经皮钉-棒内支架治疗不稳定骨盆前环骨折

Anterior subcutaneous fixation with screw-rod internal fixator for the treatment of unstable anterior pelvic ring fractures

目的探讨经皮钉-棒内支架治疗不稳定骨盆前环骨折临床应用。方法回顾性分析经皮钉-棒内支架治疗的12例不稳定骨盆前环骨折患者的临床资料,男性8例,女性4例;年龄23～63岁,平均43.8岁。骨盆骨折按照Tile分类：B3 4例,C1 4例,C2 3例,C3 1例。后环损伤采用经皮骶髂螺钉固定2例,髂腰固定1例,钢板固定6例,其中M张力带钢板固定4例。结果前环固定平均出血70m L（50～90m L）,平均手术时间65min（50～85min）。单侧股外侧皮神经损伤5例,均恢复正常;随访4～15个月,无切口感染、内固定失效等,骨折均获骨性愈合,疗效满意。结论经皮钉-棒内支架是治疗不稳定骨盆前环骨折微创舒适、简便、安全的方法,疗效好,但术中应警惕股外侧皮神经损伤。

Objective To study percutaneous internal fixation with screw-rod system for the treatment of unstable anterior pelvic ring fractures. Methods The clinical data of 12 cases of unstable anterior pelvic ring fractures treated with anterior subcutaneous fixation with screw-rod system was retrospectively analyzed. According to the Tile＇s classification,4 cases were B3,4 cases were C1,3 cases were C2,and 1 case was C3. In all these posterior ring fractures,2 cases were treated with percutaneous iliosacral screw fixation,1 case with ilio-lumbar fixation,and6 cases with plate fixation（ including M-shaped tension plate fixation in 4 cases）. Results The average blood loss and operation time of anterior pelvic ring fixation were 70 m L（ ranged from 50 to 90 m L） and 65 min（ ranged from 50 to 85min） respectively. Unilateral lateral femoral cutaneous nerves were inpaired in 5 cases and the symptoms resolved after 2 weeks. All cases were followed up for 4 to 15 months,indicating bone healing and satisfactory clinical results,without wound infection or fixation failure. Conclusion The percutaneous internal fixation with screw-rod system is a minimally invasive,comfortable,simple and safe way for treating unstable anterior pelvic ring fractures with good results,but vigilance is necessary in order to avoid the lateral femoral cutaneous nerve injury in operation.