3钉椎弓根螺钉系统前环经皮内固定支架治疗TileB型骨盆骨折

Anterior subcutaneous internal fixation with triple pedicle screws for treatment of Tile type B pelvic fractures

目的探讨3钉椎弓根螺钉系统前环经皮内固定支架（ASIF）治疗TileB型骨盆骨折的疗效。方法回顾性分析2013年8月-2015年4月收治的38例骨盆骨折患者，其中男24例，女14例；年龄16～74岁[（41．5±5．5）岁]。致伤原因：交通伤28例，重物砸伤6例，高处坠落伤4例。骨折按Tile分型：B1型5例，B2型29例，B3型4例。患者均采用3钉椎弓根螺钉系统行ASIF治疗。观察患者术中出血量、手术时间、平均住院时间及术后并发症情况。采用Majeed评分对术后功能进行评估。结果38例均获得随访6．5-13．5个月，平均10．5个月。术中出血量为（30．8±7．1）ml，手术时间为（51．5±9．2）min，术后住院时间为（5．0±3．1）d。34例术后双侧髋关节屈曲超过95°，24例术后1．5个月可深蹲。术后无骨不连、延迟愈合、浅表或深部感染等并发症发生，无尿道、生殖系统的损伤等并发症发生。2例发生一过性股外侧皮神经刺激症状。Majeed评分：优32例（84％），良6例（16％）。结论采用3钉椎弓根螺钉系统ASIF治疗TileB型骨盆骨折愈合率高，并发症少，值得临床推广。

Objective To evaluate the clinical outcome of anterior subcutaneous internal fixator （ASIF） system with triple pedicle screws in stabilizing Tile type B pelvic fractures. Methods From August 2013 to April 2015, 38 cases of pelvic fractures were stabilized with the ASIF system using triple pedicle screws. There were 24 male and 14 female cases, with the age range of 16-74 years [ （41.5 ±5.5 ）years]. Causes of injury were traffic accidents （n = 28 ）, crushing injury （n = 6 ） and fall from height （ n = 4）. All cases had Tile type B fractures, including 5 cases of type B1,29 type B2 and 4 type B3. Intraoperative blood loss, operation time, length of hospitalization and complications were detected. Postoperative function evaluation was done using the Majeed score. Results All cases were available for follow-up of 6.5-13.5 months （ mean, 10.5 months）. Intraoperative blood loss was （30.8 ± 7.1 ） ml, operation time was （51.5 ± 9.2） minutes, and length of hospitalization was （5.0 ± 3.1 ） days. Among them, 34 cases showed bilateral hip flexion over 95 degrees after operation, and 24 cases were able to squat fully 1.5 months after operation. No cases experienced nonunion, delayed union, superficial or deep surgical wound infection, urethral injury and dysuresia. Two cases developed temporary lateralfemoral cutaneous nerve numbness. According to the Majeed score, excellent results were found in 32 cases （84%） and good results in 6 cases （ 16% ）. Conclusion ASIF system with triple pedicle screws results in high healing rate and few complications in the treatment of Tile type B pelvic fractures, and hence deserves popularization in clinic.