外固定支架与皮下前环内置外架治疗骨盆前环骨折疗效比较

Anterior Pelvic External Fixation Versus Internal Anterior Fixation in the Treatment of Anterior Ring Pelvic Fractures

目的探讨骨盆前环外固定架固定(anterior pelvic external fixation,APEF)与皮下前环内置外架(internal anterior fixation,INFIX)治疗骨盆前环骨折的临床疗效。方法回顾性分析2015年1月至2019年1月由河南省人民医院骨科收治的61例骨盆不稳定骨折的患者资料,根据治疗方式分为两组:APEF固定组30例,其中男17例,女13例;年龄36~58岁,平均为(46.2±2.2)岁。骨盆骨折根据Tile分型,B型14例,C型16例;均采用外固定架固定前环。INFIX组31例,其中男14例,女17例;年龄37~60岁,平均为(47.1±2.4)岁。骨盆骨折根据Tile分型:B型13例,C型18例;均采用皮下前环内置外架固定前环。比较两组患者的术后骨折复位质量、手术或术后并发症(包括医源性神经损伤、感染、螺钉松动、骨不愈合等)及疗效等。结果61例患者均获得随访,随访时间12~18个月,平均(14.2±2.3)个月。术后骨折复位质量根据Matta评分标准评定,APEF组优10例,良16例,可3例,差1例,优良率为86.7%;INFIX组优9例,良18例,可2例,差2例,优良率为87.1%;两组比较差异无统计学意义(P>0.05)。末次随访时根据Majeed骨盆功能评分系统评定疗效,APEF组优15例,良10例,可5例,优良率为83.3%;INFIX组优16例,良12例,可3例,优良率为90.3%;两组比较差异有统计学意义(P<0.05)。两组患者在术后3个月随访时骨折均全部愈合。APEF组3例(10%)患者股外侧皮神经损伤,5例(16.7%)出现螺钉松动,4例(13.3%)发生钉道感染;INFIX组4例(12.9%)出现股外侧皮神经损伤,1例(3.2%)出现皮肤感染,无螺钉松动发生。APEF组股外侧皮神经损伤发生率较INFIX组相比差异无统计学意义(P>0.05);APEF组患者螺钉松动、钉道感染率高于INFIX组,差异均有统计学意义(P<0.05)。结论APEF和INFIX均能提高骨盆的稳定性,但INFIX可获得较好的临床疗效,且并发症发生率较低,患者接受度高。

Objective To compare anterior pelvic external fixation(APEF)and internal anterior fixation(INFIX)in the treatment of anterior ring pelvic fractures.Methods From January 2015 to January 2019,a consecutive series of 61 patients who underwent surgical stabilization of anterior ring pelvic at our department were studied.They were divided into two groups according to their fixation of the anterior pelvic ring.30 cases were treatedwith APEF.There were 17 males and 13 females.The average was(46.2±2.2)years(range,36 to 58 years).According to Tile,s classification,14 of them were type B,16 were type C.31 cases were treated withINFIX,there were 14 males and 17 females.The average age was(47.1±2.4)years(range 37 to 60 years).According to Tile,s classification,13 of them belonged to type B and 18 to type C.Data of surgical or postoperative complications was collected,including iatrogenic nerve injury,infection,implant failure and radiographic union.The quality of fracture reduction of the two groups was evaluated by Matta standard,and the recovery of limb function was evaluated by Majeed scoring system.Finally,statistical analysis was performed to evaluate significant differences between two groups.Results The patients were followed up foran average of(14.2±2.3)months(range,12 to 18 months).According to Matta criteria for fracture reduction,10 cases were excellent,16 good,3 fair and one poor case in the APEF,(excellent and good rate:86.7%).In the INFIX group,there were 9 cases excellent,18 good,2 fair,2 poor(excellent and good rate:87.1%).There was no significant difference between the two groups(P>0.05).There were 15 cases excellent,10 good,5 fair of the pelvic function assessed by the Majeed scoring system at the final follow-up in the APEF(excellent and good rate:83.3%),and 16 cases excellent,12 good,3 fair in the INFIX(excellent and good rate:90.3%).The difference was statistically significant between the 2 groups(P<0.05).At the 3 months follow-up,there were no bone nonunion.In the APEF group,3 cases(10%)were suffered from lateral femoral cutaneous nerve injury,5(16.7%)had screw loosening and 4(13.3%)had pin tract infection.In INFIX group,4 cases(12.9%)had lateral femoral cutaneous nerve injuries,one(3.2%)had skin infection,there were no screw loosening.There was no significant difference in lateral femoral cutaneous nerve injury between the two groups(P>0.05),but there were statistically significant differences in screw loosening and pin infection between the APEF group and the INFIX group(P<0.05).Conclusion APEF and INFIX can improve the pelvic stability,but INFIX can achieve better clinical outcomes and fewer operative complications in the treatment of anterior pelvic ring fractures.