钉棒系统联合钢板内固定治疗Tile C1、C2型骨盆骨折

Screw rod system combined with steel plate internal fixation for treatment of Tile type C1 and C2 pelvic fracture

目的探讨钉棒系统联合钢板内固定治疗Tile C1、C2型骨盆骨折的临床疗效。方法 2014年5月—2016年9月,采用钉棒系统联合钢板内固定治疗Tile C1、C2型骨盆骨折患者21例,男性15例,女性6例;年龄25~64岁,平均42岁。骨盆骨折Tile分型C1型8例,C2型13例。术中用骨盆重建钢板固定后环,钉棒系统固定前环,随访观察骨折愈合及功能恢复情况。结果本组均顺利完成手术,手术时间1~4h,平均2.6h。失血量400~1 300mL,平均740mL。有5例患者输血,输血量200~800mL,平均400mL。21例均获随访,随访时间8~12个月,平均10.5个月;骨折均愈合,愈合时间10~14周,平均12周。术后在骨盆X线片上依据Matta影像学评分标准评价骨折复位质量,优10例,良8例,中3例。参照Majeed骨盆骨折评分标准评价疗效,Majeed评分术前(49.2±2.6)分,末次随访时(89.6±4.3)分,差异有统计学意义(t=2.475,P=0.031)。末次随访时,疗效评价优11例,良8例,中2例。术后发生切口脂肪液化2例,经换药切口愈合。无神经、血管损伤及内固定松动、断裂及异位骨化发生。结论钉棒系统联合钢板内固定治疗Tile C1、C2型骨盆骨折,既为骨折提供了坚强的固定,又避免了采用外固定架和钢板固定前环的缺点。创伤小,出血少,固定可靠,骨折愈合好,有利于骨盆功能的恢复,且并发症少。

Objective To explore the clinical curative effects of screw-rod system combined with steel plate internal fixation in the treatment of Tile type C1 and C2 pelvic fractures. Methods Twenty-one patients with Tile type C1 and C2 pelvic fracture were treated with screw-rod system and steel plate internal fixation from May 2014 to Sep. 2016. The patients consisted of 15 males and 6 females,and ranged in age from 25 to 64 years（ median = 42 years）. The fractures belonged to C1（ n = 8） and C2（ n = 13） according to the Tile classification standard of pelvic fracture. The posterior and anterior rings were fixed with pelvic reconstructive steel plate and screw-rod system during the operation,respectively. The patients were followed up and the fracture healing and function recovery were observed. Results The operations were finished successfully in all patients,and the patients ranged in operation time from 2 to 4 hours（ mean = 2. 6 hours） and ranged in blood loss volume from 400 to 1300 mL（ mean = 740 mL）.Five patients received blood transfusion with range from 200 to 800 mL（ mean = 400 mL）. All patients were followed up for 8-12 months（ mean = 10. 5 months） and all fractures healed for 10-14 weeks（ mean = 12 weeks）. The fracture reduction quality were evaluated by using Matta imaging evaluation standard on X-ray films of pelvis after operation,indicating 10 cases of excellent,8 cases of good and 3 cases of fair. The clinical curative effect was evaluated according to the Majeed evaluation standard of pelvic fracture,and the results showed that the Majeed scores were（ 49. 2 ± 2. 6） points and（ 89. 6 ± 4. 3） points before operation and at the last follow-up,respectively. There was statistical difference in Majeed scores（ t = 2. 475,P = 0. 031）. The results of therapeutic effect evaluation showed 11 cases of excellent,8 cases of good and 2 cases of fair at the last follow-up. Postoperative fat liquefaction of incisions（ 2 cases） was found,the incisions healed after dressing changes,and no nerve or blood vessel injuries,internal fixation loosening,rupture or heterotopic ossification was found. Conclusion The combination therapy of screw-rod system and steel plate internal fixation has such advantages as less trauma,less bleeding,reliable fixation,and good fracture healing in the treatment of Tile type C1 and C2 pelvic fracture. Meanwhile,it provides strong fixation for fractures and avoids the disadvantages of application of external fixators and steel plates in fixing anterior rings,so it is conducive to the pelvic function recovery with less complications.