前路重建钢板固定治疗不稳定性骨盆后环损伤  

Anterior reconstruction plate fixation for unstable posterior pelvic ring injuries

作　　者：蒋建农[1] 王勇[1] 张雷炎[1] 郝思春[1] 孟维春[1] 蒋海平[1] 周建刚[1] 谈俊[1] 蒋臻欢[1] 

机构地区：[1]江苏大学附属宜兴市人民医院骨科,214200

出　　处：《中华创伤杂志》2012年第8期730-735,共6页Chinese Journal of Trauma

摘　　要：目的探讨前路重建钢板固定治疗不稳定性骨盆后环损伤的适应证、优缺点及其疗效。方法回顾性分析2004年8月-2010年7月应用前路重建钢板固定治疗的不稳定性骨盆后环损伤、临床资料完整并获得至少1年随访的36例患者，其中男25例，女11例；年龄13～62岁，平均35．8岁。骶髂关节前脱位2例，后脱位34例。按Tile分类：B1型3例，B2型1例，C1—1型17例，C1—2型12例，c2型2例，c3型1例。结果全部患者获得随访平均2．3年（1—6年）。术后脂肪液化浅表感染2例，经换药、少量多次输血愈合。术中损伤股外侧皮神经8例，通过经神经营养药物治疗后5例完全恢复，其中3例仍遗留大腿外侧麻木。k神经根牵拉损伤1例，经神经营养药物治疗3个月后恢复。复位质量根据Matta和Tornetta标准：优23例，良11例，可2例，优良率为94％。无复位丢失或内固定失败患者。临床疗效按照Majeed评分系统：优17例，良14例，可4例，差1例，优良率为86％。术前合并骶丛损伤的7例患者中，3例完全恢复，2例部分恢复，2例无恢复。结论前路重建钢板固定具有手术适应证广、暴露简单、感染率低、复位满意和固定牢靠等优点，可获得满意的临床疗效，是治疗不稳定性骨盆后环损伤的主要方法之一。Objective To discuss the surgical indications, relative merits and clinical outcomes of anterior reconstruction plate fixation for treating unstable posterior pelvic ring injuries. Methods A retrospective study was done on clinical data of 36 patients with unstable posterior pelvic ring injuries trea- ted with anterior reconstruction plate fixation from August 2004 to July 2010 and followed up for minimum one year. There were 25 males and 11 females, at mean age of 35.8 years （range, 13-62 years）. There were two patients with anterior dislocation of the sacroiliac joint and 34 with posterior dislocation. Accord- ing to Tile classification, there were four patients with type B fractures （ B1：3, B2 ： 1 ） and 32 with type C fractures （C1-1：17, C1-2：12, C2：2, C3：1）. Rseults All patients were followed up for average 2.3 years （ range, 1-6 years）. Fat liquefaction and superficial infection were founded in two patients who were cured by dressing change and frequent but low-dose blood transfusion. Eight patients were subjected to iatrogenic lateral femoral cutaneous nerve injury. Meanwhile, five of them was recovered after treatment with neurotrophic drugs, but there were still three patients leaving lateral thigh numbness. One patient had L5 nerve root injury due to pull force, and was recovered after three months of neurotrophie drug ther- apy. According to Matta and Toruetta criteria, the reduction results were excellent in 23 patients, good in 11 and fair in four, with excellence rate of 94%. No reduction loss or implant failure occurred. According to Majeed scoring system, the clinical outcomes were excellent in 17 patients, good in 14, fair in four and poor in one, with excellence rate of 86%. Of the seven patients pre-operatively associated with sacral plexusinjury, three obtained full recovery, two got partial recovery and two were free from recovery. Conclu- sion The anterior reconstruction plate fixation takes advantages of wide surgical indications, simple ex- posure, low infection

关 键 词：骨盆 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]