骶髂关节脱位及周围骨结构骨折的前后入路手术治疗特点

Characteristics of treating dislocation and fracture of sacroiliac joint through anterior and posterior approches

目的：探讨前后入路手术骶髂关节脱位及周围骨结构骨折的治疗特点。方法：自2006年1月至2012年9月，收治39例骶髂关节脱位及周围骨结构骨折患者，均进行手术治疗。其中男28例，女11例；年龄12-64岁，平均41．3岁。前入路手术处理17例，后入路手术治疗13例，前后联合入路9例。前入路取仰卧位，切开复位，用2块4孔重建钢板，横跨骶髂关节做固定。后入路取俯卧位，选择闭合或切开复位，在C形臂X线机透视下攻入1～2枚直径7．3nlFtl的60～75mm空心松质骨拉力螺丝钉。术后观察两组的并发症情况，参照Matta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：所有患者获随访，时间6～36个月。术后2~4周患者可在床上坐起，6周后可扶拐下地活动。术后随访期间未发现内固定松动及螺钉钢板断裂。x线片示除陈旧性骶髂骨骨折1例复位欠佳，其余骶髂关节脱位及周围骨折术后对位良好。根据Matta标准评定：优30例，良8例，可1例；根据Majeed功能评分标准，优14例，良20例，中4例，差1例。结论：经前后入路手术治疗骶髂关节脱位及周围骨结构骨折均有良好的治疗疗效，但需要根据脱位骨折的解剖部位及类型、移位的方向程度以及术前的复位程度，对术中复位的难易程度评估、固定强度等因素综合考虑来确定入路方式。

To investigate characteristics of treating dislocation and fracture of sacroiliac joint through anterior and posterior approaches. Methods：Between January 2006 and September 2012,39 patients with dislocations and fractures of sacroiliac joint were treated with operation. There were 28 males and 11 females, aged 12 to 64 （mean, 41.3 ） years old. Seven teen cases were chosen through anterior approach, 13 cases through posterior and 9 cases were combined with anterior and posterior approaches. The anterior approach were made with supine position,performed open reduction, and two plates with 4 holes were used as internal fixation for arthrodesis of sacroiliac joint after reduction ;while posterior approach prone position, close or open reduction was performed ,and one or two partial thread lag screws ,which with 7.3 mm in diameter and 60 to 75 mm in length,were penetrated via sacroiliac joint for fixation under X-ray. Postoperative complications were observed, Matta and Majeed scoring were used to evaluated currative effects. Results：All patients were followed up from 6 to 36 months. The patient could sit on the bed 2 to 4 weeks after surgery and walk with a crane 6 weeks later. No breakage or loosening of screw occurred during follow-up. In all hut one case with old sacral iliac fractures reducted poor, others obtained good opposition. Ac cording to Matta＇s criteria, 30 cases got excellent resuhs, 8 good and 1 fair. According to Majeed＇s funtional standard, 14 pa- tients got excellent results, 20 good 4 fair and 1 poor. Conclusion：Treating dislocation and fracture of sacroiliac joint through anterior and posterior approaches can obtain good effects. However, anatomic location, fracture types, degree of displacement, the rate of preoperational reduction, vulnerability assessment of operation and fixation strength should he considered,