髂骨截骨治疗骨盆骨折畸形愈合

Malunion of pelvic fracture： reconstruction with transiliac osteotomy

目的探讨髂骨截骨治疗骨盆骨折畸形愈合的临床疗效。方法回顾性分析2005年1月至2012年12月收治的9例骨盆骨折畸形愈合患者，男5例，女4例；平均年龄为27．0岁（22～35岁）；初次骨盆骨折按Tile分型：C1．1型3例，C1．2型4例；C2型2例。9例患者患肢均存在不同程度短缩，平均短缩4．3cm（3．5。5．2cm）。所有患者均主诉髋部疼痛、活动受限，并伴有不同程度的跛行。受伤至手术时间平均为6．2个月（3．5—11．0个月）。9例患者均采用髂骨截骨、植骨双钢板内固定治疗。末次随访时采用疼痛视觉模拟评分（VAS）、骨盆骨折Majeed评分标准评定患者疗效，同时记录患者术后并发症的发生情况。结果9例患者术后获平均29个月（11～40个月）随访。末次随访时骨盆骨折Majeed评分由术前平均45．7分（42～56分）上升至85．3分（78—91分），疼痛VAS评分由术前平均6．1分（4．8分）降低至1．6分（0—3分）。术后X线片测量示患肢延长3．3～4．0cm，平均3．6cm。1例患者术后7d发现下肢深静脉血栓形成，1例患者术后1年出现截骨侧大腿外侧囊性肿块。无一例患者发生感染、钢板断裂及脱出、医源性神经及血管损伤等并发症。结论髂骨截骨治疗骨盆骨折畸形愈合，能矫正骨盆畸形、延长肢体长度、重建骨盆环的稳定性，临床效果良好。

Objective To evaluate transiliac osteotomy for treatment of malunion of pelvic fracture. Methods From January 2005 to December 2012, 9 patients with malunion of pelvic fracture were treated in our department. They were 5 men and 4 women, 22 to 35 years of age （average, 27.0 years） . According to the Tile classification, 3 eases were C1.1, 4 C1, 2, and 2 C2. The mean leg length discrepancy in all patients was 4.3 cm shorter （from 3.5 to 5.2 cm） . All patients complained about hip pain, limited motion and lameness more or less. The mean time from injury to surgery was 6.2 months （from 3.5 to 11.0 months）. They were treated with transiliac osteotomy, bone grafting and double steel plating. Visual analogue scale （VAS） and Majeed evaluation system were used to assess functional recovery. Complications were recorded at the follow-up. Results All cases were followed up for an average duration of 29 months （from 11 to 40 months）. Last follow-ups showed that the Majeed scores increased from 45.7 points （from 42 to 56 points） preoperatively to 85.3 points （from 78 to 91 points） postoperatively. The preoperative VAS scores of 6.1 points （from 4 to 8 points） decreased to 1.6 points （from 0 to 3 points） at last follow-ups. According to the pelvic X-ray films, the limbs were lengthened by an average of 3.6 cm （from 3.3 cm to 4.0 cm） . Postoperative complications included deep venous thrombosis in one case and cystic mass at the affected thigh in another. No infection, fixation failure, iatrogenic nerve or vessel injury was recorded. Conclusion Transiliac osteotomy can be an effective surgical strategy to treat malunion of pelvic fracture, because it can correct pelvic deformity, lengthen the limb and rebuild stability of the pelvic ring, leading to fine functional recovery and good clinical results.