内置外架联合髂腰固定术治疗Tile C型骨盆骨折

Internal fixator with iliolumbar fixation in treating vertically unstable pelvic fracture

目的:探讨采用内置外架(INFIX)联合髂腰固定术治疗垂直不稳定型骨盆骨折(Tile C型)的临床疗效。方法:选取2016年5月至2017年4月台州市第一人民医院收治的采用INFIX联合髂腰固定术治疗的5例垂直不稳定型骨盆骨折患者。其中,男2例,女3例,年龄为23~65(42.3±14.8)岁。所有病例均为Tile C型骨折,其中C1.1型3例,C1.2型2例。采用常规后路术式,复位骨盆垂直移位后,伤侧L4、5椎体及髂后上棘采用椎弓根钉棒系统固定,前环双侧髂前下棘处髂骨使用椎弓根螺钉固定,椎弓根螺钉通过经下腹部皮下固定连接杆治疗骨盆前环损伤。分别采用Matta评分和Majeed评分来评价骨盆复位质量和临床疗效,同时对术后骨折愈合、神经功能、临床功能及并发症进行分析。结果:术后所有患者随访3~10个月,末次随访X线片均提示骨盆骨折复位良好,后环形态满意;根据Matta评分标准:优3例,良2例。随访结束时Majeed评分标准:优1例,良3例,中1例。所有患者未出现神经血管损伤,随访结束行走及屈髋屈膝功能恢复满意。结论:INFIX联合髂腰固定术可重建Tile C型骨盆骨折的垂直不稳和旋转不稳,疗效满意,同时具有操作简便、并发症少等优点。

Objective:To evaluate the clinical outcomes of Internal fixator(INFIX)with iliolumbar fixation in treating vertically unstable pelvic fracture(Tile C).Methods:The clinical data of 5 patients with a vertically unstable pelvic fracture were treated with INFIX with iliolumbar fixation from May 2016 to April 2017 were retrospectively analyzed.There were 2 males and 3 females,aged from 29 to 65 years old with an average of(42.3±14.8)years.Among them,five fractures were classified as type C according to the classification of Tile.This fixation construct comprised a vertical lumbopelvic distraction component which fixed L4,5 and the posterior superior iliac spine and percutaneous internal fixator using the vertebral pedical screwrod system which fixed anterior inferior iliac spine.Vertical displacement and functional outcome were evaluated by Matta method and Majeed score criteria respectively,and fracture healing time,nerve function,clinical function and complications were documented.Results:All the patients were followed up for 10 to 16 months.In the present clinical series,all fractures healed without significant loss of reduction.There were 3 excellent,2 good according to the Matta criteria.There were 1 excellent,3 good and 1 fair according to the Majeed score evaluation by the end of last follow-up visit.No iatrogenic complications of neurovascular injury occurred.Patients now walk unassisted without pain in the waist or legs,and with no shortening of lower limbs or claudication.Conclusion:INFIX with iliolumbar fixation that allows early mobilization and ambulation,with general applicability and definite safety,is an effective surgical technique for the treatment of vertically unstable pelvic fracture.