腰髂固定联合经皮骨盆前环固定治疗垂直旋转不稳定型骨盆环骨折

Treatment of unstable pelvic ring injury by posterior lumbo-iliac fixation combined with minimally invasive percutaneous anterior pelvic ring internal fixation

目的 探讨腰髂固定联合经皮骨盆前环固定治疗垂直旋转不稳定型骨盆环骨折的近期临床疗效。方法 收集了新疆维吾尔自治区人民医院2018年9月至2022年1月接诊的不稳定型骨盆环损伤并接受前路皮下内固定(INFIX)联合后路腰椎-骨盆内固定治疗的患者进行回顾性分析。采用Matta标准对骨盆复位质量进行评估,Majeed评分对患者临床结果进行评估。进一步评估手术时间、术中失血量和并发症发生情况。结果 患者随访平均时间为12.6个月(6~18个月),其中前路皮下INFIX联合后路腰椎-骨盆内固定的平均手术时间和术中失血量分别为117.6 min(96~162 min)和203.6 mL(146~280 mL),复位质量优良率86.8%(优25例,良好8例,一般5例,差0例),无异位骨化迹象。末次随访时,Majeed评分的临床结果:优良率84.2%(优28例,良好4例,一般4例,差2例)。骶神经根损伤患者共6例,并进行术中减压,5例患者症状改善;2例前路INFIX术后感染,4周取内固定后好转;3例股外侧皮神经刺激。结论 腰髂固定联合经皮骨盆前环固定治疗垂直旋转不稳定型骨盆环骨折具有手术时间短、出血少、术中软组织损伤降低等优点,近期临床疗效满意。

Objective To investigate the short-term clinical effect of lumbo-iliac fixation combined with percutaneous anterior pelvic ring fixation in the treatment of vertically rotating unstable pelvic ring fractures.Methods Patients with unstable pelvic ring injury who were treated with anterior subcutaneous internal fixation(INFIX) combined with posterior lumbar inter-pelvic internal fixation were collected and analyzed retrospectively from September 2018 to January 2022.The Matta standard was used to evaluate the quality of pelvic reduction,and the Majeed score was used to evaluate the clinical outcomes of patients.Further evaluation included surgical time,intraoperative blood loss,and incidence of complications.Results The average follow-up time of patients was 12.6 months(6-18 months).The average operation time and intraoperative blood loss were 117.6 min(96-162 min) and 203.6 m L(146-280 m L) respectively for anterior subcutaneous INFIX combined with posterior lumbar inter-pelvic internal fixation.The excellent and good rate of reduction quality was 86.8%(25 cases were excellent,8 cases were good,5 cases were average,and 0 case was poor).There was no sign of heterotopic ossification.At the last follow-up,the clinical results of Majeed's score showed that the excellent and good rate was 84.2%(excellent in 28 cases,good in 4 cases,general in 4 cases,poor in 2 cases).A total of 6 patients with sacral nerve root injury underwent intraoperative decompression,and the symptoms of 5 patients improved.Two cases of infection after anterior INFIX were improved after 4 weeks of internal fixation.Lateral femoral cutaneous nerve stimulation in 3 cases.Conclusion The treatment of vertically rotating unstable pelvic ring fracture with lumbo-iliac fixation combined with percutaneous anterior pelvic ring fixation has the advantages of short operation time,less bleeding and less intraoperative soft tissue damage,and the short-term clinical effect is satisfactory.