内置外架系统结合空心钉治疗合并耻骨联合分离的骨盆前环损伤

Using internal fixator combined with hollow nail in the treatment of anterior pelvic ring injury with symphyseolysis

目的探讨应用内置外架系统(internal fixator,INFIX)结合空心钉治疗合并耻骨联合分离的骨盆前环损伤的临床疗效。方法回顾性分析2016年1月至2018年12月收治且获得随访的12例合并耻骨联合分离的骨盆前环损伤患者资料,男8例,女4例;年龄39.5岁(范围,23~64岁);交通伤4例,坠落伤3例,挤压伤5例;均为前后挤压伤。骨盆骨折按Tile分型:B1型6例,B3型3例,C1型1例,C2型2例。6例B1型损伤患者和3例B3型损伤患者后环采用经皮骶髂关节空心钉固定,1例C1型损伤患者和2例C2型损伤患者后环采用脊柱-骨盆三角固定治疗。记录每例患者INFIX结合耻骨联合空心钉手术时间、术中出血量、切口大小、X线透视次数,术后摄骨盆X线片及行CT检查观察复位情况及螺钉位置,应用Matta放射学标准评定骨折复位质量,末次随访时采用Majeed评分评价骨盆骨折后功能恢复程度。结果12例患者手术时间42 min(范围,35~56 min),术中出血量28 ml(范围,15~40 ml),两侧INFIX置钉处切口长度2.7 cm(范围,2.2~3.5 cm),耻骨联合空心钉置钉处切口长度0.8 cm(范围,0.6~1.2 cm),X线透视次数38次(范围,26~55次)。术后X线片及CT检查示所有螺钉位置均准确,固定牢固,耻骨联合复位良好。术后Matta放射学标准评定:优10例,良2例,优良率为100%(12/12)。12例患者术后均获得随访,随访时间12个月(范围,6~15个月)。末次随访时影像学检查均示骨折愈合良好,耻骨联合复位未丢失,骨折均愈合,愈合时间13.4周(范围,10~18周);Majeed评分88.34分(范围,73~97分),其中优8例、良3例、可1例,优良率91.7%(11/12)。术后1例出现股神经压迫症状,去除INFIX后恢复正常;1例股外侧皮神经损伤,3个月后症状消失。结论应用INFIX结合空心钉治疗耻骨联合分离,手术微创,术后疗效优良,并发症发生率低。

Objective To investigate the clinical efficacy of using INFIX combined with hollow nail in the treatment of anterior pelvic ring injury with symphyseolysis.Methods Data of 12 patients with anterior pelvic ring injury and symphyseolysis who were treated from January 2016 to December 2018 were retrospectively analyzed.They were 8 males and 4 females with an average age of 39.5 years(range,23-64 years).There were 4 cases of traffic injury,3 cases of falling injury and 5 cases of crush injury;all the cases were combined with front and rear crush injury.According to Tile classification for pelvic fractures,there were 6 cases of type B1,3 cases of type B3,1 case of type C1 and 2 cases of type C2.Six cases of B1 and 3 cases of B3 patients used percutaneous inter fixation with sacroiliac joint cannulated screw in posterior ring;1 case of C1 and 2 cases of C2 used spinal-pelvic fixation.Every patients'operating time of INFIX combined with the pubic symphysis hollow nail,amount of hemorrhage,length of incisions and number of X-ray projections were recorded.Pelvic X-ray and CT scan were taken postoperatively to observe the reduction and screw position.Postoperative reduction quality was assessed using Matta radiological criteria and Majeed criteria was used at the final follow-up to evaluate the pelvic function.Results The average operating time for 12 patients was 42 min(range,35-56 min);the average amount of hemorrhage was 28 ml(range,15-40 ml);the average length of incision at INFIX nail placement on both sides were 2.7 cm(range,2.2-3.5 cm);the average length of incisions at the pubic symphysis hollow nail placement was 0.8 cm(range,0.6-1.2 cm)and the average number of X-ray projections was 38 times(range,26-55 times).Postoperative X-ray and CT scan showed that all the hollow screws are located accurately and firmly,and pubic symphysis had good reduction and no infection occurred in the surgical incision at the screw placement site.Postoperative reduction quality was evaluated according to Matta radiological criteria,and there were excellent in 10 and good in 2,giving an excellent to good rate of 100%(12/12).The average follow-up time for the 12 patients was 12 months(range,6-15 months).At the final follow-up,all patients showed fine fracture union and no looseness of pubic symphysis occurred according to imaging test.According to the Majeed criteria,the pelvic function was excellent in 8 cases,good in 3 cases and fair in 1 case,giving a good to excellent rate of 91.7%(11/12).One case developed symptoms of femoral nerve compression after surgery and returned to normal after removal of the INFIX.Another case had damage to the lateral femoral cutaneous nerve and the symptoms disappeared after three months.Conclusion Using INFIX combined with hollow nail in the treatment of symphyseolysis can lead to more minimally invasive with excellent postoperative efficacy and markedly reduced the morbidity of complication.