摘要
目的比较微创经皮桥式内固定支架与传统外固定支架治疗不稳定骨盆骨折的疗效。方法回顾分析2013年1月—2018年2月收治的符合选择标准的45例不稳定骨盆骨折患者临床资料,根据手术方式不同分为两组,观察组(25例)采用微创经皮桥式内固定支架固定,术前采用3D打印实体模型制定个体化复位策略,并模拟植钉;对照组(20例)采用传统外固定支架固定。两组患者性别、年龄、致伤原因、骨折Tile分型及受伤至手术时间等一般资料比较差异无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、骨折愈合时间及并发症发生情况;复位质量按Matta标准进行评价,末次随访时按Majeed评分标准评价功能。结果患者均获随访,随访时间12~20个月,平均15个月。观察组手术时间明显长于对照组(t=2.719,P=0.009),术中出血量两组比较差异无统计学意义(t=0.784,P=0.437)。骨折愈合时间两组比较差异无统计学意义(t=0.967,P=0.341)。根据Matta标准评价复位质量,观察组优良率92%,对照组70%,两组比较差异无统计学意义(χ2=3.748,P=0.053);末次随访时采用Majeed评分标准评价功能,观察组优良率88%,对照组优良率60%,两组比较差异有统计学意义(χ2=4.717,P=0.030)。术后切口及钉道感染、骨折二次移位及畸形愈合发生率观察组均低于对照组,差异有统计学意义(P<0.05);两组股外侧皮神经医源性损伤、深静脉血栓形成及固定物松动发生率比较,差异均无统计学意义(P>0.05)。结论微创经皮桥式内固定支架治疗不稳定骨盆骨折,具有创伤小、固定稳定,对患者日常生活干扰少、有利于早期功能锻炼等特点,是一种安全、有效的治疗术式。
Objective To evaluate the effectiveness of unstable pelvic fractures treated with minimally invasive percutaneous bridge internal fixator or traditional external fixator.Methods The clinical data of 45 patients with unstable pelvic fractures who met the selection criteria between January 2013 and February 2018 were retrospectively analyzed.According to the different surgical methods,they were divided into two groups.In the observation group(25 cases),minimally invasive percutaneous bridge internal fixators were used,and three-dimensional printing pelvic models were used to simulate the reduction and fixation before operation to develop individual reduction strategies.In the control group(20 cases),external fixators were used.There was no significant difference between the two groups in gender,age,cause of injury,fracture type(according to Tile classification),and time from injury to operation(P>0.05).The operation time,intraoperative blood loss,fracture healing time,and complications were recorded and compared between the two groups.The reduction quality was evaluated according to the Matta standard,and functional recovery was evaluated according to the Majeed scoring standard.Results All patients were followed up 12-20 months(mean,15 months).The operation time of the observation group was significantly longer than that of the control group(t=2.719,P=0.009);no significant difference in intraoperative blood loss was found between the two groups(t=0.784,P=0.437).There was no significant difference between the two groups in fracture healing time(t=0.967,P=0.341).According to the Matta standard,the excellent and good rate of the observation group was 92%,and that of the control group was 70%,showing no significant difference between the two groups(χ2=3.748,P=0.053).At last follow-up,according to the Majeed scoring standard,the excellent and good rate of the observation group was 88%,and that of the control group was 60%,showing significant difference between the two groups(χ2=4.717,P=0.030).The incidences of incision and nailway infection,secondary displacement of fracture,and malunion in the observation group were significantly lower than those in the control group(P<0.05);the differences in incidences of iatrogenic injury of lateral femoral cutaneous nerve,deep vein thrombosis,and loosening of fixation between the two groups were not significant(P>0.05).Conclusion Minimally invasive percutaneous bridge internal fixator is a safe and effective method for the treatment of unstable pelvic fractures.It has the advantages of minimal trauma,stable fixation,less interference to patients’daily life,early functional exercise,and quickly recovery after operation.
作者
吴刚
谭伦
李邦青
张才东
张志伟
WU Gang;TAN Lun;LI Bangqing;ZHANG Caidong;ZHANG Zhiwei(Department of Orthopaedics,The 4th People’s Hospital of Zigong,Zigong Sichuan,643000,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第5期563-568,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
不稳定骨盆骨折
微创
经皮桥式内固定支架
外固定支架
Unstable pelvic fracture
minimally invasive
percutaneous bridge internal fixator
external fixator
