骨盆骨折后环不稳的治疗策略  

Treatment strategy of unstable posterior pelvic ring fracture

作　　者：冯华明[1] 叶书熙[2] 杨成亮[2] 熊然[2] 王华[2] 李涛[2] 韩卫雨[2] 樊仕才[2] 

机构地区：[1]孝感市中心医院骨科,湖北432100 [2]南方医科大学第三附属医院骨科中心,广东广州510630

出　　处：《创伤外科杂志》2013年第1期28-31,共4页Journal of Traumatic Surgery

摘　　要：目的探讨骨盆骨折后环不稳的手术方法、操作要点及临床疗效。方法回顾2008年1月～2010年12月我科收治并手术治疗的44例骨盆骨折后环不稳患者的临床资料;其中男性35例,女性9例;年龄18～27岁,平均38.8岁。道路交通伤17例,高处坠落伤21例,砸伤6例;按Tile分型:C1.1型20例,C1.2型8例,C1.3型11例,C2型5例;合并前环不稳者先行前环骨折复位内固定后,在C型臂X线机引导下经皮微创置入骶髂空心拉力螺钉内固定35例,行后路经皮微创双侧髂骨钢板固定3例,行经腹直肌旁切口腹膜外入路切开复位钢板内固定6例。分析其治疗效果。结果 44例均顺利完成手术,手术时机选择伤后5～18d。术后X线及CT扫描重建显示骨折复位固定好,3例后路手术中有1例出现伤口感染,经换药后愈合;44例均痊愈出院,无神经损伤等手术并发症发生。结论骨盆后环不稳定骨折的复位固定是重建骨盆环稳定性的重要环节;C型臂X线机透视下经皮空心螺钉固定手术操作简单、时间短、出血少、损伤少、内固定稳定,是首选的手术方法;对术前牵引复位不满意者可选择后路或前路复位固定。Objective To explore the operative procedure, clinical outcome and operation points for unstable posterior pelvic ring fracture. Methods From Jan. 2008 to Dec. 2010,44 patients with unstable posterior pelvic ring fracture were treated with operation,which involved in 35 males and 9 females. There were 17 cases of traf- fic accident injury,21 cases of falling injury,6 cases of crush injury. According to tile classification system： there were 20 cases of C1.1,8 cases of C1.2,11 cases of C1.3 and 5 cases of C2. After open reduction and internal fixation,which were performed on the anterior pelvic ring,35 cases were treated with percutaneous sacroiliac lag screws fixation,3 cases were treated with fixation with percutaneous posterior bilateral iliac plates,6 cases were treated by straight lateral rectus incision and extraperitoneal internal fixation. Results The operation time was 5-18 days after injury. Operations were smoothly performed on all of the 44 cases. All of the 44 cases had recovered smoothly, without sacral nerve injury. Only 3 cases received the posterior approach operation suffered from wound infection, fortunately, they finally had recovered satisfactorily. The postoperative X-ray and CT films indicated satisfactory reduction of pelvic fracture. Conclusion It is very important to reconstruct the pelvic ring for the pelvic＇ s stabilization. The operation by percutaneous sacroiliac lag screws fixation with i, C＂-arm is the principal choice for treating the unstable posterior pelvic ring fracture, because of simple operation, stable fixation, less time consuming, less bleeding and slight injury. Those who can＇t receive a satisfactory reduction can choose the anterior/posterior open reduction and internal fixation.

关 键 词：骨盆骨折 微创 内固定 骶髂关节 

分 类 号：R683.3[医药卫生—骨科学]