单一腹直肌外侧切口治疗骨盆前后环骨折

Single lateral-rectus approach for the treatment of anteroposterior pelvic ring fracture

目的探讨应用单一腹直肌外侧入路手术治疗骨盆前后环骨折的临床疗效。方法对2015年6月—2016年3月采用腹直肌外侧手术入路治疗的11例骨盆前后环损伤的治疗效果进行总结分析。骨盆骨折Tile分型:B2型5例,B3型2例,C1型2例,C2型2例,其中3例合并胸腰段骨折,2例合并跟骨骨折。均采用单一腹直肌外侧入路切开复位、重建接骨板内固定。术后观察切口愈合、功能及并发症发生情况,通过X线及CT评价骨折复位情况。采用Matta影像学评估标准评估复位质量,根据Majeed评分标准进行功能评价。结果 11例患者骨盆骨折均获满意复位,术后得到10~20个月随访,均达到骨性愈合。患者Matta影像学复位标准:优7例,良3例,可1例;Majeed骨盆骨折评分逐渐提高,末次随访Majeed评分:优6例,良4例,可1例。结论单一腹直肌外侧入路具有切口方便直接、创伤小、易于复位,固定及切口并发症少的特点。手术治疗骨盆前后环骨折,单一腹直肌外侧入路是一个理想的选择。

Objective To investigate the clinical effectiveness of single lateral-rectus approach for the treatment of anteroposterior pelvic ring fracture. Methods The therapeutic effects of 11 patients with anteroposterior pelvic ring fracture treated through the single lateral-rectus approach from Jun. 2015 to Mar. 2016 were summarized and analyzed. According to the Tile classification,5 cases were B2,2 were B3,2 were C1 and 2 were C2.There were 3 patients associated with thoracolumbar fractures,and 2 patients associated with calcaneal fractures.Surgical treatment through the single lateral-rectus approach and internal fixation with reconstruction plate were applied. Postoperatively,the wound healing,function and complications were observed,and X-ray and CT scans were used for evaluation of the fracture reduction. Matta imaging was used for evaluation of reduction results and functional recovery was evaluated according to the Majeed score. Results All 11 patients obtained good reduction and bony union after 10-20 months follow-up postoperatively. The Matta imaging showed excellent in 7 cases,good in 3 and fair in 1. The Majeed score in all patients showed a gradual increase postoperatively. At the last follow-up,Majeed scoring showed excellent in 6 cases,good in 4 and fair in 1. Conclusion The single lateral-rectus approach is characterized by convenience and directness in making incisions. It is minimally invasive with easy reduction and few complications and hence is an ideal choice in surgical treatment of anteroposterior pelvic ring fracture.