耻骨联合矫形加压解剖接骨板固定治疗耻骨联合周围骨折或脱位的疗效分析

The pubic symphysis orthotic compression anatomic plate for treatment of fractures and dislocations around the pubic symphysis

目的探讨耻骨联合矫形加压解剖接骨板(PSOCAP)固定治疗耻骨联合周围骨折或脱位的临床疗效。方法回顾性分析2021年1月至2022年6月期间南方医科大学第三附属医院骨科医学中心创伤骨科采用PSOCAP治疗的16例耻骨联合周围骨折或脱位患者资料。男8例,女8例;年龄(41±19)岁;骨盆骨折Tile分型:B1型3例,B3型2例;C1.2型1例,C1.3型4例,C2型3例,C3型3例。耻骨联合周围损伤类型:耻骨联合分离8例,耻骨支骨折8例(NakataniⅠ区2例,Ⅱ区6例)。受伤至手术时间16(11,53)d,范围值为4~348 d。耻骨联合周围骨折或脱位采用改良Stoppa入路显露、PSOCAP辅助复位、固定,骨盆后环采用相应手术方法复位固定。记录患者骨盆前环的手术时间、术中出血量、术后骨折复位质量、手术并发症及末次随访时骨盆功能等。结果16例患者顺利完成手术,骨盆前环的手术时间为(58±15)min,范围值为40~90 min;术中出血量为85(63,150)mL,范围值为50~250 mL。术后骨折复位质量按Matta评分标准评定:优10例,良3例,可3例。16例患者术后获(10±3)个月随访,骨折均获愈合,愈合时间为(12±2)周;末次随访时根据骨盆Majeed评分系统评定骨盆功能:优5例,良7例,可4例。随访期间无一例患者发生骨折移位、内固定失效等并发症。结论PSOCAP为双平面、一体化设计,可辅助复位耻骨联合周围骨折或脱位,实现解剖复位和坚强内固定,临床疗效良好。

Objective To evaluate our self-designed pubic symphysis orthotic compression anatomic plate(PSOCAP)in the treatment of fractures and dislocations around the pubic symphysis.Methods A retrospective study was conducted to analyze the 16 patients with fracture or dislocation around the pubic symphysis who had been treated by our self-designed PSOCAP at Department of Traumatic Surgery,Center for Orthopaedic Surgery,The Third Hospital Affiliated to Southern Medical University from January 2021 to June 2022.There were 8 males and 8 females with an age of(41±19)years.According to the Tile classification for pelvic fractures,there were 3 cases of type B1,2 cases of type B3,1 case of type C1.2,4 cases of type C1.3,3 cases of type C2,and 3 cases of type C3.There were 8 cases of pubic symphysis separation and 8 fractures of the pubic ramus(2 ones at Nakatani zoneⅠand 6 ones at Nakatani zoneⅡ).Time from injury to surgery was 16(11,53)days,ranging from 4 to 348 days.The fractures or dislocations around the pubic symphysis were exposed by the modified Stoppa approach,reduced with the assistance of PSOCAP and fixated with PSOCAP;the posterior pelvic ring was reduced and fixated by corresponding surgical methods.Recorded were the surgical time,intraoperative bleeding,postoperative quality of fracture reduction,surgical complications,and functional recovery at the last follow-up concerning the pelvic anterior ring.Results Surgery went on successfully in the 16 patients.Their surgical time was(58±15)min,ranging from 40 to 90 min,and their intraoperative bleeding 85(63,150)mL,ranging from 50 to 250 mL.According to the Matta scoring,the fracture reduction was evaluated as excellent in 10 cases,as good in 3 cases and as fair in 3 cases.The(10±3)-month follow-up for the 16 patients revealed complete fracture union for all after(12±2)weeks.According to the Majeed scoring at the last follow-up,the pelvic function was evaluated as excellent in 5 cases,as good in 7 cases,and as fair in 4 cases.No such postoperative complications as fracture displacement or internal fixation failure occurred.Conclusion Owing to the biplane and integrated structure,our self-designed PSOCAP can help reduce the fractures or dislocations around the pubic symphysis to achieve anatomical reduction and strong internal fixation,leading to good clinical efficacy.