钉棒系统治疗不稳定型骨盆骨折的疗效

Efficacy of the system of pedicle screw-rod in the treatment of unstable pelvic fractures

目的探讨应用钉棒系统治疗不稳定型骨盆骨折的临床疗效。方法采用钉棒系统内固定治疗23例不稳定型骨盆骨折患者。对Tile B型骨折采用骨盆前环的钉棒皮下内固定,对Tile C型骨折加用后路钉棒内固定或骶髂关节螺钉内固定。术后采用Matta标准评价骨盆骨折复位情况,采用Majeed评分系统评价临床疗效。结果前路手术时间20～30 min,术中出血量17～22 ml;后路手术时间45～75 min,术中出血量115～180 ml。23例患者均获得随访,时间6～27个月。患者均无深部感染、医源性神经损伤、内固定松动及断裂等并发症发生。手术切口全部甲类愈合,未出现骶尾部皮肤压疮、坏死。术后X线片根据Matta标准评定骨盆骨折复位情况:优13例,良6例,可4例。术后6个月按Majeed评分评价临床疗效:优14例,良6例,可2例,差l例。结论椎弓根钉棒系统治疗不稳定型骨盆骨折具有操作简便安全、创伤较小、并发症少的优点,患者可早期负重,功能恢复良好,临床疗效满意。

Objective To investigate the efficacy of unstable pelvic fractures treated with the system of pedicle screwrod. Methods The 23 patients with unstable pelvic fractures were treated with the system of pedicle screw-rod. Patients with type B pelvic fracture were treated only with anterior subcutaneous pelvic fixator; while the type C pelvic fractures were treated with anterior subcutaneous pelvic fixator combined with posterior subcutaneous pedicle screwrodor sacroiliac joint screw. The Matta standard was used to evaluate the reduction degree of the pelvic fractures,and the Majeed score system was used for clinical effect evaluation. Results The operation time of the anterior approach was 20 ～ 30 min,the intraoperative blood loss was 17 ～ 22 ml. While the operation time of the posterior approach was 45 ～ 75 min,the intraoperative blood loss was 115 ～ 180 ml. All patients were followed up for 6 ～ 27 months after surgery. All patients had no complications such as deep infection,iatrogenic nerve injury,loosen screws or broken screws,pressure sores. According to Matta reduction evaluation criteria,the results were excellent in 13 cases,good 6 cases,fair 4 cases. At 6 months after surgery,the Majeed scores results were excellent in 14 cases,good in 6 cases,fair in 2 cases and poor 1 case. Conclusions The system of pedicle screw-rod that allow patients to do early mobilization and weight bearing,with general applicability,definite safety and less complications,which is an effective surgical technique for the treatment of unstable pelvic fracture.