个性化定制前环皮下内置外固定架在老年骨盆骨折中的应用

Application of personalized infix in elderly pelvic fractures

目的探讨个性化定制前环皮下内置外固定架(anterior subcutaneous internal fixation,INFIX治疗老年骨盆骨折的临床疗效。方法2019年1月至2021年12月采用个性化定制INFIX治疗老年骨盆骨折27例,受伤至手术时间为7~30天,平均(13.1±1.8)天。所有病历通过术前CT数据,结合Mimics17.0软件,采用3D打印及镜面技术,个性化定制INFIX治疗老年骨盆骨折,记录术前、术后第2天及随访结束时视觉模拟评分(visual analogue scale,VAS)进行疼痛评估,根据Matta放射学评定标准对复位质量进行评价,详细记录并发症的发生情况,应用Majeed功能评分和Koval指数评定术后功能。结果26例获得有效随访,其中男6例,女20例,年龄为61~89岁,平均(78.6±2.3)岁,按照老年脆性骨盆骨折(fragility fracture of the pelvis,FFP)分型,Ⅱ型8例,Ⅲ型16例,Ⅳ型2例,随访4~12个月,平均(5.8±2.1)个月。疼痛评估情况:术前VAS评分平均为(6.8±0.8)分(5~9分),术后第2天VAS评分(3.1±0.6)分(1~5分);随访结束时VAS评分(3.4±0.7)分(2~6分);根据Matta标椎,复位优良率92.3%;5例发生并发症:股外侧皮神经刺激2例,异位骨化2例,内固定松动1例,无股神经损伤及切口感染病例;Majeed功能评分优良率为80.8%;Koval指数评定有3例患者由室外行走降至室内行走,衰减率为11.5%。结论个性化定制INFIX治疗老年骨盆骨折,可以有效缓解疼痛,稳定骨盆前环损伤,同时可以改进INFIX技术,缩短手术时间,降低术后并发症。

Objective To explore the clinical efflcacy of personalized inflx in the treatment of elderly pelvic fractures.Methods From January 2019 to December 2021,27 elderly patients with pelvic fractures were treated with customized inflx.The average time from injury to operation was(13.1±1.8)days(range:7-30 days).Combining preoperative CT data,Mimics17.0 software,3D printing and mirror technology,customized inflx was made to treat elderly pelvic fractures.VAS scores before operation,the second day after operation and at the end of follow-up were recorded.Quality of repositioning according to Matta radiology evaluation standard was recorded.The occurrence of complications was observed in detail.Postoperative function was evaluated by Majeed function score and Koval index.Results A series of 26 patients were followed up effectively,including 6 males and 20 females,with an average age of(78.6±2.3)years(range:61-89 years).According to FFP classiflcation,there were 8 cases of typeⅡ,16 cases of typeⅢand 2 cases of typeⅣ,with an average follow-up of(5.8±2.1)months(range:4-12 months).VAS score:(6.8±0.8)(range:5-9)preoperatively;(3.1±0.6)(range:1-5)the second day after operation;(3.4±0.7)(range:2-6)at the end of follow-up.According to Matta standard,the excellent and good rate of reduction was 92.3%.Complications occurred in 5 patients:lateral femoral cutaneous nerve stimulation in 2 cases,heterotopic ossiflcation in 2 cases,internal flxation loosening in 1 case,no femoral nerve injury or wound infection was observed.The excellent and good rate of Majeed function score was 80.8%.According to Koval index,3 patients attenuated from outdoor walking to indoor walking,and the attenuation rate was 11.5%.Conclusions Personalized inflx can effectively relieve pain and stabilize the injury of anterior pelvic ring in the treatment of elderly pelvic fractures.At the same time,it can improve inflx technology,shorten the operation time and reduce postoperative complications.