经前侧入路手术治疗骨盆新月型骨折  

OPERATION VIA ANTERIOR APPROACH IN TREATING PELVIC CRESCENT FRACTURE

作　　者：秦晖[1] 安智全[1] 姜朝来[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2011年第7期816-820,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨经前侧入路治疗骨盆新月型骨折的疗效。方法 2007年6月-2009年12月,采用经前侧入路治疗骨盆新月型骨折18例,其中男11例,女7例;年龄19～52岁,平均32岁。左侧10例,右侧8例。交通事故伤10例,高处坠落伤5例,重物压伤3例;均为侧方挤压暴力。受伤至手术时间3～22 d,平均7.8 d。按照Matta等的方法测量术前骨盆后环骨折移位为5～24 mm,平均13.7 mm。记录手术时间、术中失血量、手术纠正骨盆后环骨折移位、骨折愈合时间、Hannover骨盆评分。结果手术时间110～230 min,平均175 min;术中失血量300～1 100 mL,平均561.7 mL。术后24 h骨盆后环骨折移位0～3 mm,平均1.2 mm;手术纠正移位4～23 mm,平均12.6 mm。术中无腰骶神经根损伤患者。术后2例切口浅表感染,经敞开切口引流、换药及应用抗生素1周,无炎性反应后缝合治愈;其余患者切口均Ⅰ期愈合。15例获随访,随访时间13～22个月,平均16.1个月。X线片示患者骨折均愈合,愈合时间3～4个月,平均3.6个月。未出现骨折复位丢失,无内固定物移位、断裂等并发症发生。按照Hannover骨盆评分标准:临床症状恢复获优10例(66.7%),良5例(33.3%);重返社会能力方面,完全重返13例(86.7%),部分重返2例(13.3%)。结论经前侧入路手术治疗骨盆新月型骨折可以取得良好疗效。Objective To evaluate the effectiveness of operation via anterior approach in treating pelvic crescent fracture. Methods Between June 2007 and December 2009, 18 patients with pelvic crescent fracture were treated, including 11 males and 7 females with an average age of 32 years （range, 19-52 years）. The locations were the right in 8 cases and the left in 10 cases. Fractures were caused by traffic accident in 10 cases, by falling from height in 5 cases, and by crushing with heavy weights in 3 cases. All patients suffered lateral compression injuries of the pelvis. The mean time from injury to operation was 7.8 days （range, 3-22 days）. The preoperative mean displacement of the posterior pelvic ring was 13.7 mm （range, 5-24 mm） according to the method described by Matta et al. The operation time, intraoperative blood loss, displacement correction of the posterior pelvic ring, fracture healing time, and Hannover pelvic score were recorded. Results The average operation time was 175 minutes （range, 110-230 minutes）; the average intraoperative blood loss was 561.7 mL （range, 300-1 100 mL）; the postoperative mean displacement of the posterior pelvic ring was 1.2 mm （range, 0-3 ram）; and the mean displacement correction of the posterior pelvic ring was 12.6 mm （range, 4-23 mm）. No intraoperative lumbosacral nervous injury occurred. Superficial wound infection occurred in 2 cases and was cured after 1 week of wound drainage and application of antibiotic. The others achieved healing of incision by first intention. Fifteen patients were followed up 16.1 months on average （range, 13-22 months）. The X-ray films showed fracture healing in all patients. The fracture healing time was 3.6 months on average （range, 3-4 months）. No patient had loss of reduction or failure of internal fixation. The clinical outcome was excellent in 10 cases （66.7%） and good in 5 cases （33.3%） according to Hannover pelvic score; social reintegration was complete in 13 cases （86.7%） and incomplete in 2 c

关 键 词：骨盆新月型骨折 骶髂关节 骨折脱位 前侧入路 

分 类 号：R687.3[医药卫生—骨科学]