前路双钢板与后路经皮空心螺钉内固定治疗骶髂关节分离的临床对比研究

Comparison between anterior dual-plate and posterior percutaneous cannulated screw internal fixation in the treatment of sacroiliac joint dislocation

目的：比较前路切开复位双钢板与后路闭合复位经皮空心螺钉内固定治疗骶髂关节分离的疗效差异。方法回顾性分析2009年7月至2013年6月广东省第二人民医院收治的24例骶髂关节分离患者的临床资料，其中12例患者行前路切开复位双钢板内固定（前路组），另12例行后路闭合复位经皮空心螺钉内固定（后路组）。对比两组手术时间、术中出血量、切口长度、住院时间和并发症发生情况；术后定期影像学检查观察骶髂关节分离在各个平面的残留距离；术后1年采用Matta评分标准评估疗效优良率。结果后路组和前路组手术时间、术中出血量、切口长度、住院时间分别为（85±8）min、（13.6±2.5）mL、（16.4±2.4）mm、（9.5±1.4）d和（100±10）min、（440.8±41.4）mL、（142.9±11.3）mm、（17.8±1.8）d，后路组上述指标均明显优于前路组，两组比较，差异有统计学意义（P＜0.05）。患者全部获得有效随访，平均随访时间15.3个月（12～18个月）。未见感染或神经、血管损伤病例，无一例出现内固定松动、断裂。术后1年影像学检查显示骶髂关节分离在各个平面上的残留距离均在0.5 cm以内。术后1年两组Matta评分优良率比较，差异无统计学意义（P＞0.05）。结论后路经皮空心螺钉内固定治疗骶髂关节分离可获得与前路双钢板内固定相似的临床疗效，同时还具有创伤小、出血量少、手术时间短、术后恢复快等优点。

Objective To investigate the difference of clinical effects between anterior open reduction internal fixation with dual-plate and posterior close reduction internal fixation with percutaneous cannulated screw for patients with sacroiliac joint dislocation. Methods From July 2009 to June 2013, 24 patients with sacroiliac joint dislocation were treated in the Second People＆#39;s Hospital of Guangdong Province, in which 12 patients were treated with anterior open reduction and dual-plate internal fixation （anterior surgery group）, and the other 12 patients with posterior close reduction and percutaneous cannulated screw internal fixation （posterior surgery group）. Their clinical data were collected and retrospectively analyzed, and the operative time, intraoperative estimate blood loss, length of surgical incision, length of hospital stay as well as postoperative complications in two groups were compared; During the follow-up, regular radiological examinations were underwent to observe the residual dislocation distance of sacroiliac joint in each plane; At 1 year after the operation, the excellent and good rate of the curative effect in each group was evaluated by Matta assessment standard. Results Operative time, intraoperative estimate blood loss, length of surgical incision, length of hospital stay were （85 ± 8） min, （13.6 ± 2.5） mL, （16.4 ± 2.4） mm, （9.5 ± 1.4） d in posterior surgery group, and （100 ± 10） min, （440.8 ± 41.4） mL, （142.9 ± 11.3） mm, （17.8 ± 1.8） d in anterior surgery group respectively, the former results were better than the latter＇s （P〈0.05）. All patients were followed up with an average of 15.3 months （12-18 months）. No infection, nerve or vascular injuries, and no internal fixator loosening or breakage were found. One year after the operation, the imaging examination showed that the residual dislocation distance of sacroiliac joint in each plane was all less than 0.5 cm. At 1 year after the operation, there was no statistical difference of Matta score between two groups （P〉0.05）. Conclusions Posterior percutaneous cannulated screw internal fixation could obtain similar clinical effects to anterior dual-plate internal fixation, besides, it has the advantages of less injury, less intraoperative blood loss, shorter operative time and rapid postoperative rehabilitation.