骨盆环微创内固定治疗骨盆C型骨折

Minimally invasive internal fixation of pelvic ring for type C pelvic fracture

目的 :探讨骨盆前、后环微创内固定在骨盆C型骨折治疗中的可行性、技术要点以及临床效果。方法:自2010年12月至2015年12月,选择经髂腹股沟微创小切口重建接骨板内固定治疗骨盆前环损伤;经皮骶髂关节螺钉内固定治疗骨盆后环损伤患者18例,男11例,女7例;年龄29~68岁,平均43.6岁。骨折按Tile分型:C1型14例,C2型3例,C3型1例。耻骨骨折合并同侧骶骨骨折12例,耻骨骨折合并同侧骶髂关节脱位2例,双侧耻骨骨折合并单侧骶骨骨折伴耻骨联合分离3例,双侧耻骨骨折合并双侧骶髂关节骨折脱位1例。观察结果包括手术时间、手术出血量、腰骶神经及髂血管损伤情况、骨折复位情况等。结果:所有患者伤口Ⅰ期愈合,无感染、深静脉血栓、腰骶神经及髂血管损伤、异位骨化等并发症发生。根据Matta复位标准,优14例,良3例,可1例。16例患者获得随访,时间6~33个月,平均16.7个月。根据Majeed疗效评价标准,优15例,良1例,Majeed评分92.13±5.44。结论:骨盆前环损伤选择经髂腹股沟微创小切口重建接骨板内固定,骨盆后环损伤选择经皮骶髂关节螺钉内固定治疗骨盆C型骨折具有手术时间短、创伤小、出血少等优点,临床操作安全可行,疗效满意。

Objective：To evaluate the feasibility of minimally invasive internal fixation of pelvic anterior and posterior ring for the treatment of type C pelvic fracture,and to explore its operative techniques and therapeutic efficacy. Methods：From December 2010 to December 2015,18 patients with type C pelvic fracture were treated by reconstructive plates fixation through minimally invasive ilioinguinal approach for pelvic anterior ring injuries,and by invasive percutaneous sacroiliac joint screw fixation for pelvic posterior ring injuries. There were 11 males and 7 females ranging from 29 to 68 years old with an average age of 43.6 years old. According to Tile classification,there were 14 cases of type C1,3 cases of type C2,1 case of Type C3. To be specific,12 cases with hemi fracture of rami ossa pubis accompanied with fracture of the sacrum,2 cases with hemi fracture of rami ossa pubis accompanied with sacro iliac joint dislocation,3 cases with bilateral fracture of rami ossa pubis combined with pubic symphysis separation accompanied with single fracture of the sacrum,1 case with bilateral fracture of rami ossa pubis combined with bilateral fracture of sacro iliac joint were included. Operation time,intra operative blood loss,injuries of lumbosacral nerves and iliac blood vessels,and fracture reduction were observed. Results：All wounds were primary healing. No complications such as infection,deep venous thrombosis,injuries of lumbosacral nerves and iliaca vessels or heterotopic ossification occurred. According to Matta criterion of fracture reduction,14 cases got excellent results,3 good and 1fair. Sixteen patients were followed up in a period varying from 6 to 33 months with 16.7 months on average. And according to functional score of Majeed,13 cases obtained excellent results,2 good and 1 fair,with an average score of 92.13±5.44. Conclusion：Internal fixation with reconstructive plates through the ilioinguinal approach and with percutaneous iliosacral screw for type C pelvic facture on pelvic anterior ring and pelvic posterior ring respectively have advantages of shorter operation time,smaller invasive trauma,less blood loss and etc. Thus,this technique is safe and practicable,yielding satisfying results.