髋臼横向双柱螺钉内固定治疗骨盆新月形骨折

Transverse screw fixation of double columns in crescent pelvic fractures

目的探讨髋臼横向双柱螺钉内固定治疗骨盆新月形骨折的临床效果。方法回顾性分析2012年12月-2015年12月收治的20例骨盆新月形骨折患者，其中男13例，女7例；年龄22。72岁，平均39．5岁。致伤原因：交通伤15例，高处坠落伤3例，重物砸伤2例。受伤至手术时间3—14d。按照国际骨创伤协会（OTA）骨盆骨折分型标准，均为61-B2型。骨盆前环耻骨上支骨折均采用重建钢板固定，髂骨后部新月形骨折采用顺行置钉或逆行置钉技术行髋臼横向双柱螺钉内固定。记录术中置入空心螺钉时间、手术时间、术中出血量、术中C形臂X线机透视次数。术后常规摄骨盆X线片和CT平扫、冠状面和矢状面重建，评估复位和螺钉钉道情况。根据Matta和Tornetta骨盆骨折复位标准对复位质量进行评价。观察并发症发生情况。根据Majeed骨盆骨折功能标准对疗效进行评价。结果术中置钉时间3—16min，平均5min。手术时间50-130min，平均80min；术中出血量200～550ml，平均280ml。置钉过程中，C形臂x线机透视次数1～5次，平均2次。术后x线片及cT复查均显示钉道复位固定良好，螺钉未穿出髂骨内外板。根据Matta和Tometta骨盆骨折复位标准：优16例，良4例，优良率100％。术后无死亡，无切口感染、坐骨神经或臀上神经损伤、下肢深静脉血栓形成等并发症。随访期间无骨不愈合、复位丢失、内固定断裂。最终有19例患者获得随访，时间3—36个月，平均19．6个月。骨盆骨折均愈合，愈合时间8～17周，平均11．2周。末次随访时根据Majeed骨盆骨折功能标准：优17例，良2例，优良率100％。结论髋臼横向双柱螺钉内固定治疗61-B2型骨盆新月形骨折，置钉安全方便，创伤小，并发症少，疗效优良。

[ Abstract] Objective To discuss the clinical effects of transverse screw fixation of double columns in crescent pelvic fractures. Methods Twenty patients with crescent pelvic fractures hospitalized from December 2012 to December 2015 were reviewed retrospectively. There were thirteen male and seven female patients with the age ranging from 22 to 72 years （ mean, 39.5 years ）. Causes of injury were traffic accidents in fifteen patients, falling from high places in three and bitting by heavy objects in two. Time interval between injury and operation was 3-14 d. According to the Orthopedic Trauma Association （OTA） classification, all were classified as 61- B2 type. Reconstruct plate was used to stabilize the supperior pubic ramus fractures, and transverse double-column fixation with anterograde or retrograde screws was used for the posterior iliac crescent fractures. Duration of inserting screws, operation time, intraoperative blood loss and frequency of C-arm X-ray were recorded. Radiological and clinical outcomes were evaluated after operation. Results Duration of inserting screws ranged from 3 to 16 rain （mean, 5 rain）. Operation time ranged from 50 to 130 min （mean, 80 rain） and the intraoperative blood loss ranged from 200 to 550 ml （ mean, 280 ml）. Frequency of C-arm X-ray in the surgery ranged from 1 to 5 times （mean, 2 times）. All screws were in the expected location, without any piercing out of the iliac bone dependent on the confirmation of X-ray and CT-scan after operation. According to the Matta and Tornetta radiologieal evaluation, the reduction was rated excellent in sixteen patients and good in four, with the excellent-good rate of 100%. There was no death, wound infection, sciatic nerve or superior gluteal nerve injury or deep venous thrombosis of lower extremities. At the follow- up, no nonunion, loss of reduction, and breakage of internal fixation occurred. Nineteen patients were followed up, and mean follow-up time was 19.6 months （range, 3 to 36 months）. Union was obtained in ＇all patients in a period of 8-17 months （mean, 11.2 months）. According to the Majeed functional evaluation at the final follow-up, the outcome was rated excellent in seventeen patients and good in two, with the excellent-good rate of 100%. Conclusion Transverse screw fixation of double columns in crescent pelvic fracture of 61-B2 type can reduce the operation injury, decrease complications, and have good clinical results.