经皮复位螺钉固定与切开复位内固定治疗耻骨联合分离的疗效比较  

Outcome of plate fixation and percutaneous screw fixation in the treatment of traumatic diastasis of the pubic symphysis

作　　者：黄高[1] 王金华[1] 张军[1] 孔建中[1] 郭晓山[1] 水小龙[1] 

机构地区：[1]温州医学院第二附属医院骨科,浙江325000

出　　处：《创伤外科杂志》2013年第1期36-40,共5页Journal of Traumatic Surgery

摘　　要：目的比较经皮螺钉固定和切开复位钢板固定治疗耻骨联合分离的疗效。方法 2003年1月～2009年12月我院共治疗了90例创伤性耻骨联合分离的病人,45例采用经皮螺钉固定,45例采用切开复位钢板固定。通过统计骨折的类型、手术切口长度、出血量、内固定失败率、骨不愈合率、再次手术率以及功能恢复评分,比较两组治疗效果。结果随访83例,平均随访时间21个月(18～26个月),7例失访。比较两组中骨折分类和受伤严重程度评分无差别(P>0.05),经皮螺钉固定组比切开复位钢板固定组出血少,手术创伤小(P<0.01),术后功能恢复较好(P=0.01)。两组在固定稳定性(P=0.32)、内固定失败率(P=0.39)、畸形愈合率(P=0.15),再次手术率(P=0.27),男性性功能障碍发生率(P=0.20)以及内固定取出时间(P=0.12)方面没有显著性差异。结论经皮螺钉固定治疗耻骨联合分离除了医源性损伤率较低以及术后功能恢复较好外,其固定强度接近钢板内固定。Objective To compare the outcome of plate fixation and percutaneous screw technique in the treatment of traumatic diastasis of the pubic symphysis. Methods Ninety patients with traumatic symphysis pubis diastasis were treated from Jan. 2003 to Dec. 2009 at two Level 1 regional trauma centers. Forty five patients were treated by percutaneous screw fixation. Forty five patients were treated by plate and screws fixation. The fracture type, surgical incision length, blood loss, fixation failure, malunion rate, revision surgery rate and functional scores were compared. Results Eighty-three patients were followed up, with mean time of 21 months （ 18 to 26）. Seven cases were not followed up due to other factors. There was no difference in the fracture type, and Injury Severity Score between the two groups（P 〉 0.05）. There was less blood loss（P 〈0. 01）, minimal trauma （P 〈 0.01 ） and better postoperative function （P =0. 01） in the pereutaneous screw fixation group while compared with the plate fixa- tion group. There were no significant differences in the fixation quality（P = O. 32）, fixation failure rate （P = 0.39）, malunion rate （P = O. 15） and revision surgery rate（P = O. 27） between the two groups. Conclusion Pereutaneous screw fixation in treating traumatic diastasis of the pubic symphysis can achieve lower rate of iatrogenic injuries, better functional outcome. Moreover, its fixation reliability is similar to the plate fixation method.

关 键 词：创伤 耻骨联合分离 复位 内固定 

分 类 号：R681.6[医药卫生—骨科学]