自制骨盆微创通道器械辅助治疗骨盆环骨折脱位

Self-made minimally invasive pelvic channel instrument for treatment of pelvic ring fracture- dislocation

目的探讨应用自制骨盆微创通道器械辅助治疗骨盆环骨折脱位的临床疗效。方法回顾性分析2015年12月至2017年11月期间北京朝阳急诊抢救中心骨一科收治且获得随访的35例骨盆环骨折脱位患者资料。男25例,女10例;年龄为20~73岁,平均41.3岁。骨折按Tile分型:B型26例,其中B1型8例,B2型12例,B3型6例;C型9例,其中C1型5例,C2型3例,C3型1例。11例患者采用内置外架或前路钢板联合经皮骶髂关节空心钉内固定,5例患者采用骶髂三角固定联合经皮前环空心钉内固定,其余19例患者前后环均采用空心钉内固定。所有空心钉内固定均采用自制骨盆微创通道器械建立通道,记录每枚空心钉的置入时间、X线透视次数,记录患者术后骨折复位质量、末次随访时骨盆功能及并发症发生情况等。结果35例患者共置入84枚空心钉,术中每枚空心钉置入时间为5~13min(平均8.1min),术中每枚空心钉置入所需X线透视次数为7~15次(平均10.3次)。术后CT示所有螺钉均位于预设通道内。术后骨折复位质量根据Matta评分标准评定:优29例,良4例,可2例,优良率为94.3%。35例患者术后获6~15个月(平均12.3个月)随访。随访期间所有患者骨折愈合良好,1例患者1枚骶髂关节螺钉在术后3个月出现松动,其余患者螺钉无松动、断裂及退出。末次随访时根据Majeed骨盆功能评分系统评定骨盆功能:优27例,良5例,可3例,优良率为91.4%。结论应用自制骨盆微创通道器械建立骨盆微创通道,具有置入精准、手术时间短及X线透视次数少等优点。

Objective To evaluate the clinical efficacy of our self-made minimally invasive pelvic channel instrument in the treatment of pelvic ring fracture-dislocation. Methods A retrospective study was conducted of the 35 patients who had been treated for pelvic ring fracture-dislocation from December 2015 to November 2017 and fully followed up at Department I of Orthopaedis, Beijing Chaoyang Emergency Rescue Center. They were 25 males and 10 females, aged from 20 to 73 years (average, 41.3 years). According to the Tile classification for pelvic fractures, there were 26 cases of type B (type B1 in 8, type B2 in 12 and type B3 in 6) and 9 cases of type C(type C1 in 5, type C2 in 3 and type C3 in 1). Infix or anterior plate combined with percutaneous internal fixation with sacroiliac cannulated screws was used in 11 patients, sacroiliac triangle fixation combined with percutaneous internal fixation with anterior ring cannulated screws in 5 ones, and internal fixation with cannulated screws for anterior and posterior rings in 19 ones. All the channels were established using our self-made minimally invasive pelvic channel instrument for internal fixation with cannulated screws. The time for each screw placement and the number of X-ray projection were recorded. Postoperative reduction, pelvic function at the final follows-ups and complications were recorded. Results A total of 84 cannulated screws were inserted in the 35 patients. The time for each cannulated screw placement ranged from 5 to 13 minutes (average, 8.1 minutes);the number of X-ray projection for each screw placement ranged from 7 to 15 times (average, 10.3 times). Postoperative CT showed that all the cannulated screws were located in the preset channels. According to the Matta radiological criteria, postoperative reduction quality was excellent in 29, good in 4 and fair in 2, giving a good to excellent rate of 94.3%. The follow-up time for the 35 patients ranged from 6 to 15 months (average, 12.3 months). At the final follow-ups, all the patients showed fine fracture union. There was no loosening or breakage of screws in all but one patient in whom one sacroiliac screw became loose 3 months after surgery. By the Majeed criteria, the pelvic function was excellent in 27 cases, good in 5, fair in 3 and poor in one, giving a good to excellent rate of 91.4%. Conclusion Our self-made minimally invasive pelvic channel instrument can be used to establish pelvic channels, leading to more accurate placement, shorter operative time and less X-ray projection.