跨骶骨的髂骨间接骨板后路微创治疗骶髂关节脱位骨折22例分析

Analysis of iliac plates crossing sacrum in posterior surgeries in 22 cases with sacroiliac joint dislocation and fracture

背景：累及骶髂关节的骨盆骨折在治疗上具有创伤大、手术风险高、易损伤血管神经等特点。目的：探讨应用跨骶骨的髂骨间接骨板后路微创治疗骶髂关节脱位骨折的特点和可行性。方法：2013年1月至2013年12月收治22例含骶髂关节骨折脱位的骨盆骨折患者,采用跨骶骨的髂骨间接骨板后路微创治疗骨盆后环不稳。男15例,女7例;年龄15-65岁,平均（38.3±11.1）岁。术后根据Matta评定标准评定骨折复位质量,根据Majeed功能评分标准评定手术疗效。结果：所有患者术后获6个月至2年随访,平均（12.4±5.3）个月。平均切口长度、手术时间、术中出血量分别为（3.2±0.8）cm、（35.1±10.5）min和（37.8±18.6）ml。无切口感染、神经损伤等手术并发症发生。患者术后2-4周可坐起,6周可扶拐下地活动,随访期间未发现内固定松动及断裂。根据Matta评定标准评定骨折复位质量：优16例,良3例,可2例,差1例,优良率达95.5%;Majeed功能评分：优8例,良11例,可2例,差1例,优良率86.4%。结论：采用跨骶骨的髂骨间接骨板治疗骶髂关节脱位骨折具有操作简单、安全、微创等优点,是一种比较理想的固定骨盆后环的手术方式。

Background：The treatment of pelvic fracture with sacroiliac joint dislocation is hard and has high risks for orthopedic surgeons.Objective：To investigate the features and feasibility of iliac plate crossing sacrum in posterior surgeries for sacroiliac joint dislocation and fracture.Methods：A retrospective analysis was performed in 22 cases of sacroiliac joint dislocation and fracture at our department from January 2013 to December 2013.They were 15 men and 7 women,aged from15 to 65 years（average[38.3±11.1]years）.The posterior surgeries using iliac plates crossing the sacrum were performed to fix posterior ring of the pelvis.The quality of fracture reduction and curative effect were investigated according to the Matta criteria and the Majeed criteria.Results：The patients were followed up for 6-24 months（average[12.4±5.3]months）.The average incision length,operative time and intraoperative blood loss was（3.2±0.8） cm,（35.1±10.5） min,and（37.8±18.6） ml,respectively.No wound infection,nerve damage or other complications occurred.Patients could sit up in 2-4 weeks after surgery,and walk with a crutch 6 weeks later.No breakage or loosening of screw occurred during follow-up.By Matta criteria,we had 16 excellent,3 good,and 2 fair cases,yielding an excellent to good rate of 95.5%.By Majeed criteria,8 cases were judged excellent,11 were good,and 2 were fair,yielding an excellent to good rate of 86.4%.Conclusions：It is a easy,safe and minimally invasive treatment by posterior surgeries with iliac plates crossing sacrum for sacroiliac joint dislocation and fracture.It is a kind of ideal method to fix posterior ring of pelvis.