CT引导下经皮空心钉内固定治疗骶髂关节复合体损伤  

Percutaneous CT-guided hollow screw fixation for treatment of sacroiliac complex injury

作　　者：杨军[1] 周振东[1] 李建军[1] 顾海伦[1] 张传辉[1] 

机构地区：[1]中国医科大学附属盛京医院脊柱创伤骨科,沈阳110004

出　　处：《中华创伤杂志》2011年第1期44-48,共5页Chinese Journal of Trauma

摘　　要：目的 评价CT引导下经皮空心钉治疗骶髂关节复合体损伤的安全性、可靠性及疗效.方法 45例骶髂关节复合体损伤患者,男20例,女25例;年龄15～58岁.交通伤28例,高处坠落伤17例.其中骶骨骨折14例（Dennis Ⅰ型5例,Ⅱ型9例）,骶髂关节脱位12例,骶骨骨折合并骶髂关节脱位6例,骶髂关节复合体损伤合并骨盆前环损伤9例,合并肢体其他骨折4例.牵引复位,在CT室中应用体表定位纸定位入针点,局部麻醉下采用经皮空心钉固定骶髂关节,术后早期进行功能锻炼.结果 45例共置入空心钉72枚,手术时间21～68 min（平均37 min）,术中出血约30～75 ml.38例获得随访,时间6～26个月.根据Majeed评分标准,患者评分72～96分,平均90.3分,优33例,良2例,优良率92%,无医源性神经损伤、切口感染及内固定物断裂等并发症.结论 CT引导下经皮空心钉内固定治疗骶髂关节复合体损伤定位准确,内固定稳定,手术操作安全可靠,联合早期功能锻炼,疗效肯定,是固定骨盆后环损伤的最佳治疗方法之一.Objective To evaluate the safety, feasibility and efficacy of CT-guided percutaneous hollow screw fixation in the treatment of patients with sacroiliac complex injury. Methods Forty-five patients （at age range of 15-58 years） with sacroiliac complex injuries including 20 males and 25 females were enrolled in this study. There were 28 traffic injuries and 17 fall injuries. Fourteen patients with sacral fractures （ 15 patients with Dennis type Ⅰ fractures and nine with Dennis type Ⅱ fractures）, 12 with sacroiliac joint dislocation, six with sacral fracture combined with sacroiliac joint dislocation and nine with sacroiliac joint complex injury. All patients were treated by CT-guided percutaneous hollow screw fixation. The functional exercise was performed early after operation. Results Seventy-two hollow screws were installed in 45 patients, with the operation time for 21-68 minutes （ average 37 minutes） and the operative blood loss for 30-75 ml. Of all, 38 patients were followed up for 6-26 months. According to the Majeed functional criteria, the score of the patients was 72-96 points （average 90. 3 points ）, which showed that the results were excellent in 33 patients and good in two, with excellence rate of 92%. No iatrogenic nerve injury, incision infection or screw fracture were detected. Conclusion CT-guided percutaneous hollow screw fixation takes advantages of precise direction, stable fixation and safe operation and hence is one of safe and effective methods for treatment of sacroiliac complex injury.

关 键 词：骶髂关节 体层摄影术 X线计算机 微创 

分 类 号：R687.3[医药卫生—骨科学]