经皮微创桥接组合式内固定系统治疗骨盆后环损伤

Percutaneous bridge combined fixation system for pelvic posterior ring injuries

[目的]介绍桥接组合式内固定系统治疗骨盆后环损伤的手术技术。[方法]2015年1月~2018年6月,对19例骨盆后环损伤的患者行经皮微创桥接组合式内固治疗,其中12例还行前环有限切开内固定。先取俯卧位或者漂浮体位的前倾体位固定骨盆后环,然后再改为仰卧位后漂浮体位的后仰体位复位固定骨盆前环。于两侧髂后上棘外侧做斜形3~5cm切口,显露骨折脱位处,牵拉、撬拨、挤压等方法予以骨折复位,再将塑形后的连接棒经皮下隧道穿过,安装连接块,调整至最佳位置,钻孔并拧紧螺钉,穿透双侧骨皮质,利用桥接系统的撑开加压功能辅助进一步复位,至满意后锁定固定系统。[结果]19例患者均顺利手术,无血管、神经损伤等严重并发症。术后随访时间12~39个月。根据Majeed功能评分,优12例,良5例,可2例,优良率89.47%。影像评估方面,复位质量根据Matta评分标准:优18例,良1例,可0例,优良率为94.74%。[结论]经皮微创桥接组合式内固定系统治疗骨盆后环损伤,操作简单灵活,固定可靠,并发症少。

[Objective] To introduce the surgical technique of the percutaneous bridge combined fixation system (BCFS) for treatment of unstable pelvic posterior ring injuries.[Methods] From Jan 2015 to Jun 2018, 19 patients received percutaneous BCFS for unstable pelvic posterior ring injuries, including 12 patients who had additional internal fixation for the anterior ring by mini-incision. The patient was placed in prone position or anteversion of floating position for posterior procedure first, and then changed to supine position or retroversion of floating position for the anterior procedure. Two oblique mini-incisions 3~5 cm in length were made on the lateral sides of the posterosuperior iliac spine to expose the fracture and dislocation sites, and then reduction of fracture and dislocation was conducted by traction, poking or compression. After that, a pre-shaped link rod was inserted subcutaneously to attach the bilateral masses, which were adjusted to the best position. Iliosacral screws were placed through the bilateral mass to penetrate bilayer cortical bone. Finally, the fracture and dislocation were furtherly re duced by using distraction or compression of the system to satisfactory condition, and locked the system.[Results] All the patients had surgical procedure performed smoothly without serious complication, such as neurovascular injuries. The patients were followed up for 12~39 months. The clinical out comes were graded as excellent in 12, good in 5 and fair in 2 patients with excellent and good rate of 89.47% according to Ma jeed’s criteria. Regarding to radiographic assessment, the quality of fracture reduction was excellent in 18, good in 1, and fair in 0 with excellent and good rate of 94.74% based on the Matta’s criteria.[Conclusion] The BCFS is one of the effective instru mentations for unstable pelvic posterior ring injuries, with advantages of minimizing iatrogenic trauma, good flexibility in opera tion, proper strength for fixation and less complications.