the results were excellent in 14 cases and good in 3 cases. According to Majeed functional scoring, the results were excellent in 11 patients, good in 5 patients and fair in 1 patient, with an excellent and good rate of 94.12%. Conclusion The sacroiliac screw fixation has been proved to be an ideal surgery method because of less damage and blood loss, milder pain and quicker recovery in treatment of unstable pelvic fracture.