累及骶髂关节儿童骨盆骨折临床治疗研究

Retrospective analysis of pediatric pelvic fractures involving sacroiliac joints

目的分析累及骶髂关节儿童骨盆骨折的发病特点、治疗方法及疗效,为制定最佳的治疗方案提供依据。方法回顾性分析重庆医科大学附属儿童医院2010年1月至2017年12月收治的32例累及骶髂关节骨盆骨折患儿诊治经过及随访资料,按Tile法进行骨盆骨折分型,根据自行制定的标准进行骶髂关节损伤分级,采用Cole法进行最终疗效功能评估。结果累及骶髂关节的儿童骨盆骨折分型以Tile分型C型为主,骶髂关节损伤较重的3、4级损伤均发生在C型骨盆骨折患儿中。26例获得完整随访的患儿中,Cole法功能评价优19例、良3例、可4例,总体优良率84.6%。损伤分级3级以上者,若不能及时解剖复位和有效固定,预后较差。结论1、2级累及骶髂关节儿童骨盆骨折可保守治疗,3、4级损伤则建议手术解剖复位治疗。

Objective To summarize the characteristics,therapeutic method and corresponding curative effects of pediatric pelvic fractures involving sacroiliac joints and to provide the basis for formulating the best clinical treatment plan. Methods Medical record and follow-up data of 32 cases of pelvic fractures involving sacroiliac joints,admitted to the Children′s Hospital affiliated to Chongqing Medical University from Jan.2010 to Dec.2017,were retrospectively analyzed.The pelvic fracture was classified according to Tile method,the injury of sacroiliac joint was graded according to the self-developed criteria,and the final curative effect was evaluated by the effect score table of Cole pelvic fracture. Results The main fracture classification was type C according to Tile classification,and the third and fourth grade injuries with more severe sacroiliac joint injury occurred in children with type C pelvic fractures.Among the 26 patients with complete follow-up data,the functional evaluation was excellent in 19 cases,good in 3 cases and fair in 4 cases.The overall excellent and good rate was 84.6%.Cases with grade 3 or higher of injury grade could not be timely fixed and fixed effectively,and the prognosis was poor. Conclusion Pediatric pelvic fractures involving the sacroiliac joints should be treated according to the injury condition.Grade 1 and 2 injuries of the sacroiliac joints could be treated conservatively,while grade 3 and 4 injuries might be suggested to be treated with surgical anatomic reduction.