Starr架辅助复位INFIX与前柱螺钉内固定治疗不稳定骨盆骨折临床比较分析

Clinical comparative analysis of Starr-assisted reduction INFIXor anterior column screw fixation for unstable pelvic fractures

目的应用Starr复位架经皮复位、骨盆前环皮下钉棒系统(INFIX)与前柱拉力螺钉固定治疗Tile B/C型骨盆骨折,比较疗效并探讨操作技巧。方法回顾性分析比较2016年4月—2017年6月广西医科大学附属第四医院收治的35例Tile B/C型骨盆骨折患者,其中B1型4例,B2型10例,B3型5例,C1型10例,C2型6例;男性16例,女性19例;年龄22～66岁,平均42岁。前环损伤采用INFIX内固定系统固定19例(INFIX组),采用前柱螺钉固定16例(前柱螺钉组)。骨盆后环损伤均采用骶髂关节螺钉固定。记录各组Starr架复位时间、前环内固定置入时间、透视次数等,按Matta标准评定骨盆骨折复位质量,功能评分采用Majeed功能评分量表。结果两组患者Starr架复位时间分别为(30. 3±11. 2) min、(34. 4±5. 9) min;INFIX组内固定置入时间(25. 4±2. 1) min,前柱螺钉组(38. 0±4. 2) min,差异无统计学意义。两组透视次数分别为(30. 2±3. 5)次、(26. 1±9. 2)次,差异有统计学意义。Matta标准评定骨折复位结果显示INFIX组优10例,良8例,差1例;前柱螺钉组优9例,良6例,差1例。Majeed功能评分显示INFIX组优8例,良11例;前柱螺钉组优10例,良6例。两组骨折复位及功能评分结果比较,差异无统计学意义。结论 Starr复位架辅助复位灵活可靠,INFIX或前柱螺钉固定治疗Tile B/C型骨盆骨折操作简便、疗效确切;经皮复位微创螺钉置入技术具有明显临床优势及广阔应用前景。

Objective To apply Starr frame for reduction,INFIX subcutaneous pedicle screw-rod system or anterior column screw to treat Tile B/C pelvic fracture and compare their efficacy.Methods Totally 35 cases of Tile B/C fractures in our hospital from Apr.2016 to Jun.2017 on whom Starr frame assisted reduction was applied were retrospectively reviewed.There were 16 males and 19 females aged from 22-66(average,42)years.Of them 4 cases were Type B1,10 cases were B2,5 cases were B3,10 cases were C1 and 6 cases were C2.Of them 19 cases(INFIX group)had the anterior pelvic ring fracture fixed with INFIX internal fixation,and 16 cases(sacroiliac screw group)were fixed with the sacroiliac screw.The reduction time,anterior ring internal fixation placement time,and fluoroscopy times were recorded.The reduction quality of pelvic fracture was assessed according Matta criteria,and the functional score was based on the Majeed scale.Results The reduction duration of Starr frame in the two groups was(30.3±11.2)min,(34.4±5.9)min,respectively.The duration of anterior ring internal fixation placement time in the INFIX group was(25.4±2.1)min,and(38.0±4.2)min in the anterior column screw group.The times of fluoroscopy were 30.2±3.5,26.1±9.2,respectively.The results of Matta criteria displayed 10 cases of excellent,8 cases of good and 1 case of fair in the INFIX group,while 9 case of excellent,6 case of good and 1 case of fair in the anterior column screw group.Majeed scales showed that 8 cases were excellent and 11 cases were good in the INFIX group,while 10 cases were excellent and 6 cases were good in the anterior column screw group.No significant difference was found between the two groups.Conclusion It is simple and flexible to treat Tile B/C pelvic fractures with the help of Starr frame for reduction,and the application of INFIX or screw was easy and effective.The technique of percutaneous reduction and minimally invasive screw placement has obvious clinical advantages and wide application prospect.