有限切开复位钢板内固定治疗Tile C型骨盆骨折

Limited Open Reduction and Internal Fixation for Tile C Pelvic Fractures

目的：探讨有限切开复位钢板内固定治疗TileC型骨盆骨折的方法和疗效。方法2010年6月至2012年5月，采用有限切开复位钢板内固定治疗Tile C型骨盆骨折15例。其中：C1型10例，C2型4例，C3型1例。评估术中出血量、手术时间及术后患者功能恢复情况。结果15例患者术后获12～24个月（平均15个月）随访。骨盆前环手术的手术时间和出血量平均分别为61 min、92 mL；后环手术平均分别为71 min、165 mL。术中均无重要血管、神经损伤等并发症发生。1例耻骨处伤口发生浅表感染，经换药治愈。骨折复位按Matta影像学评分标准评定：解剖复位10例，满意复位4例，可1例。骨折愈合时间为2～6个月，平均2.9个月。末次随访时采用Majeed骨盆骨折评分标准评定疗效：优12例，良2例，可1例。结论通过有限切开复位和钢板内固定可以对Tile C型骨盆骨折进行良好的显露和牢靠的固定，并且不需要暴露神经、血管等结构，具有微创特点，疗效显著。

Objective To investigate the efficacy of Tile C pelvic fractures treated with limited open reduction and internal fixation. Methods A total of 15 unstable pelvic fractures were treated with limited open reduction and internal fixation from June 2010 to May 2012 in our department. According to the Tile classification,10 cases were of type CI,4 cases of type C2,and 1 case of type C3. Intraoperative blood loss,operation time were measured and postoperative functional outcomes were evaluated during follow-up. Results All patients obtained an average follow-up of 15 months（ range,12 to 24months）. The average operation time and intraoperative blood loss by the anterior approach were 61 minutes and 92 mL respectively. while those by the posterior approach were 71 minutes and 165 mL. There were no neurovascular structures lesion occurred in 15 cases. One case suffered superficial infection and were controlled after subsequently treated with wound dressing in the pubic incision. The quality of reduction according to Matta′s criteria was graded as excellent in 10 fractures,good in 4 and moderate in 1. All fractures healed 2. 9 months（ range,2 to 6months）after operation. According to Majeed′s pelvic fracture criteria. There weere excellent in 12 cases,good in 2 and moderate in 1 at the last follow-up. Conclusion Limited open reduction and internal fixation permits excellent exposure of the Tile C pelvic fracture and provides safe and stable fixation without the necessity to dissect neurovascular structures.