微创入路结合锁定加压钢板在治疗骨盆后环损伤中的运用

Minimally invasive treatment of the posterior pelvic ring fracture with locking plate fixation

目的探讨经后入路微创锁定钢板治疗C1型骨盆后环骨折的手术适应证及临床疗效。方法对2013年2月至2016年6月我院收治的10例(男6例,女4例)C1型骨盆后环骨折患者采用微创锁定钢板治疗,年龄31~56岁,平均35.7岁。受伤原因:车祸伤5例,高处坠落伤2例,重物挤压伤3例。Tile分型:C1.1型4例、C1.2型3例、C1.3型3例。合并伤:腹腔实质脏器破裂或包膜下血肿4例、肠破裂2例、尿道损伤2例,颅脑外伤1例,股骨干骨折1例。骨盆后环损伤Denis分型:Ⅰ区3例、Ⅱ区5例、Ⅲ区2例。结果 9例患者切口均一期愈合,1例发生浅表感染,换药后10天愈合。10例均随访12~36个月,平均18.6个月。根据Majeed功能评分,优5例,良4例,可1例,优良率90%。腰骶部及下肢活动、感觉均正常。无会阴部感觉障碍。结论微创入路加锁定钢板治疗C1骨盆后环骨折,固定可靠,符合生物力学要求,手术损伤小,出血量少,操作简便,可获得良好的临床疗效。

Objective To explore the indications and effects of minimally invasive treatment of the posterior pelvic ring fracture of type C1 with locking plate fixation. Methods From February 2013 to June 2016, minimally invasive locking plate was applied in the treatment of 10 patients（ 6 males and 4 females） of type C1 pelvic ring fracture. The mean age was 35.7 years old（ range： 31-56 years）. Cause of injury： traffic accident in 5 cases, fall injury in 2 cases, heavy crush injury in 3 cases. Tile posterior pelvic ring fractures： C1.1 type 4 cases, C1.2 type 3 cases, C1.3 type 3 cases. Associated injuries： abdominal parenchymal organ srupture or subcapsular hematoma in 4 cases, intestinal rupture in 2 cases, urethral injury in 2 cases, traumatic brain injury in 1 case, femoral shaft fracture in 1 case. Posterior pelvic ring injury according to Denis classification： Ⅰ District 3 cases, Ⅱ District 5 cases, Ⅲ District 2 cases. Results One stage healing was achieved in 9 patients. Superficial infection occurred in 1 patient, which healed by 10 days＇ dressing. All 10 cases were followed up for 12-36 months（ mean： 18.6 months）. According to Majeed function score： excellent in 5 cases, good in 4 cases, fair in 1 case, excellent and good rate 90%. Lumbar and lower extremity activity, sensation were normal. No perineal sensory impairments. Conclusions Minimally invasive treatment of the posterior pelvic ring fracture of type C1 with locking plate fixation is reliable, and consistent with biomechanical requirements. It is easy to operate and less invasive with less bleeding, achieving good clinical efficacy.