骨盆骨折三轴移位方式及复位原则

Three-axis displacement classification of pelvic fracture and its reduction principles

目的基于骨盆CT三维重建,建立骨盆三维立体坐标系,分析骨盆骨折的三轴移位方式并建立复位原则。方法纳入2015年6月-2016年5月正常骨盆CT数据21例,建立均值骨盆三维模型,以髂前下棘中点为原点建立骨盆三维立体坐标轴,并基于此坐标系统建立一种骨盆骨折三轴移位方式分类。对临床中2012年1月—2016年5月收治的55例骨盆骨折患者(男29例,女26例;年龄11~66岁,平均35.6岁),根据上述三轴移位方式分类方法,按逆向复位原则行闭合或切开复位,运用空心螺钉、钢板或外固定支架固定治疗,评估骨盆骨折三轴移位方式分类的临床指导价值。结果根据三轴原理,将骨盆骨折移位分为x轴正移位/负移位、旋正/旋负移位,y轴正移位/负移位、旋正/旋负移位,z轴正移位/负移位、旋正/旋负移位。纳入骨盆骨折患者的手术切口平均7.1 cm;复位时间平均12.2 min;受辐射时间平均55.3 s;螺钉植入时间平均27.2 min,术后骨盆X线片或三维CT显示所有骨盆骨折复位良好,螺钉钢板植入无误;术中失血量平均96.5 mL;手术时间平均2.1 h;住院时间平均18.7 d。患者均获随访,随访时间6~53个月,平均16.7个月。末次随访时根据Matta评分标准,获优39例,良13例,可3例,优良率94.55%。结论基于骨盆三轴立体坐标轴的骨盆骨折三轴移位方式分类,能简便、精确表示患者骨折的移位方式,并可为患者术中复位进行精确指导。

Objective Based on images of pelvic CT three-dimensional reconstruction, to establish three-dimensional coordinate system of pelvis and investigate the three-axis displacement classification of pelvic fracture and its reduction principles. Methods Between June 2015 and May 2016, 21 cases of normal pelvic CT data were included in the study, and the mean pelvic three-dimensional model was established. The pelvic three-dimensional axis was established by defining the origin as the midpoint of the anterior superior iliac spine. Based on this coordinate system, a three-axis displacement classification of pelvic fracture were built. To assess the clinical guidance value of the three-axis classification, 55 cases （29 males and 26 females, aged 11-66 years with an average of 35.6 years） of pelvic fractures were analyzed by this classification, and replaced and fixed according to the principles of the reverse reduction. Results According to the theory of three-axis, pelvic fractures were divided into x-axis positive displacement/negative displacement, positive rotation/negative rotation; y-axis positive displacement/negative displacement, positive rotation/negative rotation; z-axis positive displacement/negative displacement, positive rotation/negative rotation. The average incision of included patients with pelvic fractures was 7.1 cm. The average reduction time was 12.2 minutes and the average radiation time was 55.3 s. The average time of screw implantation was 27.2 minutes. Postoperative pelvic X-ray films or three-dimensional CT showed all pelvic fracture was reducted well and the screw or plate was implanted correctly. The average intraoperative blood loss was 96.5 mL, the average operation time was 2.1 hours, and the average hospitalization time was 18.7 days. All patients were followed up 6-53 months （mean, 16.7 months）. At last follow-up, according to Matta standard by pelvic radiography evaluation, there were excellent in 39 cases, good in 13 cases, and fair in 3 cases, the excellent and good rate was 94.55%. Conclusion Based on three-dimensional coordinate system, three-axis displacement classification of pelvic fracture can illustrate the displacement mode of patient simply and accurately, and can also guide the intraoperative reduction precisely.