经皮桥接钢板与逆行耻骨上支髓内螺钉固定骨盆前环骨折的疗效比较

Comparative study of percutaneous bridging plate and retrograde suprapubic intramedullary screw fixation for anterior pelvic ring fracture

目的:比较经皮桥接钢板与逆行耻骨上支髓内螺钉固定骨盆前环骨折的疗效。方法:回顾分析2013年1月至2017年6月收治的40例累及前环的不稳定性骨盆骨折患者,根据固定方式分成两组,其中经皮桥接钢板组(钢板组)20例,男9例,女11例;骨折按Tile分型,B1型1例,B2型14例,B3型2例,C1型2例,C2型1例。逆行耻骨上支髓内螺钉组(螺钉组)20例,男10例,女10例;骨折按Tile分型,B1型1例,B2型12例,B3型3例,C1型3例,C2型1例。分别对两组的手术切口长度、手术时间、透视次数、术中出血量、术后Matta评分、术后并发症及末次随访Majeed功能评分进行比较分析。结果:两组病例均获随访,钢板组随访8~15(12.25±2.24)个月;螺钉组随访6~18(12.4±2.6)个月,两组差异无统计学意义。螺钉组手术切口长度(3.85±0.75)cm短于钢板组(7.05±1.39)cm;螺钉组手术时间(27.70±5.36)min长于钢板组(15.10±2.07)min;螺钉组透视次数(6.00±1.83)次大于钢板组(3.75±1.33)次。螺钉组出血量(22.50±10.82)ml与钢板组(25.25±9.93)ml相比,差异无统计学意义(P>0.05);两组术后Matta评价及末次随访Majeed功能评分差异均无统计学意义。螺钉组发生1例浅表皮肤感染,钢板组1例浅表皮肤感染,1例股外侧皮神经短暂性麻痹。结论:经皮桥接钢板与逆行耻骨上支髓内螺钉固定骨盆前环骨折疗效相当。经皮钢板组的手术时间更短、术中透视次数更少,而且学习曲线短,但术中需注意股外侧皮神经变异。

Objective:To compare the effect of percutaneous bridging plate and retrograde suprapubic intramedullary screw in the treatment of anterior ring fracture of pelvis.Methods:From January 2013 to June 2017,40 patients with unstable pelvic fractures involving anterior ring were analyzed retrospectively.According to the fixation method,they were divided into two groups,there were 20 patients in percutaneous bridging plate group(plate group)including 9 males and 11 females;according to tile classification,fractures were classified as type B1 in 1 case,type B2 in 14,type B3 in 2,type C1 in 2 and type C2 in 1.There were 20 cases in retrograde suprapubic intramedullary screw group(screw group)including 10 males and 10 females;according to tile classification,there were 1 case of type B1,12 cases of type B2,3 cases of type B3,3 cases of type C1 and 1 case of type C2.The incision length,operation time,times of fluoroscopy,intraoperative bleeding volume,postoperative Matta score,postoperative complications and the last follow-up Majeed function score of the two groups were compared and analyzed.Results:Both groups were followed up for 8 to 15(12.25±2.24)months in the plate group and 6 to 18(12.4±2.6)months in the screw group,there was no significant difference between the two groups.The incision length of screw group was(3.85±0.75)cm shorter than that of steel plate group(7.05±1.39)cm;the operation time of screw group was(27.70±5.36)min longer than that of steel plate group(15.10±2.07)min;the fluoroscopy times of screw group was(6.00±1.83)more than that of steel plate group(3.75±1.33).The bleeding volume was(22.50±10.82)ml in of screw group,(25.00±9.93)ml in steel plate group,there was no significant difference between the two groups(P>0.05).There was no significant difference in Matta evaluation and Majeed functional score in the last follow-up.One case of superficial skin infection occurred in screw group,one case of superficial skin infection and one case of transient paralysis of lateral femoral cutaneous nerve occurred in steel plate group Conclusion:Percutaneous bridging plate and retrograde suprapubic intramedullary screw fixation of pelvic anterior ring fracture have the same effect.The operation time of the percutaneous plate group was shorter,the times of intraoperative fluoroscopy was less,and the learning curve was shorter,but the variation of the lateral femoral cutaneous nerve should be noted during the operation.