经皮空心螺钉固定治疗垂直不稳定型骨盆骨折的临床应用  

Percutaneous screw fixation of unstable pelvic fracture:experience in 14 patients

作　　者：项大业 池永龙[1] 郑安祥 何少波[2] 连永生[2] 

机构地区：[1]乐清市第二人民医院骨科,浙江325608 [2]温州医学院附属第二医院骨科

出　　处：《中华医学杂志》2007年第9期585-589,共5页National Medical Journal of China

摘　　要：目的探讨经皮空心螺钉固定治疗垂直不稳定型骨盆骨折的临床可行性和安全性。方法测量40例18～68岁成人骶骨,CT 水平面扫描图象之最佳体表进钉点和进钉角度,得出结论供临床参考。临床应用14例,男9例,女5例,年龄19～68岁,均为垂直不稳定型骨盆骨折,Tile 分类C_1型11例,C_2型2例,C_3型1例,术前均经大重量牵引纠正移位,仰卧位先行骨盆环经皮内固定,再取俯卧位作骶髂关节经皮空心钉内固定。结果通过40例 CT 片测量,得出标准进针点到躯干中线的距离平均为10.78 cm(9.80～12.00 cm),标准进针角度为61.24°(52.18～68.20°)。临床应用14例均达解剖复位,其中1例螺钉进入椎间孔1/2,有神经症状,于术后21 d 拔除螺钉后症状消失;1例术后耻骨联合因螺钉陷入而分离。经6～24个月随访,14例骨折愈合后恢复原有工作。结论经皮空心螺钉治疗垂直不稳定型骨盆骨折具有操作简单、固定牢固、创伤少、切口小、出血少等优点。Objective To evaluate the clinical feasibility and safety of percutaneous screw fixation in the management of vertically unstable pelvic fractures. Methods Forty S1 CT films of orthopedic patients aged 18 -73, were analyzed so as to provide the best screw entrance point and angle for screw entrance. The data thus obtained were used on 14 patients with unequivocally vertical unstable pelvic fractures, 11 cases being of Tile Cl type, 2 of C2 type, and 1 of C type, 9 males and 5 females, aged 19 to 68. All the patients received heavy traction to reduce displacement before the surgery. Percutaneous pelvic screw fixation of the disrupted pelvic ring was performed when the patients were in the supine position, and then fixation of sacroiliac joint was performed when the patients were in the prone position. Results S1 CT scanning showed an average distance from the standard screw entrance point to the backbone of 10.78 cm （9.80 - 12. 00 cm）, and a standard screw entrance angle of 61.24° （52. 18 - 68.20°）. Anatomic reduction was achieved in all 14 patients. One patient had neurological deficit due to the screw penetrating into 1/2 of the intervertebral foramen, but the side-effect was released when the screw was removed 21 days after operation. A 6-24 months postoperative follow-up revealed that all the patients had recovered from fracture and resumed their previous work. Conclusion With advantages including simple procedures, better bony stability, minimal invasion of compromised soft tissue and limited blood loss, percutaneous screw fixation is a practical technique which can be widely used to treat vertical unstable pelvic fracture.

关 键 词：骨折固定术内 骨折固定术 骨盆 

分 类 号：R687.3[医药卫生—骨科学]