经皮骶髂螺钉固定技术治疗不稳定骨盆骨折的疗效评价  

EVALUATION OF PERCUTANEOUS ILIOSACRAL SCREWS FOR UNSTABLE PELVIC FRACTURES

作　　者：高伟强[1] 王光林[1] 刘华渝[1] 吴刚[1] 池雷霆[1] 方跃[1] 刘雷[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2008年第3期321-323,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价经皮骶髂螺钉技术在不稳定骨盆骨折治疗中的安全性及疗效。方法 2003年3月-2007年1月,收治15例Tile C型骨盆骨折患者。男6例,女9例;年龄21～56岁。车祸伤8例,高处坠落伤6例,压砸伤1例。伤后至就诊时间4 h～3 d。耻骨骨折合并骶骨骨折7例,髂骨骨折合并骶骨骨折2例,耻骨骨折合并骶髂关节脱位4例,前环耻骨骨折、后环骶骨骨折合并骶髂关节脱位2例。采用经皮骶髂螺钉技术固定骨盆后环,合并的前环损伤中7例采用外固定支架固定,3例钢板固定,5例钢板联合外固定支架固定。结果 15例住院16～33 d,平均22.4 d。除4例同时行髋臼骨折固定患者术中失血量1 000～1 500 mL,余失血约50 mL。手术时间60～305 min,平均153.6 min。15例均获随访6个月～3年,平均18个月。根据Matta评分标准,优14例,良1例。最后1次随访时,X线片示患者骨折均愈合,平均28.8个月。1例骨折愈合后骶髂螺钉松动,3例腰骶部劳累后疼痛,2例轻度跛行,均未作特殊处理。9例恢复原工作,3例改变工作,3例仍未工作。Majeed功能评分,优11例,良4例,优良率100%。结论经皮骶髂螺钉固定技术可重建骨盆后环的稳定性,可获得良好的功能康复,同时手术并发症发生率低及创伤小,是不稳定骨盆骨折后环稳定性重建的良好方法之一。Objective To evaluate the effectiveness of percutaneous fixation with il iosacral screw in the management of unstable pelvic fractures. Methods From March 2003 to January 2007, 15 patients with unstable pelvic fractures were treated by percutaneous fixation with iliosacral screws. There were 6 males and 9 females, aged 21-56 years. Fractures were caused by traffic accident in 8 cases, high falling in 6 cases and crushing injury in 1 case. The disease course ranged from 4 hours to 3 days. Of 15 patients, 7 had fractures of pubium and sacrum; 2 had fractures of ilium and sacrum; 4 had dislocation of sacroiliac joint with fractures of pubic rami; and 2 had dislocation sacroiliac joint with fracture of sacrum of pubium. Anterior fixation was performed by means of plating in 3 cases, by external fixation in 7 cases, and by both in 5 cases. Results The blood loss was from 1000 to 1500 mL in 4 patients with acetabular fracture and about 50 mL in the others. The average operative time was 153.6 minutes （range, 60-305 minutes）. Fifteen patients were followed up 6 months to 3 years with an average of 18 months. According to Matta criterion for fracture reduction, the results were excellent in 14 cases and good in 1 case. After a follow-up of 28.8 months, fracture union was achieved in all patients. Screw loosening occurred in 1 case, pain of lumbosacral region in 3 cases after tiredness and mild claudication in 2 cases. Nine patients returned to their occupation, three patients changed occupation, and 3 patients could not work at last follow-up. According to Majeed functional scoring, the results were excellent in 11 cases and good in 4 cases. Conclusion Percutaneous iliosacral screw fixation is a useful method in treatment of unstable pelvic fracture.

关 键 词：不稳定骨盆骨折 骶髂螺钉 经皮内固定 

分 类 号：R687.3[医药卫生—骨科学]