脊柱骨盆内固定系统治疗骶髂关节骨折脱位

Operative treatment of sacroiliac joint fracture and dislocation with a vertebro-pelvic internal fixation system

[目的]探讨脊柱骨盆内固定系统治疗骶髂关节骨折脱位的疗效。[方法]2007年8月～2011年11月共收治骶髂关节骨折脱位患者14例，其中男12例，女2例；年龄22—57岁，平均42．3岁；交通事故伤11例，高处坠落伤3例。合并骨盆前环骨折9例，骶丛神经损伤4例，四肢骨折6例，尿道断裂1例。根据骨盆环损伤的Tile分型法，该组病例均为骶髂关节复合体旋转垂直不稳定，c1型5例，c2型9例。14例患者均行脊柱骨盆内固定系统治疗。受伤至手术时间7—14d。术前经骨牵引，使骶髂关节骨折脱位基本复位后，采用Colorad02。”脊柱内固定系统和髂骨螺钉固定骶髂关节。应用Majeed评分标准评价患者功能恢复情况。应用PACS软件系统测量患者术后即刻及术后1年骶髂关节中部间隙变化，评价内固定的有效性。[结果]14例患者均获随访，随访时间16～24个月，平均21．3个月。术后x线片复查示骶髂关节垂直和旋转移位均获满意复位，骶髂关节得到有效固定，未发生严重的血管、神经损伤等并发症。未发现内固定松动、断裂，骶髂关节无再移位情况发生。Majeed评分获优6例，良4例，一般3例，差1例。[结论]脊柱骨盆内固定系统可使骨折脱位的骶髂关节获得有效的即刻稳定性并维持至骨折愈合，是治疗骶髂关节骨折脱位的有效方法之一。

[ Objective] To investigate the effectiveness of a vertebro -pelvic internal fixation system in the stable recon- struction of sacroiliac joint fracture and dislocation. [ Method ] Between August 2007 and November 2011,14 sacroiliac joint fractures and dislocations were treated with the vertebro - pelvic internal fixation system. The subjects were 12 men and 2 women with a mean age of 42.3 years （range ,22 -57 years）. The fractures and dislocations were caused by a traffic accident in 11 ca- ses and by a fall from height in 3 cases. Associated injuries included anterior ring fracture in 9 cases, plexus sacralis injury in 4 cases,limb fracture in 6 cases, and vesicle rupture in 1 case. According to the Tile classification system,5 cases were classified as type C1 and 9 cases as type C2. All patients received the vertebro - pelvic internal fixation system. The time between injury and operation was 7 - 14 days. Preoperative skeletal traction, as an aid to reduce the injured sacroiliac joints, was applied. The Colorado 2 spinal system and iliac bone screws were used to fix the sacroiliac joints. The Majeed scoring system was used for postoperative functional evaluation. [ Result] All patients were followed up. The postoperative follow - up period ranged from 16 to 24 months （mean,21.3 months）. The postoperative radiographs showed that the reduction of vertical and rotatory dislocations was satisfactory, and the posterior pelvic ring achieved stability. No blood vessel or nerve injury occurred. No loosening or break- age of the internal fixation was observed, and no redislocation of the sacroiliac joint occurred. According to Majeed ~ functional criteria, the results were excellent in 6 cases, good in 4 cases, fair in 3 cases, and poor in 1 case at the last follow - up examina- tion. [ Conclusion] The vertebro - pelvic internal fixation system is an effective treatment method for sacroiliac joint fracture and dislocation. It can provide adequate immediate stability for the maintenance of sacroiliac joint reduction.