微创手术治疗老年人脆性骨盆骨折

Minimal invasive surgery for fragility fracture of pelvis in elderly patients

目的探讨微创手术治疗老年人脆性骨盆骨折的疗效。方法回顾性分析2015年1月至2019年12月采用微创手术治疗老年脆性骨盆骨折并获得随访患者,基于骨盆脆性骨折(FFP)分型对老年脆性骨盆骨折患者行骨盆前环不稳的内固定架(INFIX)加后环骶髂螺钉或髂窝入路切开复位内固定术。记录患者年龄,受伤机制,受伤至手术时间,术前、术后视觉模拟评分法(VAS)评分,手术出血量,围手术期并发症,术后下地活动时间,随访术后2年死亡率和Koval行走能力指数以评价微创手术治疗老年人骨盆骨折的临床疗效。结果随访32例,其中男11例,女21例,年龄65~88岁,平均(76.9±5.5)岁。受伤机制59.4%(19/32)为平地摔倒,25.0%(8/32)为坐位摔倒,15.6%(5/32)例外伤史不详。受伤至手术时间3~36 d,平均(9.6±3.3)d。老年人脆性骨盆骨折FFP分型包括Ⅱ型50.0%(16/32),Ⅲ型31.3%(10/32),Ⅳ型18.8%(6/32)。患者术前VAS评分5~9分,平均(6.41±1.07)分;术后VAS评分1~4分,平均(1.71±0.63)分。手术出血量20~200 ml,平均(65.9±35.2)ml。围术期并发症发生率9.4%(3/32),其中消化道出血1例,下肢深静脉血栓形成1例,伤口浅表感染1例。56.3%(18/32)患者术后4周下地活动,31.3%(10/32)患者术后6周下地活动,12.5%(4/32)患者术后8周下地活动。术后24个月随访死亡6.3%(2/32),其余30例患者Koval行走指数1级46.9%(15/32),2级18.8%(6/32),3级6.3%(2/32),4级18.8%(6/32),6级3.1%(1/32)(手术后1年脑梗后肢体偏瘫卧床)。结论微创手术治疗老年脆性骨盆骨折能够显著改善患者疼痛症状,允许患者早期离床活动。

Objective To evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of elderly patients with fragility fracture of pelvis.Methods Elderly patients with fragile pelvic fractures undergoing minimally invasive surgery and being followed up were retrospectively analyzed from January 2015 to December 2019.Based on the classification of pelvic fragile fractures(FFP),open reduction and internal fixation with pelvic anterior ring instability internal fixator(INFIX)plus posterior ring sacroiliac screw,or open reduction and internal fixation with iliac fossa approach,were performed for elderly patients with fragile pelvic fractures.The general data of all patients(age,sex,mechanism of injury)were recorded.Time from injury to operation,VAS(visual analogue scale)before and after operation,blood loss during operation,complications during hospitalization,time to ambulation,mortality,and Koval walking index at 2 year follow-up were recorded to evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of fragility fracture of pelvis.Results Thirty-two patients were followed up,including 11 males and 21 females,aged 65-88 years(76.9±5.5)years.The mechanism of injury was fall on the ground as a percentage of 59.4%(19/32),fall in the sitting position as a percentage of 25.0%(8/32),and 15.63%(5/32)had unknown history of trauma.The time from injury to operation was 3-36 days(9.6±3.3)days.There were 50.0%(16/32)typeⅡ,31.3%(10/32)typeⅢand 18.8%(6/32)typeⅣcases according to FFP classification.The mean blood loss during operation was(65.9±35.2)ml(range,20-200 ml).The preoperative VAS score was 5-9 scores,with an average of(6.41±1.07)scores.The postoperative VAS score was 1-4(1.71±0.63).Average time from injury to operation was(9.6±3.3)days(range,3~36).The incidence of complications during operation was 9.4%(3/32),including 1 case of gastrointestinal bleeding,1 case of lower extremity deep vein thrombosis,and 1 case of superficial wound infection.Ambulation was at 4 weeks post-operation in 56.3%(18/32)cases,at 6 weeks post-operation in 31.3%(10/32)cases and at 8 weeks post-operation in 12.5%(4/32)cases.6.25%(2/32)patients died within 2 year follow-up.Koval walking index of the rest 30 patients included grade 1 in 46.9%(15/32)cases,grade 2 in 18.8%(6/32)cases,grade 3 in 6.3%(2/32)cases,grade 4 in 18.8%(6/32)cases and grade 6 in 3.1%(1/32)case(1 year after surgery,hemiplegia after cerebral infarction).Conclusions Minimal invasive surgery achieves significant pain relief and early mobilization in patients with fragility fracture of pelvis.