髂腹股沟微创小切口在骨盆前环损伤中的应用

Application of internal fixation for injuries of pelvic anterior ring through minimally invasive ilioinguinal approach

目的:探讨有限切开,微创内固定治疗骨盆前环损伤的可行性、技术要点及临床效果。方法:2009年3月至2012年3月,选择经髂腹股沟微创小切口内固定治疗骨盆前环损伤患者20例,男13例,女7例;年龄25～61岁,平均41.6岁。前环损伤按Tile分型:A2型5例,B1型2例,B2型9例,B3型1例,C1型3例。单纯前环骨折15例,前环骨折合并耻骨联合分离2例,前后环均骨折3例。观察内容包括手术时间、术中出血量、股神经及髂血管损伤情况、术后骨折复位情况等。结果:所有患者伤口Ⅰ期愈合,无感染、深静脉血栓、股神经及髂血管损伤等并发症发生。根据Matta复位标准,优12例,良7例,可1例。18例患者获得随访,时间6～32个月,平均16.3个月。根据Majeed疗效评价标准,优15例,良3例,Majeed评分94.3±6.0。结论:经髂腹股沟微创小切口内固定治疗骨盆前环损伤具有手术时间短、创伤小、术中出血少等优点,临床操作安全可行,疗效满意。

Objective：To evaluate the reliability of limited open reduction and minimally invasive plate osteosynthesis （MIPO） for injuries of pelvic anterior ring and to explore its operative techniques and therapeutic efficacy. Methods：From March 2009 to March 2012,20 patients with injuries of pelvic anterior ring were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach. There were 13 males and 7 females with an average age of 41.6 years ranging from 25 to 61 years. According to classification of Tile, there were 5 cases of type A2,2 cases of type B1,9 cases of type B2,1 case of type B3,3 cases of type C 1. Including 15 cases with anterior ring fracture, 2 cases with anterior ring fracture combined with pubic symphysis separation, and 3 cases with anterior and posterior fractures. Operation time, intra-operative blood losing,injuries of femoral nerve and iliac blood vessels, condition of fracture reduction were observed. Results： All wounds healed at one stage. No complications such as infection or deep venous thrombosis occurred. According to Matta criterion of fracture re- duction, 12 cases got excellent results,7 good, I fair. Eighteen patients were followed up from 6 to 32 months with a mean of 16.3 months. According to functional score of Majeed, 15 cases obtained excellent results and 3 good,with an average score of 94.3±6.0. Conclusion：The modified ilioinguinal approach has advantage of short operation time,less blood losing, minimally invasive in treating injuries of pelvic anterior ring and can obtain satisfactory outcomes.