经椎弓根定位导向骶髂螺钉治疗骨盆后环损伤的临床疗效

Treatment of posterior pelvic ring fracture with a sacroiliac screw through pedicle orientation

目的评价经椎弓根定位导向骶髂螺钉治疗骨盆后环损伤的临床疗效。方法回顾性分析2013年10月至2016年10月经椎弓根定位导向骶髂螺钉治疗骨盆后环损伤患者的资料,其中男11例,女4例,年龄34~67岁,平均47.6岁。所有患者均在C形臂X射线机监测下经椎弓根定位并置入骶髂螺钉,末次随访时分别采用Matta评分标准和Majeed骨盆骨折康复评分评估术后骨折复位、功能恢复情况。结果所有患者手术时间31~58 min(平均40.8 min)。术中无重要血管及神经损伤,术后经骨盆正位、侧位、出口位及入口位X线检查验证所有骶髂螺钉置入位置准确,未发生突破前方骨皮质或向后进入椎管或骶孔。所有患者平均随访18.5个月,末次随访时Matta评分优12例,良3例,Majeed骨盆骨折康复评分优13例,良2例。结论经椎弓根定位导向骶髂螺钉治疗骨盆后环损伤可降低手术难度,缩短学习曲线,是一种安全有效的治疗方法。

Objective To explore the efficacy of a sacroiliac screw through pedicle orientation for treatment of the posterior pelvic ringfracture. Methods From October 2013 to October 2016,15 patients withposteriorpelvic ring fractures, undertheC-arm fluoroscopy, weretreatedwith a sacroiliac screwthroughpedicleorientation. There were 11 males and 4 females at a meanageof 47. 6 years （range,34-67 years）. Fracture reduction and functional rehabilitation were evaluated with the Matta criterion and Majeed scoring at the last follow-up. Results The operation lasted for 31-58 minutes （average 40. 8 minutes）. The mean fol^w-up was 18. 5 months. No vascular injury and nerveinjury occurred during the surgery,moreover,the postoperative anteroposterior,lateral inletand outletviews located within the sacrum. No screws broke the anterior bone cortex or the posterior cortex into the sacrumcanal. According to the Matta criterion, 12 cases were regarded as excellent and 3 cases good; according to the Majeed scoring, 13 cases were excellent and 2 cases good. Conclusion The sacroiliac screw through pedicle orientation is safe and effective in the treatment of posterior pelvic ring fracture with ^wertechnical demands and a shorter Earning curve.