经皮螺钉内固定治疗骨盆后方新月形骨折脱位

Internal fixation with percutaneous screws for crescent fracture.dislocation of the sacroiliac joint

目的探讨闭合复位经皮螺钉内固定治疗骨盆后方新月形骨折脱位的临床疗效。方法回顾性分析2003年6月至2014年10月收治的78例骨盆后方新月形骨折脱位患者资料，男41例，女37例；年龄为18～68岁（平均37．9岁）。骨折按Day分型：Ⅰ型18例，Ⅱ型35例，Ⅲ型25例。72例患者行闭合复位经皮螺钉内固定：对于Ⅰ型骨折，在仰卧位下行经髂前下棘至髂后上棘，或者俯卧位下经髂后上棘至髂前下棘的髂骨骨质较厚区域1—2枚平行螺钉（髂骨后部螺钉）垂直骨折线固定；Ⅱ型骨折采用俯卧位下1～2枚髂骨后部螺钉和1～2枚骶髂关节螺钉交叉固定；Ⅲ型骨折采用骶髂关节螺钉固定。6例闭合复位失败患者行切开复位内固定术。结果72例闭合复位患者后方新月形骨折脱位闭合复位内固定的时间平均为38min，术中出血量平均为23mL，手术切口长度平均为1．9cm，住院时间平均为5．2d。其中70例患者术后获平均14个月（6～24个月）随访。骨折复位质量根据Matta评分标准评定：优24例，良30例，可14例，差2例，优良率为77．1％；骨折愈合时间平均为12．0周。末次随访时根据Majeed评分系统评定患髋功能：优34例，良26例，可8例，差2例，优良率为85．7％。随访期间无一例患者发生骨折再移位、骨折不愈合及内固定物松动、断裂等并发症。结论在Day分型的基础上，绝大部分骨盆后方新月形骨折脱位可采用微创经皮螺钉内固定治疗，且疗效良好。

Objective To investigate the clinical outcomes of closed reduction and internal fixation with percutaneous screws for crescent fracture-dislocation of the sacroiliac joint. Methods We reviewed 78 consecutive patients treated operatively for crescent fracture-dislocation of the sacroiliac joint from June 2003 to October 2014. They were 41 males and 37 females, with a mean age of 37.9 years （range, from 18 to 68 years）. By Day classification, there were 18 cases of Type I, 35 ones of Type II, and 25 ones of Type III. Closed reduction and percutaneous fixation was performed in 72 patients. For Type I fractures, perpendicular to fracture line fixation was performed with 1-2 parallel iliac screws. For Type II, crossed fixation was performed with 1-2 posterior iliac screws and 1-2 SIJ screws. For Type III, fixation was performed with SIJ screws. Open reduction and internal fixation was performed in the 6 patients whose closed reduction failed. Results Time for closed reduction and internal fixation for posterior crescent fracture-dislocation averaged 38 minutes in the 72 patients; their intraoperative blood loss was 23 mL; their incision length was 1.9 cm; their hospitalization time averaged 5.2 days. Of them, 70 were followed up for an average time of 14 months （from 6 to 24 months）. By Matta scoring criteria, the reduction was excellent in 24 cases, good in 30, fair in 14, and poor in 2, giving an excellent to good rate of 77. 1%. The average fracture healing time was 12. 0 weeks. By Majeed system, functional outcome at the last follow-up was excellent in 34 cases, good in 26, fair in 8, and poor in 2, giving an excellent to good rate of 85.7%. No complications like redislocation, nonunion and implant failure occurred during the follow-ups. Conclusion Based on the Day classification, closed reduction and percutaneous screw fixation is an effective treatment for the majority of crescent fracture-dislocations of the sacroiliac joint.