导航下经皮空心螺钉与后路经皮重建钢板内固定治疗DayⅡ型骨盆新月形骨折脱位的疗效比较

Efficacy comparison of navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation for the treatment of Day typeⅡcrescent fracture dislocation of pelvis

目的比较导航下经皮空心螺钉与后路经皮重建钢板内固定治疗DayⅡ型骨盆新月形骨折脱位(CFDP)的临床疗效。方法采用回顾性队列研究分析2012年1月至2021年6月解放军中部战区总医院收治的40例DayⅡ型CFDP患者临床资料,其中男23例,女17例;年龄42~73岁[(54.2±7.8)岁]。19例采用导航下经皮空心螺钉内固定治疗(导航组),21例采用后路经皮重建钢板内固定治疗(钢板组)。比较两组切口长度、手术时间、术中出血量及住院时间。术后2 d采用Matta影像学标准评定骨盆复位质量,术后3,6个月采用Majeed功能评分评价功能恢复情况。观察术后并发症发生情况。结果患者均获随访10~24个月[(13.6±2.9)个月]。导航组切口长度、手术时间、术中出血量、住院时间分别为(2.4±0.3)cm、(43.1±5.2)min、(48.4±18.4)ml、(14.4±1.9)d,钢板组分别为(8.8±0.4)cm、(132.2±19.4)min、(302.9±57.5)ml、(18.9±3.7)d(P均<0.01)。术后2 d Matta影像学标准评定,导航组优13例,满意4例,可2例,优良率为89%;钢板组优15例,满意5例,可1例,优良率为95%(P>0.05)。术后3个月Majeed功能评分,导航组优12例,良5例,可2例,优良率为89%;钢板组优15例,良5例,可1例,优良率为95%(P>0.05)。术后6个月Majeed功能评分,导航组优14例,良4例,可1例,优良率为95%;钢板组优17例,良3例,可1例,优良率为95%(P>0.05)。患者未出现医源性神经血管损伤。导航组1枚骶髂螺钉出现松动,1枚髂骨后螺钉穿出骨内侧皮质,并发症发生率为11%(2/19);钢板组2例出现钢板处皮肤压痛,2例出现下肢深静脉血栓形成,2例出现切口感染,并发症发生率为29%(6/21)(P<0.05)。结论对于DayⅡ型CFDP,导航下经皮空心螺钉与后路经皮重建钢板内固定均可获得满意疗效,但前者具有手术时间短、创伤小、术中出血量少、住院时间短及并发症发生率低等优点。

Objective To compare the clinical outcome of navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation for Day typeⅡcrescent fracture dislocation of pelvis(CFDP).Methods A retrospective cohort analysis was performed on clinical data of 40 patients with Day typeⅡCFDP treated in General Hospital of Central Theater Command of PLA from January 2012 to June 2021.There were 23 males and 17 females,with age range of 42-73 years[(54.2±7.8)years].A total of 19 patients were treated with navigation-assisted percutaneous cannulated screw fixation(navigation group)and 21 with posterior percutaneous plate fixation(plate group).The incision length,operation time,intraoperative blood loss and in-hospital time were compared between the two groups.The reduction quality was evaluated by Matta radiographic standard at day 2 after surgery.The functional recovery was assessed by Majeed functional score at 3 and 6 months after surgery.The postoperative complications were observed.Results All patients were followed up for 10-24 months[(13.6±2.9)months].The incision length,operation time,intraoperative blood loss and in-hospital time was(2.4±0.3)cm,(43.1±5.2)minutes,(48.4±18.4)ml and(14.4±1.9)days in navigation group,showing significant difference compared with plate group[(8.8±0.4)cm,(132.2±19.4)minutes,(302.9±57.5)ml,(18.9±3.7)days](all P<0.01).According to Matta radiographic standard at day 2 after surgery,the excellent and good rate was 89%in navigation group(excellent in 13 patients,satisfactory in 4 and poor in 2)and 95%in plate group(excellent in 15 patients,satisfactory in 5 and poor in 1)(P>0.05).According to Majeed criteria at 3 months after surgery,the excellent and good rate was 89%in navigation group(excellent in 12 patients,good in 5 and poor in 2)and 95%in plate group(excellent in 15 patients,good in 5 and poor in 1)(P>0.05).According to Majeed criteria at 6 months after surgery,the excellent and good rate was 95%in navigation group(excellent in 14 patients,good in 4 and poor in 1)and 95%in plate group(excellent in 17 patients,good in 3 and poor in 1)(P>0.05).There was no iatrogenic neurovascular injury.The incidence of complications was 11%(2/19)in navigation group,including one patients with sacroiliac screw loosening and one with posterior iliac screw penetrating the medial cortex of the bone,while that was 29%(6/21)in plate group,including two patients with skin tenderness,two with deep vein thrombosis in the lower extremity and two with incision infection(P<0.05).Conclusions For Day typeⅡCFDP,both navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation can attain satisfactory efficacy,but the former has advantages of shorter operation time,less surgical trauma,less bleeding,shorter in-hospital time and lower incidence of complications.