微创椎弓根钉棒系统内固定治疗不稳定骨盆环损伤

Treatment of unstable pelvic ring injuries with minimally invasive pedicle screw-rod system

目的探讨应用微创椎弓根钉棒系统内固定治疗不稳定骨盆环损伤的可行性及临床疗效。方法笔者自2014-06—2015—06应用微创椎弓根钉棒系统内固定治疗12例不稳定骨盆环损伤，9例TileB型单纯固定前环。3例TileC型固定前、后环，顺序为先前环再后环。结果单纯前环固定手术时间25．45min，平均32min，术中出血量10～35ml。平均18ml；前后环固定手术时间50-65min，平均55min，术中出血量20—50ml，平均32ml。所有患者均获得随访6～12个月，平均7．5个月。骨折均一期愈合，愈合时间9—14周，平均12．5周。无切口感染、内固定失败及异位骨化。所有患者日常生活基本无影响，仅1例诉性生活不适。4例出现单侧股外侧皮神经损伤，1例出现单侧股神经麻痹，最终均恢复正常。采用Matta标准评价骨折复位质量：优6例，良5例，可1例，优良率91．67％。术后6个月疗效根据Majeed评分系统评定：平均81．5分，优3例，良7例，可2例，优良率83．33％。结论在掌握手术适应证的前提下，微创椎弓根钉棒系统的微创固定技术创伤小、复位牢靠、并发症少，是治疗骨盆环损伤一种有前景的术式。

Objective To investigate the feasibility and clinical effect of minimally invasive pedicle screw-rod system in treatment of unstable pelvic ring injuries. Methods From June 2014 to June 2015, 12 patients with unstable pelvic ring injuries were treated with minimally invasive pedicle screw-rod system. According to the Tile classification, 9 cases were type B treated in anterior pelvic ring, 3 cases were type C treated in both anterior and posterior pelvic ring. Results The operation in anterior ring lasted for average 32 minutes（range, 25-45 minutes）, with average blood loss of 18 ml（range, 10-35 ml）. The operation in both anterior and posterior ring lasted for average 55 minutes（range, 50-65 minutes）, with average blood loss of 32 ml（range, 20-50 ml）. All patients were followed up for average 7.5 months（range, 6-12 months）, which showed that the fractures were healed at one stage for average 12.5 weeks （range, 9-14 weeks）. None had surgical site infection, failures of internal fixations or heterotopic ossification, All patients had no adverse effects on basic daily life, except for only one discomfort of sexual life. The lateral femoral cutaneous nerve injury at one side occurred in 4 cases and femoral nerve paralysis at one side in 1 case, but all restored finally. According to Matta criteria, reduction was excellent in 6 cases, good in 5 cases, fair in 1 case, with the excellent and good rate of 91.67%. According to Majeed score system at postoperative 6- month, the functional evaluation at last follow-up was excellent in 3 cases, good in 7 cases, fair in 2 cases （average 81.5 points）, with the excellent and good rate of 83.33%. Conclusion Under the precondition of surgical indications, the minimally invasive pedicIe screw-rod system takes advantages of minor trauma, strong reduction and few complications. Therefore, it is a promising surgical method in the treatment of unstable pelvic ring injuries.