组合式腰椎骨盆固定治疗陈旧性骨盆垂直不稳定骨折脱位

Combined lumbar pelvic fixator for treatment of unstable vertical fracture and dislocation of old posterior pelvic ring

目的探讨应用组合式腰椎骨盆固定装置治疗陈旧性骨盆垂直不稳定骨折脱位的临床疗效。方法回顾性分析2017年1月至2020年4月收治且获得随访的7例陈旧性骨盆垂直不稳定骨折脱位患者资料,男4例,女3例;年龄22~73岁,平均42.4岁;交通伤3例,坠落伤3例,摔伤1例。骨盆骨折按Tile分型:C1型5例,C2型1例,C3型1例;骨折至手术时间3~10周,平均5.4周。7例患者中,4例后环骨折采用组合式腰椎骨盆三角固定,3例后环骨折采用组合式腰椎骨盆固定;4例前环损伤未做处理,2例前环损伤行闭合空心钉内固定,1例前环损伤行INFIX+空心钉固定。记录每例患者腰椎骨盆固定手术时间、术中出血量、切口长度、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固定钉位置,应用Matta的X线评价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7例患者手术时间96~205 min,平均143 min;术中出血量300~1650 ml,平均579 ml;切口长度9~15 cm,平均12.9 cm;X线透视次数15~52次,平均27次。术后X线片及CT检查示后环位移复位良好,所有螺钉位置均准确,固定牢固。术后Matta的X线评定:优4例,良2例,可1例,优良率为85.7%(6/7)。7例患者术后均获得随访,随访时间6~16个月,平均12个月。7例患者骨折愈合良好,愈合时间12~20周,平均14.2周。末次随访时,影像学检查均示骶髂关节复位良好,前、后环复位未丢失。Majeed评分,术后(54.90±6.64)分(范围48~58分),术后3个月(71.40±7.32)分(范围67~75分),术后6个月(84.90±8.14)分(范围68~96分),差异有统计学意义(F=0.614,P=0.004);术后6个月Majeed评价,优5例、良1例、可1例,优良率为85.7%(6/7)。结论应用组合式腰椎骨盆固定装置治疗陈旧性骨盆垂直不稳定骨折脱位,复位质量佳,固定强度大,术后疗效优良。

Objective To investigate the clinical effect of using combined lumbar pelvis fixation device in the treatment of old vertical unstable fracture dislocation of posterior pelvic ring.Methods Data of 7 patients with old vertical unstable fracture dislocation of posterior pelvic ring admitted and followed up from January 2017 to April 2020 were retrospectively analyzed,including 4 males and 3 females with an average age of 42.4 years old(range,22-73 years old).There were 3 cases of traffic injury,3 cases of falling injury and 1 case of tumble injury.According to Tile classification for pelvic fractures,there were 5 cases of type C1,1 case of type C2 and 1 case of type C3.The average time from fracture to surgery was 5.4 weeks(range,3-10 weeks).Among the 7 patients,4 patients'posterior ring fractures were fixed by combined lumbar pelvic triangle fixation,and 3 patients'posterior ring fracture were fixed by combined lumbar pelvic fixation.4 patients'anterior ring injury were not treated,2 patients'anterior ring injury were treated by closed cannulated screw and internal fixation,and 1 patient's anterior ring injury was fixed by INFIX and cannulated screw.Every patient's operating time,intraoperative blood loss,length of incision and times of X-ray fluoroscopy were recorded.Pelvic X-ray and CT scan were taken postoperatively to observe the condition of reduction and screw position.Postoperative fracture reduction quality was assessed by Matta radiological criteria and Majeed criteria was used at the final follow-ups to evaluate the degree of functional recovery after pelvic fracture.Results The average operating time of 7 patients was 143 min(range,96-205 min);the intraoperative average blood loss was 579 ml(range,300-1650 ml);the average length of incisions was 12.9 cm(range,9-15 cm)and the average time of X-ray fluoroscopy was 27 times(range,15-52 times).Postoperative X-ray and CT scan showed that the displacements of the posterior rings were reset well and all the hollow screws were located accurately and firmly.Postoperative radiation quality was evaluated according to Matta radiological criteria,and there were 4 cases of excellent,2 cases of good and 1 case of fair,with an excellent and good rate of 85.7%(6/7).Seven patients had good fracture union.The average followed up time for all 7 patients was 12 months(range,6-16 months).At the last follow-up,imaging examination showed good reduction of the sacroiliac joint,and the reduction of anterior and posterior rings were not lost.The healing time was 14.2 weeks(range,12-20 weeks).Majeed score:postoperative 4.90±6.64 points(range,48-58 points),postoperative 3 months 71.40±7.32 points(range,67-75 points),postoperative 6 months 84.90±8.14 points(range,68-96 points),the difference was statistically significant(F=0.614,P=0.004).Majeed score 6 months after operation showed that 5 cases were excellent,1 case was good and 1 case was fair,and the excellent and good rate was 85.7%(6/7).Conclusion Using combined lumbar pelvis fixation device in the treatment of old vertical unstable fracture dislocation of posterior pelvic ring has good reduction quality,high fixed strength and good postoperative effect.