3D导航下微创空心螺钉内固定治疗中老年Tilt骨盆骨折的疗效观察

The clinical efficacy of 3D image-guided minimally invasive screw fixation in the treatment of Tilt pelvic fracture in middle-aged and elderly patients

目的探讨3D导航下微创空心螺钉内固定治疗中老年Tilt骨盆骨折的临床疗效。方法回顾性分析2015年6月至2017年1月解放军武汉总医院骨科应用3D导航技术微创(经皮或小切口)空心螺钉内固定治疗的35例中老年Tilt骨盆骨折患者资料,男性15例(42.9%),女性20例(57.1%);年龄45~73岁,平均(57±4)岁。骨盆骨折按Tile分型:B2.1型23例,B2.2型9例,B3型3例。其中,单侧耻骨支骨折32例,双侧耻骨支骨折3例;骶骨骨折:DenisⅠ区23例,DenisⅡ区12例。记录手术切口、置钉时间、置钉出血量,根据骨折复位质量、末次随访Majeed骨盆骨折功能评分及术后并发症等评定临床疗效。结果所有患者术后均获得随访,随访时间3~12个月,平均(6.9±1.9)个月;手术切口长约1~4 cm,平均(2.7±1.5)cm;每枚螺钉置入耗时20~38 min,平均(29.4±1.7)min;置入每枚螺钉的出血量较少,无法计算。骨盆前环复位质量根据Matta标准评定,优27例,良4例,可4例,优良率88.6%。骨盆后环复位质量根据Matta标准评定,优27例,良5例,可3例,优良率91.4%。末次随访根据Majeed骨盆骨折功能评分,优23例,良6例,可6例,优良率82.9%。术后所有患者均未出现长期疼痛、伤口感染、神经血管损伤、异位骨化、血栓形成等并发症。结论 3D导航下微创空心螺钉内固定治疗中老年Tilt骨盆骨折精准安全、创伤小、并发症少,是一种可选择的较为理想的内固定方法。

Objective To evaluate the clinical efficacy of 3D image- guided minimally invasivescrew internal fixation in the treatment of Tilt pelvic fracture in middle- aged and elderly （45- 74years）patients. Methods A retrospective analysis including 35 middle-aged and elderly patients with Tilt pelvicfracture treated with the minimally invasive screw internal fixation was done from June 2015 to January2017. Fifteen males （42.9%） and 20 females （57.1%）. The age range was 45 to 73 years with an average of（56.4±3.7） years. According to the Tile classification 23 cases was B2.1 type, 9 cases was B2.2 type and 3B3 type. The posterior pelvic ring injuries had 23 DenisⅠtype, and 12 DenisⅡtype. The operative incision,blood loss during insert screw, time of operation, reduction quality, Majeed pelvic fractures function scoresat the last follow-up and postoperative complications were recorded to evaluate its clinical effect. ResultsAll patients had follow- up for an average of （6.9 ± 1.9） months,range from 3 to 12 months. Length ofincision was （2.7±1.5） cm, range from 1 to 4 cm. The time of each screw insertion was （29.4±1.7） min, rangefrom 20 to38 min. Blood loss for screw insertion was too small to count. The quality of anterior pelvic ringfractures reduction were evaluated according to Matta standardization, 27 cases were excellent, 4 cases weregood and 4 moderate, rate of excellent to good reduction was 88.6%. The quality of posterior pelvic ringfractures reduction were 27 excellent, 5 good and 3 moderate, the excellent to good rate of reduction was 91.4 %. The Majeed standardization showed 23 cases were excellent, 6 cases were good and 6 cases weremoderate, the excellent to good rate of healing was 82.9%. There were no pain, wound infection, nerveinjury, heterotopic ossification, thrombosis complications occurred. Conclusion The 3D image- guidedminimally invasive screw internal fixation is a precise, safe, less trauma and low complications for middleagedand elderly patients with Tilt pelvic fractures, it is a possible ideal method for clinics.