微创经皮钢板内固定术重建骨盆前环的近期疗效

SHORT-TERM EFFECTIVENESS OF MINIMALLY INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS IN TREATMENT OF ANTERIOR PELVIC RING FRACTURES/

目的探讨微创经皮钢板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗骨盆前环骨折的近期疗效。方法 2012年1月-2013年10月,采用MIPPO治疗16例骨盆前环骨折患者。男10例,女6例;年龄20~63岁,平均41岁。致伤原因:交通事故伤9例,高处坠落伤7例。受伤至入院时间2 h^5 d,平均1 d。骨折按Tile分型:B2型8例,B3型4例,C1型2例,C2型2例。2例合并髂骨翼骨折,4例合并骨盆后环骨折。入院至手术时间3~12 d,平均6 d。结果术中出血量60~120 m L,平均70 m L。术后患者切口均Ⅰ期愈合,无下肢深静脉血栓形成或长期持续疼痛等并发症发生。16例均获随访,随访时间5~27个月,平均11.5个月。术后患者均未出现股外侧皮神经损伤及精索损伤表现,男性患者提睾反射均存在。X线片示骨折均获骨性愈合,愈合时间12~16周,平均13周。随访期间骨折复位无丢失,内固定物无松动、断裂。末次随访时,根据Matta影像学评分标准,复位获满意13例,良好3例;根据Majeed骨盆骨折评分系统行功能评价,获优12例,良4例。结论采用MIPPO治疗骨盆前环骨折具有术中出血少、软组织并发症少及感染率低等优点,近期疗效满意。

Objective To investigate the short-term effectiveness of minimally invasive percutaneous plate osteosynthesis （MIPPO） in treatment of anterior pelvic ring fractures. Methods Between January 2012 and October 2013, 16 patients with anterior pelvic ring fractures were treated with MIPPO. There were 10 males and 6 females at the age of 20-63 years （mean, 41 years）. The causes of injury were traffic accident in 9 cases and failing from height in 7 cases. The duration of injury to admission was 2 hours to 5 days （mean, 1 day）. According to Tile classification, 8 cases were rated as type B2, 4 cases as type B3, 2 cases as type C1, and 2 cases as type C2. Of them, 2 cases had iliac wing fracture, and 4 cases had pelvic posterior ring fracture. The time from admission to operation was 3-12 days （mean, 6 days）. Results The bleeding volume was 60-120 mL （mean, 70 mL）. All wounds healed by first intention. No postoperative complication of deep venous thrombosis or long-term continuous pain occurred. All cases were foUowed up 5-27 months （mean, 11.5 months）. No clinical manifestation of lateral femoral cutaneous nerve injury or spermatic cord injury was found, and cremasteric reflex existed in males. All cases obtained bony union, and the healing time was 12-16 weeks （mean, 13 weeks）. During the follow-up period, no loss of fracture reduction and no internal fLxation loosening or broken were observed. According to Matta radiological evaluation criterion, 16 cases had anatomical reduction, and 3 cases had satisfactory reduction; according to Majeed scoring system of pelvic fracture, the results were excellent in 12 cases and good in 4 cases. Conclusion MIPPO for treatment of anterior pelvic ring fractures has the advantages of less intraoperative blood loss, few soft tissue complications, and low infection rate, and can get satisfactory short- term effectiveness.