经皮骶髂关节螺钉内固定治疗骨盆骨折

Percutaneous Iliosacral Internal Screw Fixation for Pelvic Fracture: Report of 27 Cases

目的评价经皮骶髂关节螺钉内固定治疗Tile B型及C型骨盆骨折的临床疗效。方法回顾性分析2011年5月～2012年10月27例骨盆环损伤患者的临床资料。Tile B型9例,C型18例。术前牵引复位效果均满意,采用骶髂关节螺钉闭合内固定。结果 24例无血管神经损伤;3例有坐骨神经症状,均于术后1个月恢复,未遗留症状。术后2个月X线平片根据Matta标准评价,优11例,良好13例,一般3例。失访2例,余25例术后随访2～17个月,平均7.5月,主观症状根据Majeed标准,优7例,良好15例,一般3例。结论经皮骶髂关节螺钉内固定治疗骨盆骨折损伤小、出血少、固定效果较好,但对操作者要求高。复位依赖术前大重量骨牵引,有造成神经损伤的可能,并不能完全替代传统切开复位钢板内固定手术。

Objective To evaluate the efficacy of percutaneous iliosacral internal screw fixation for pelvic fracture of Tile type B and C.Methods A retrospective analysis on 27 patients with pelvic ring damage,including 9 cases of Tile type B and 18 cases of Tile type C,who received percutaneous iliosacral internal screw fixation in our hospital during May 2011 to October 2012.ResultsAmong the 27 patients,sciatic nerve symptoms were developed in three cases,who were then cured spontaneously in one month without complications;no injury to the vessels or nerves was detected in the other 24 cases.According to Matta Standard,X-ray examination in two month showed excellence in 11 cases,good in 13,and neutral in 3.A follow-up for 2 to 17 months（mean,7.5 months） showed,based on Majeed Standard,excellence in 7,good in 15,and neutral in 3（two cases were lost）.Conclusions Percutaneous iliosacral internal screw fixation is less invasive with good fixation results,but its efficacy relies on surgical skills of the operator.We do not recommend the procedure as a replacement of traditional internal fixation with steel plate,because preoperative heavy skeletal traction may cause nerve injuries.