前路钢板与后路经皮骶髂螺钉治疗新月形骨盆骨折的比较研究

Anterior plate and posterior percutaneous iliosacral screws fixation in treating pelvic crescent fracture: a comparative study

目的比较前入路钢板与后入路经皮骶髂螺钉治疗骨盆新月形骨折的疗效。方法回顾性研究2011年12月～2015年1月收治的28例新月形骨盆骨折患者,经前路钢板治疗17例（A组）,其中男性14例,女性3例;年龄21～62岁,平均33.5岁;后路经皮骶髂螺钉治疗11例（B组）,其中男性7例,女性4例;年龄20～59岁,平均32岁。骨折按照Tile分型：B2.2型18例,B2.3型10例。术后采用Majeed评分。结果 28例获得随访,A组平均随访14.5（12～17）个月,B组平均随访13.2（11～20）个月。两组手术纠正骨盆后环移位分别为（11.1±4.9）mm和（11.7±5.4）mm,差异无统计学意义（P〉0.05）;手术时间分别为（214±23.5）min和（153±25.5）min,失血量分别为（460±109.5）m L和（189±98.5）m L,比较差异均有统计学意义（P〈0.05）。疗效参照Majeed评分：A组优13例（76%）,良3例（18%）,差1例（6%）;B组优8例（73%）,良2例（18%）,可1例（9%）,两组优良率比较差异无统计学意义（P〉0.05）。结论前路钢板和后路经皮骶髂螺钉治疗新月形骨盆骨折均可取得良好效果,应根据患者个体情况选择手术方式;后路经皮置钉创伤小、手术时间短、出血量少,但有严格的手术适应证和禁忌证。

Objective To compare the effectiveness of anterior plate and posterior percutaneous iliosacral screws fixation in treating pelvic crescent fracture. Methods The clinical data of 28 patients with pelvic crescent fracture from Dec. 2011 to Jan. 2015 was retrospectively analyzed. Among them seventeen patients were treated through anterior plate（ group A）,of whom 14 were male and 3 were female with an average age of 33. 5 years（ from21 to 62 years）. The other 11 patients were treated via posterior percutaneous iliosacral screws fixation（ group B）,of whom 7 were male and 4 were female with an average age of 32 years（ from 20 to 59 years）. According to the Tile＇s classifacation,18 cases were type B2. 2 and 10 cases were type B2. 3. Majeed Function Scoring System was used after operation. Results All of the 28 patents were followed-up with an average of 14. 5 months（ from 12 to17 months） in group A,and an average of 13. 2 months（ from 11 to 20 months） in group B. The gained reduction of posterior pelvic ring fracture was（ 11. 1 ± 4. 9） mm in group A and（ 11. 7 ± 5. 4） mm in group B without statistical significance（ P〉0. 05）. The operation time and blood loss was（ 214 ± 23. 5） min,（ 460 ± 109. 5） m L,respectively in group A and（ 153 ± 25. 5） min,（ 189 ± 98. 5） m L,respectively in group B,with statistical significance（ P〈0. 05）.According to the Majeed Function Scoring System,there were 13 excellent cases（ 76%）,3 good（ 18%）,1 poor（ 6%）in group A and 8 excellent,2 good,1 fair in group B. The excellent and good rate had no statistical significance between the two groups（ P〉0. 05）. Conclution Both anterior plate and posterior percutaneous iliosacral screws fixation in the treatment of pelvic crescent fracture can provide good clinical outcomes. The selection of the treatment method must be based on the individuality of patients. Posterior percutaneous iliosacral screws fixation is minimally invasive with less operation time and blood loss. However,it has strict operation indication and contraindication.