骶骨空心螺钉治疗骶髂关节骨折-脱位疗效分析  

Treatment effect of unstable iliosacral joint with cannulated screw placement

作　　者：张友[1] 蒋和平[1] 冯世龙[1] 谢鲤钟[1] 李波[1] 陈乙瑞[1] 

机构地区：[1]重庆三峡中心医院骨科,万州404000

出　　处：《重庆医学》2009年第12期1484-1485,I0003,共3页Chongqing medicine

摘　　要：目的探讨骶骨空心螺钉技术治疗骶髂关节骨折-脱位的效果。方法2005～2008年收治骶髂关节骨折-脱位27例，其中18例在C-臂监视下行1～2枚6．5mm骶骨空心螺钉固定（2例为双侧）；8例行2块标准AO3．5mm前路重建钢板（4～5孔）固定；1例因复合伤及骶后方软组织大面积严重挫伤坏死行骨盆外支架稳定。结果18例后路骶骨螺钉固定手术时间短，创伤小，出血少，但骨折不易复位，需术中C-臂监护，其中骶前血管损伤1例；8例前路钢板固定手术时间较长，创伤大，出血较多，但直视下容易复位。采用Pohlemann骨盆骨折评分：优13例，良9例，可4例。结论骶髂关节骨折-脱位骶骨空心螺钉固定具有较大优势，两种内固定方式各有其优缺点，应根据具体情况选择。Objective To investigate the clinical outcomes of iliosacral screw fixation for unstable posterior pelvis ring injuries, and then compare iliosacral screw fixation with anteriorly applied reconstruction plate. Methods Twenty-seven patients with fracture-dislocation of iliosacral joint were included in this retrospective study. Of these enrolled patients with posterior pelvis ring injuries,18 cases were treated by using 1 or 2 iliosacral 6.5mm cannulated screws under C-arm fluoroscopic guidance（iliosacral screwing for both sides in 2 cases） ,standard AO 3.5mm reconstruction plate were anteriorly applied in 8 cases（4-5 screw holes） ,and 1 case of the rest was fixed with pelvic external fixation to achieve temporary stability because of complex injury and large scale of serious damage of soft tissue in the sacra rear area. Results Compared with anteriorly applied reconstruction plate group of 8 ease iliosacral screwing group of 18 cases invloves some advantages and limitations, such as short periods of operation time, less blood loss intraoperatively,difficulties withreduction, screw placement under C-arm fluoroscopic guidance, and presacral vascular injury occurred in one patient. According to scoring system of Pohlemann, 13 cases were rated as excellent,9 cases good,and 4 cases fair. Conclusion The iliosacral screws is a feasible, but technically demanding, alternative to other internal fixation patterns, thus, in order to achieve stable fixation and decrease associated complications, we should deliberately make decisions for the choice of fixation patternas.

关 键 词：骶髂关节 空心螺钉 重建钢板 并发症 

分 类 号：R687.3[医药卫生—骨科学]