Surgical solution to fragility fractures of the pelvis -- ce- ment augmented transiliac internal fixator

目的探讨骨水泥型经髂骨螺钉内固定系统（TIFI）治疗老年骨质疏松性骨盆骨折的方法。方法回顾性分析2004年1月至2014年11月期间收治的104例年龄≥59岁的骨盆骨折患者资料。男11例，女93例；年龄为59～94岁，平均（77．5±7．6）岁。骨折根据Ptommens分型：I型31例，Ⅱ型39例，Ⅲ型19例，Ⅳ型15例。致伤原因：平地摔伤89例，从低于3m高处摔伤8例，无明确外伤史7例。保守治疗65例；手术治疗39例，其中17例患者采用骨水泥型TIFI固定治疗，将宁心钉和SchalIZ钉从髂后卜棘到髂前下棘置入，并固定于髋臼上方。结果65例保守治疗患者出院当天活动度：坐轮椅1例，平地行走26例，可上下楼8例，未记录30例。39例手术治疗患者出院当天活动度：坐轮椅6例，平地行走26例，可上下楼1例，未记录6例。34例Schanz钉固定患者中，有2例固定髂骨时出现螺钉穿透骶髂关节。16例Schanz钉结合骨水泥固定患者中，未观察到骨水泥溢出至骶髂关节。Schanz钉髂骨置钉深度平均为（100±20）mm，连接杆的长度平均为（62±16）mm。17例采用TIFI固定的患者中，2例术后出现血肿，I例出现浅表伤口感染，未出现深层组织感染或内固定感染。结论老午骨质疏松性骨盆骨折可根据Rommens分型来选择治疗方式。骨水泥型TIFI固定是～一种治疗老年骨质疏松性骨笳骨折的微创、可靠方法。

Objective To describe and analyze a new method of treating fragility fractures of the pelvis in the elderly patients, a cement augmentable ＂Transiliac internal Fixator＂ （TIFI）. Methods We reviewed 196 patients older than 59 years with a pelvic ring fracture who had been treated in the period from January 2004 through November 2014. They were 11 men and 93 women, aged from 59 to 94 years （average, 77.5 ± 7.6 years）. By the Romens classification, there were 31 cases of type I, 39 ones of typeⅡ, 19 ones of type Ⅲ and 15 ones of type IV. The causes tbr fracture included fall from standing height （89 cases）, fall froin a height of less than 3 meters （8 cases） and absence of a definite trauma （7 cases） . Of them, 65 re- ceived conservative management and 39 surgery. TIFI was used in 17 patients in whom cannulated and per- rotated Schanz screws were placed from the posterior superior iliac spine to the anterior inferior lilac spine and fixated into the supraaeetabular bone canal. Results Of the 65 patients receiving conservative manage- ment, on the day of discharge, one could sit on a wheel-chair, 26 could walk, 8 could go upstairs and downstairs, and 30 we not recorded. Of the 39 patients tceiving surgery, on the day of discharge, 6 couht sit on a wheel-chair, 26 could walk, one could go upstairs and downstairs, and 6 were not recorded. Of the 34 patients receiving fixation with Schanz screws, the sacro-iliac joint was penetrated by the screws in 2. In the 16 patients receiving fixation with Schanz screws plus cement augmentation, no cement leakage into the sacro-iliac joint was observed. The average length of T1FI placement was 100 ± 20 mm and the average length of connective rod 62 ± 16 ram. Of the 17 patients receiving TIFI fixation, postoperative haematoma occurred in 2, superfical wound infection in one, and deep infection or implant infection in none. Conclusions Fragility fractures of the pelvis in the elderly patients can be treated according to their Romens classifications. The new technique, TIFf, is a minimally invasive and safe treatment for fragility fractures of the pelvis.