摘要
目的探讨经皮双侧髂前下棘及耻骨结节行椎弓根钉棒系统内固定治疗骨盆前环骨折的临床效果。方法回顾性分析2016年1月至2019年1月收治的30例骨盆骨折患者的临床资料,其中男17例,女13例;平均年龄(50.6±19.3)岁。骨折按Tile分型:B1型5例,B2型22例,B3型3例。均采用经皮双侧髂前下棘及耻骨结节置入椎弓根钉棒系统行内固定支架治疗。观察患者手术时间、术中出血量、术后并发症情况。骨盆复位按照Matta影像学标准评价,功能恢复采用Majeed评分系统评价。结果本组手术时间平均(47.2±5.6)min,术中出血量平均(29.4±5.4)ml,手术切口均Ⅰ期愈合。30例患者随访6~15个月,平均(10.5±2.7)个月,骨折均愈合,愈合时间平均(12.3±1.2)周,术后平均(19.8±2.4)周取出内固定。术后复查摄骨盆X线,骨折复位按Matta影像学评分标准:优22例,良4例,中4例,优良率为86.7%。术后功能按Majeed评分:优21例,良6例,中3例,优良率为90.0%。本组无手术切口感染、骨折不愈合、骨化性肌炎、内固定松动断裂发生,无膀胱、尿道及生殖系统损伤;单侧股外侧皮神经刺激引起大腿麻木3例(10.0%)。结论经皮椎弓根钉棒系统内固定治疗骨盆前环骨折创伤小、出血少、并发症少,临床效果确切。
Objective To investigate the clinical effect of internal fixation of the percutaneous pedicle screw rod system placed by bilateral anterior inferior iliac spine and spina pubis for the treatment of anterior pelvic ring fractures.Methods Retrospective analysis was performed on 30 patients with pelvic fracture admitted from January 2016 to January 2019,including 17 males and 13 females.The average age was(50.6±19.3)years old.There were 5 cases of type B1,22 cases of type B2 and 3 cases of type B3 according to Tile typing.Internal fixation of percutaneous pedicle screw rod system was placed by bilateral anterior inferior iliac spine and spina pubis was performed in all cases.The operative time,intra-operative blood loss and postoperative complications were observed.Results All 30 patients accomplished the surgery with(47.2±5.6)min o f operation time and(29.4±5.4)ml of intra-operative blood loss.All cases were followed up for 6 to 15 months with an average of(10.5±2.7)months.The fractures achieved healing during(12.3±1.2)weeks,and the internal fixators were removed during(19.8±2.4)weeks after the surgery.The quality of fracture reduction revealed that excellence in 22 cases,good in 4 cases,fair in 4 and 86.7%of the fineness rate according to Matta criteria.The postoperative function showed that 21 of excellence,6 of good,3 of fair and 90.0%of the fineness rate based on Majeed score criteria.There was no incision infection,nonunion of fracture,myositis ossificans,loosening and breakage of internal fixator,injury of bladder,urethra and reproductive system.The symptom of thigh numbness due to unilateral lateral femoral cutaneous nerve stimulation was found in 3 cases(10.0%).Conclusion The internal fixation of percutaneous pedicle screw system placed by bilateral anterior inferior iliac spine and spina pubis is an effective surgical treatment for the pelvic anterior ring fracture with mini-trauma,less bleeding and complications.
作者
李玉军
张传寅
张亮
蒋毅
梁钟鸣
张燕鹏
周建伟
LI Yu-jun;ZHANG Chuan-yin;ZHANG Liang;JIANG Yi;LIANG Zhong-ming;ZHANG Yan-peng;ZHOU Jian-wei(Department of Orthopedics,Renhe Hospital of Baoshan,Shanghai 200431,China)
出处
《中国现代手术学杂志》
2021年第3期188-191,共4页
Chinese Journal of Modern Operative Surgery
基金
上海市宝山区仁和医院重点学科建设-骨科(项目编号:YXK-2018-05B)。
关键词
骨盆骨折
骨折固定术
内
钉棒系统
pelvic fractures
fracture fixation,internal
pedicle screw system
