长重建钢板结合MIPPO技术固定骨盆前环骨折

Fixation of anterior pelvic ring fracture with long reconstruction plate combined with MIPPO technique

目的:探讨长重建钢板结合微创经皮钢板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPO)技术治疗不稳定骨盆骨折前环骨折疗效。方法:自2013年1月至2019年2月收治16例不稳定骨盆骨折患者,其中男12例,女4例;年龄20~60岁,平均46.5岁。骨盆骨折依据Tile分型,B1型4例,B2型6例,C1型4例,C2型2例。所有骨折为闭合性,受伤至手术时间7~10 d,平均6.2 d。术后对16例患者手术时间、术中出血量、骨折复位质量、骨折愈合时间、并发症情况及肢体功能进行评价。结果:16例患者均获得随访,时间12~23个月,平均19.1个月。手术时间60~180 min,平均107.8 min;术中出血量120~600 ml,平均368.1 ml;骨折愈合时间12~20周,平均16.3周。依据Matta标准对骨折复位情况进行评价,优6例,良8例,可2例。1例患者术中股外侧皮神经损伤,术后出现大腿外侧感觉减退,6个月后恢复;1例患者由于自觉髂窝处内固定物刺激疼痛,内固定取出后症状改善,16例患者骨折均取得满意愈合,无内固定物松动。末次随访Majeed评分67~95分,优10例,良4例,可2例。结论:运用长重建钢板结合MIPPO技术通过前方入路闭合复位固定骨盆前环骨折,损伤小,术中出血时间少,节省手术时间,术中安全性及骨折愈合率高,术后可早期功能锻炼,能有效治疗骨盆前环骨折。

Objective:To evaluate the efficacy of long reconstruction plate combined with minimally invasive percutaneous plate osteosynthesis(MIPPO)technique in the treatment of unstable pelvic anterior ring fractures.Methods:From January 2013 to February 2019,16 patients with unstable pelvic fracture were treated,including 12 males and 4 females,aged from 20 to 60 years(mean 46.5 years).According to Tile classification,there were 4 cases of type B1,6 cases of type B2,4 cases of type C1 and 2 cases of type C2.The fracture of all patients was closed,and the time from injury to operation was 7 to 10 days with an average of 6.2 days.The operation time,intraoperative blood loss,fracture reduction quality,fracture healing time,complications and limb function during the final follow-up were evaluated in 16 patients.Results:All 16 patients were followed up for 12 to 23 months(mean 19.1 months).The operation time was 60 to 180 min(mean 107.8 min).The intraoperative blood loss was 120 to 600 ml(mean 368.1 ml).The fracture healing time was 12 to 20 weeks(mean 16.3 weeks).According to Matta criteria,the fracture reduction was excellent in 6 cases,good in 8 cases and fair in 2 cases.One patient suffered from lateral femoral cutaneous nerve injury during the operation,and the lateral thigh sensation decreased after operation,which recovered after 6 months.One patient had pain stimulated by internal fixation at the iliac fossa.The symptoms were improved after the internal fixation was removed.The fractures of 16 patients were healed satisfactorily and there was no internal fixation loosening.Majeed score at the final follow-up was 67 to 95,excellent in 10 cases,good in 4 cases and fair in 2 cases.Conclusion:Closed reduction and fixation of pelvic anterior ring fracture with long reconstruction plate combined with MIPPO technique through anterior approach has the advantages of less injury,less bleeding time during operation,saving operation time,high intraoperative safety,high fracture healing rate,early functional exercise after operation,and effective treatment of pelvic anterior ring fracture.