改良腰髂骨固定治疗骶骨骨折脱位临床疗效

Clinical improvement of lumbosacral fixation for the treatment of tibiofibular fracture and dislocation

目的评价应用改良腰髂骨间固定治疗骶骨骨折脱位的临床效果。方法回顾性分析2015年4月至2017年1月福州总医院476临床部收治的47例骶骨骨折脱位患者临床资料,所有患者采用椎弓根系统经腰椎-髂骨间行骨折复位和固定治疗。收集记录手术前、术后1周、术后3个月、末次随访时患者疼痛VAS评分、骨折复位、临床功能指标、骨折愈合情况,并进行评价分析。结果随访14~26(18.5±1.32)个月。术后骨折临床愈合时间为12~18(16.8±0.42)周。VAS评分:术前(8.42±1.07)、术后1周(5.81±0.85)、术后4周(3.81±0.56)、术后3个月(2.29±0.37)、末次随访(0.50±0.08)的评分逐渐减少,差异均有统计学意义(P<0.05)。伤侧骨盆较对侧上移距离术后1周[(3.24±0.33) mm]小于术前[(16.23±3.41) mm],差异有统计学意义(P<0.05)。术后1周[(3.24±0.33) mm]、术后4周[(3.25±0.32) mm]、术后3个月[(3.25±0.33) mm]、末次随访[(3.24±0.25) mm]的骨盆移位距离差异无统计学意义(P>0.05)。Majeed评分:术后4周(39.63±5.62)、术后3个月(57.42±6.18)、末次随访(92.12±7.75)的评分逐渐增加,差异有统计学意义(P<0.05)。结论改良腰髂骨固定术式治疗骶骨骨折脱位能有效维持骨盆后环稳定,手术操作简单,损伤小、微创、恢复快。

Objective To evaluate of the clinical effect of modified lumbosacral fixation for the treatment of tibiofibular fracture and dislocation.Methods This retrospective study was performed based on 47 patients with tibiofibular fractures from April2015 to January 2017 in 476 Clinical Department of Fuzhou General Hospital with vertebral pedicle system through the lumbar spinehumeral fracture reduction and fixation.The pain VAS scores,fracture reduction,clinical function indicators,and fracture healing of patients were collected and recorded before and after surgery,and evaluated and analyzed.Results The patients were followed up for 14 to 26(18.5±1.32) months.The clinical healing time of postoperative fractures was 12-18(16.8±0.42) weeks.The scores before operation(8.42±1.07),1 week after operation(5.81± 0.85),4 weeks after operation(3.81± 0.56),3 months after operation(2.29±0.37),and the last follow-up(0.50±0.08) were gradually decreased.The differences were statistically significant(P<0.05).The injury of the injured pelvis [(3.24±0.33) mm] was significantly smaller(P<0.05) than that of the first week after operation[(16.23±3.41) mm].There was no significant change in pelvic displacement distance at 1 week [(3.24±0.33) mm],4 weeks[(3.25±0.32) mm],3 months [(3.25±0.33) mm],and the last follow-up [(3.24±0.25) mm](P>0.05).Majeed score: The scores at 4 weeks(39.63± 5.62),3 months(57.42±6.18),and the last follow-up(92.12±7.75) were gradually increased(P<0.05).Conclusion The improved lumbar and sacral fixation method is effective in the treatment of sacral fracture and dislocation,which can effectively maintain the stability of the posterior pelvic ring,simple operation,minimal damage,minimally invasive and fast recovery.