Tile B骨盆骨折外固定是否耻骨支置钉的比较

External frame with or without pubic ramus pining for Tile type B pelvic fractures

[目的]比较外固定架治疗Tile B型骨盆骨折是否耻骨支置钉的临床效果。[方法]回顾性分析2019年1月—2022年4月外固定架治疗42例Tile B型骨盆骨折患者的临床资料,依据术前医患沟通结果,22例采用髂骨-耻骨支联合置钉外固定(耻骨钉组),另外20例单纯髂骨置钉外固定(无耻骨钉组)。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术,未发生血管、神经损伤等并发症。耻骨钉组手术时间[(36.8±5.8)min vs(24.5±5.1)min,P<0.001]、切口总长度[(6.1±0.6)cm vs(4.1±0.5)cm,P<0.001]、术中失血量[(27.9±7.2)ml vs(17.1±6.8)ml,P<0.001]和术中透视次数[(9.1±1.8)次vs(6.6±1.6)次,P<0.001]均显著多于无耻骨钉组,但前者下地行走时间[(22.8±2.4)d vs(41.9±3.8)d,P<0.001]、住院时间[(12.2±1.8)d vs(19.4±2.8)d,P<0.001]、完全负重活动时间[(45.7±6.6)d vs(60.7±9.4)d,P<0.001]均显著优于无耻骨钉组。随术后时间推移,两组VAS评分、髋伸屈ROM、内外旋ROM和Majeed评分均显著改善(P<0.05);术后1个月耻骨钉组在VAS评分[(2.8±1.1)vs(4.2±1.7),P=0.004]、髋伸屈ROM[(147.8±13.3)°vs(139.5±11.9)°,P=0.038]、内外旋ROM[(69.8±8.4)°vs(64.2±6.2)°,P=0.020]和Majeed评分[(76.1±9.3)vs(65.2±7.0),P<0.001]均显著优于无耻骨钉组。影像学方面,两组骨折复位质量和骨折愈合时间的差异无统计学意义(P>0.05)。[结论]髂骨-耻骨支联合置钉外固定支架治疗Tile B型骨盆骨折的临床效果优于无耻骨钉支架。

[Objective]To compare the clinical consequences of external frame fixation of Tile type B pelvic fractures with or without pubic ramus pining.[Methods]A retrospective research was performed on 42 patients who were treated with external fixators for Tile type B pelvic fractures from January 2019 to April 2022.According to the results of preoperative patient-patient discussion,22 patients re⁃ceived external frame with iliac crest and pubic ramus pining(PRP group),while the other 20 patients underwent external fixator with iliac crest pining alone(non-PRP group).The perioperative,follow-up and imaging documents of the two groups were compared.[Results]All the patients in both groups were operated smoothly,with no vascular,nerve injury and other complications.The PRP group was significantly greater than the non-PRP group in terms of operation time[(36.8±5.8)min vs(24.5±5.1)min,P<0.001],the total length of incision[(6.1±0.6)cm vs(4.1±0.5)cm,P<0.001],intraoperative blood loss[(27.9±7.2)ml vs(17.1±6.8)ml,P<0.001]and intraoperative fluoroscopy times[(9.1±1.8)times vs(6.6±1.6)times,P<0.001],but the former proved significantly superior to the latter in terms of the time to resume walk⁃ing[(22.8±2.4)days vs(41.9±3.8)days,P<0.001],hospital stay[(12.2±1.8)days vs(19.4±2.8)days,P<0.001]and the time recover full weight-bearing activity[(45.7±6.6)days vs(60.7±9.4)days,P<0.001].The VAS scores,hip flexion-extension range of motion(ROM),inter⁃nal and external rotation ROM and Majeed scores were significantly improved in both groups with postoperative time(P<0.05).The PRP group was significantly better than the non-PRP group regarding VAS score[(2.8±1.1)vs(4.2±1.7),P=0.004],hip extension-flexion ROM[(147.8±13.3)°vs(139.5±11.9)°,P=0.038],the internal-external rotation ROM[(69.8±8.4)°vs(64.2±6.2)°,P=0.020]and Majeed scores[(76.1±9.3)vs(65.2±7.0),P<0.001]one month after operation.With respect of imaging,there were no statistically significant differences in fracture reduction quality and fracture healing time between the two groups(P>0.05).[Conclusion]The clinical effect of external fixator with both iliac and pubic ramus pining is considerably better than that with iliac pining only for Tile type B pelvic fractures.